Brouhard B H, LaGrone L F, Richards G E, Travis L B
J Pediatr. 1987 May;110(5):729-34. doi: 10.1016/s0022-3476(87)80011-2.
To evaluate the glomerular filtration rate (GFR) response to a protein meal in patients with diabetes and to study the role of glucagon and growth hormone, we studied inulin clearance for three 30-minute periods before and 3 hours after an 80 g protein meal in seven healthy volunteers and 10 patients with diabetes. Patients with diabetes were chosen because their renal response to such a meal has been reported to be abnormal. All had an increase in GFR and plasma glucagon levels after the protein meal. The peak rise in GFR occurred from 1 to 2 1/2 hours after the meal (mean +/- SEM, delta 26 +/- 5 mL/min/m2, controls; delta 22 +/- 7 mL/min/m2, patients with diabetes), with the mean time to normal rise in GFR occurring at 2 hours after the meal. Similarly, plasma glucagon values peaked at different times in individual patients (delta 769 +/- 532 pg/mL, controls; delta 267 +/- 69 pg/mL, patients with diabetes), with the mean plasma glucagon rise occurring 1 hours after the meal. Premeal growth hormone levels tended to be higher in the patients with diabetes (7.6 +/- 1.4 vs 2.1 +/- 0.4 ng/mL), and did not change after the meal. To allow study of the contribution of the increased plasma glucagon to the rise in GFR, eight of these patients (five with diabetes) volunteered to undergo a second GFR response test with a simultaneous infusion of somatostatin. The glucagon response was significantly lowered at all time periods during the infusion (P less than 0.05); no significant change in growth hormone occurred. Without somatostatin in these eight patients, peak increase in postmeal GFR average 20.6 +/- 1.5 mL/min/m2; with the somatostatin, peak increase in GFR was 6.0 +/- 1.8 mL/min/m2 (P less than 0.01). Neither metabolic control nor degree of albuminuria was significantly different at the time of the two studies. Thus, as has been shown in animals, somatostatin infusion limits the rise in GFR after a protein meal in humans.
为了评估糖尿病患者对蛋白质餐的肾小球滤过率（GFR）反应，并研究胰高血糖素和生长激素的作用，我们在7名健康志愿者和10名糖尿病患者中，于80克蛋白质餐之前的三个30分钟时间段以及之后3小时研究了菊粉清除率。选择糖尿病患者是因为据报道他们对这种餐食的肾脏反应异常。所有患者在蛋白质餐后GFR和血浆胰高血糖素水平均升高。GFR的峰值升高出现在餐后1至2.5小时（平均值±标准误，对照组：Δ26±5 mL/min/m²；糖尿病患者：Δ22±7 mL/min/m²），GFR恢复正常升高的平均时间出现在餐后2小时。同样，血浆胰高血糖素值在个体患者中的峰值时间不同（对照组：Δ769±532 pg/mL；糖尿病患者：Δ267±69 pg/mL），血浆胰高血糖素平均升高出现在餐后1小时。糖尿病患者餐前生长激素水平往往较高（7.6±1.4 vs 2.1±0.4 ng/mL），餐后无变化。为了研究血浆胰高血糖素升高对GFR升高的贡献，这些患者中的8名（5名糖尿病患者）自愿接受第二次GFR反应测试，同时输注生长抑素。输注期间所有时间段的胰高血糖素反应均显著降低（P＜0.05）；生长激素无显著变化。在这8名患者中，未使用生长抑素时，餐后GFR的峰值平均升高20.6±1.5 mL/min/m²；使用生长抑素时，GFR的峰值升高为6.0±1.8 mL/min/m²（P＜0.01）。两项研究时的代谢控制和蛋白尿程度均无显著差异。因此，正如在动物中所显示的那样，输注生长抑素会限制人类蛋白质餐后GFR的升高。
