Cavallo-Perin P, Bruno A, Bozzo C, Boine L, Estivi P, Martina V, Gallone G, Pagano G
Istituto di Medicina Interna, Università di Torino, Italy.
J Endocrinol Invest. 1988 Dec;11(11):795-800. doi: 10.1007/BF03350228.
Insulin resistance in hyperthyroidism seems to depend on increased glucose production rather than on decreased glucose utilization. A decreased insulin binding on different target cells has been reported in patients in whom an in vivo evaluation of peripheral insulin sensitivity was lacking. In 20 patients with Graves' disease (6 males, 14 females), aged 40.0 +/- 2.0 yr, BMI 23.7 +/- 0.7, and in 20 well-matched controls we performed the following tests: 75 g o.G.T.T., euglycemic-hyperinsulinemic clamp at 50 microU/ml combined with D-[3-3H] glucose infusion in tracer amounts, in vitro insulin binding on circulating monocytes. Fasting plasma glucose values were similar in the two groups, whereas plasma insulin values were significantly higher in hyperthyroids (21.4 +/- 2.5 vs 10.6 +/- 0.6 microU/ml, p less than 0.01). The values of peripheral glucose utilization (5.61 +/- 0.24 vs 6.01 +/- 0.22 mg/kg-min) and of total specific insulin binding (4.07 +/- 0.20 vs 4.39 +/- 0.23% bound to 10(7) cells/ml) were not significantly different in the two groups. These results indicate that in vitro and in vivo data, when recorded in the same patients, are concordant to confirm a normal peripheral tissue sensitivity to insulin in Graves' disease.
甲状腺功能亢进症中的胰岛素抵抗似乎取决于葡萄糖生成增加，而非葡萄糖利用减少。在缺乏外周胰岛素敏感性体内评估的患者中，已报告不同靶细胞上胰岛素结合减少。在20例格雷夫斯病患者（6例男性，14例女性）中，年龄40.0±2.0岁，体重指数23.7±0.7，以及20例匹配良好的对照中，我们进行了以下测试：75克口服葡萄糖耐量试验、50微单位/毫升的正常血糖-高胰岛素钳夹联合微量D-[3-3H]葡萄糖输注、循环单核细胞的体外胰岛素结合。两组的空腹血糖值相似，而甲状腺功能亢进患者的血浆胰岛素值显著更高（21.4±2.5对10.6±0.6微单位/毫升，p<0.01）。两组的外周葡萄糖利用率（5.61±0.24对6.01±0.22毫克/千克-分钟）和总特异性胰岛素结合（4.07±0.20对4.39±0.23%结合至10⁷细胞/毫升）无显著差异。这些结果表明，当在同一患者中记录时，体外和体内数据一致，证实格雷夫斯病中外周组织对胰岛素的敏感性正常。
