Singer-Granick C, Hoffman R P, Kerensky K, Drash A L, Becker D J
Division of Pediatric Endocrinology, Children's Hospital, Pittsburgh, Pennsylvania 15213.
Diabetes Care. 1988 Sep;11(8):643-9. doi: 10.2337/diacare.11.8.643.
To investigate plasma glucagon counterregulatory responses to hypoglycemia, an intravenous insulin bolus was given over 2 min to 73 children, aged 8.5-18.8 yr, with diabetes duration 1.2-17.1 yr. The plasma glucagon responses of the 61 children without glucagon antibodies or abnormal glucagon molecules were compared with those of 13 nondiabetic control subjects, aged 8.3-18.3 yr. Glucagon increments from baseline (73 +/- 10 pg/ml) and peak glucagon responses (212 +/- 13 pg/ml) were markedly lower in diabetic patients than in control subjects (341 +/- 49 and 462 +/- 51 pg/ml, respectively, P less than .001). Glucagon responses were found to correlate positively with the age of the patients at the time of testing (r = .478, P less than .001) and inversely with metabolic control as measured by glycosylated hemoglobin (r = -.342, P less than .02). There was no relationship between glucagon responses and diabetes duration. There was also no relationship between the glucagon increments and free-insulin levels during the test. Glucose recovery from the nadir was impaired in diabetic subjects compared with control subjects and correlated inversely with free-insulin levels. However, glucose recovery did not correlate with the rise of plasma glucagon. Glucose recovery was not different in patients with glucagon antibodies. In this study, we have demonstrated a deficient glucagon response to hypoglycemia in children with insulin-dependent diabetes mellitus. However, the clinical significance of this deficit is not clear.
为研究血浆胰高血糖素对低血糖的反调节反应，对73名年龄在8.5至18.8岁、糖尿病病程为1.2至17.1年的儿童在2分钟内静脉注射胰岛素推注。将61名无胰高血糖素抗体或异常胰高血糖素分子的儿童的血浆胰高血糖素反应与13名年龄在8.3至18.3岁的非糖尿病对照受试者的反应进行比较。糖尿病患者从基线开始的胰高血糖素增量（73±10 pg/ml）和胰高血糖素峰值反应（212±13 pg/ml）明显低于对照受试者（分别为341±49和462±51 pg/ml，P＜0.001）。发现胰高血糖素反应与测试时患者的年龄呈正相关（r = 0.478，P＜0.001），与糖化血红蛋白测量的代谢控制呈负相关（r = -0.342，P＜0.02）。胰高血糖素反应与糖尿病病程之间没有关系。测试期间胰高血糖素增量与游离胰岛素水平之间也没有关系。与对照受试者相比，糖尿病受试者从最低点恢复葡萄糖的能力受损，且与游离胰岛素水平呈负相关。然而，葡萄糖恢复与血浆胰高血糖素的升高无关。有胰高血糖素抗体的患者葡萄糖恢复情况没有差异。在本研究中，我们证明了胰岛素依赖型糖尿病儿童对低血糖的胰高血糖素反应不足。然而，这种不足的临床意义尚不清楚。
