Matsui T
First Department of Surgery, Nara Medical University, Kashihara.
Nihon Heikatsukin Gakkai Zasshi. 1988 Jun;24(3):159-70. doi: 10.1540/jsmr1965.24.159.
This study was planned in pursuit of the relation between glucagon responses to glucose and the late dumping syndrome. Clinically, 75 g oral glucose tolerance test to seven late dumpers, ten gastrectomized patients and ten normal subjects were performed. And experimentary, 20 ml 25% glucose was put into small intestinal blind loops prepared in dogs, which were made the jejunum region and then the ileum region. 1. The mean oral glucose tolerance curve in gastrectomized patients was oxyhyperglycemic, and this tendency was seen in late dumpers. But, for only late dumpers, the low blood glucose concentration which was under 50 mg/dl appeared within one and half to three hours after oral glucose load. 2. The change of serum IRI in gastrectomized patients displayed the initial hyperinsulinemia, that was similar in late dumpers. 3. Pancreatic glucagon (GI) levels were within normal limits in normal subjects and late dumpers, but were significantly increased in gastrectomized patients. 4. Enteroglucagon (gutGLI) levels were not so increased in normal subjects, but were significantly increased in gastrectomized patients and late dumpers as well. 5. GutGLI levels were increased only by putting into the ileum loop. But hypersecretion of gutGLI did not affect the blood glucose curve and the change of serum IRI significantly. These results described above suggest that the pathogenesis of the hypoglycemia in the late dumping syndrome may be responsible for no hypersecretion of GI, for some reason, to prevent hypoglycemia against hyperinsulinemia with oxyhyperglycemia, and that gutGLI may not play so important part in the regulation of the blood glucose level.
本研究旨在探寻胰高血糖素对葡萄糖的反应与晚期倾倒综合征之间的关系。临床上,对7名晚期倾倒患者、10名胃切除患者和10名正常受试者进行了75克口服葡萄糖耐量试验。实验方面,将20毫升25%的葡萄糖注入犬制备的小肠盲袢中,分别在空肠段和回肠段进行。1. 胃切除患者的平均口服葡萄糖耐量曲线呈高血糖状态,晚期倾倒患者也有此趋势。但仅晚期倾倒患者在口服葡萄糖负荷后1.5至3小时内出现血糖浓度低于50毫克/分升的低血糖情况。2. 胃切除患者血清胰岛素释放指数(IRI)的变化显示出初始高胰岛素血症,晚期倾倒患者也类似。3. 正常受试者和晚期倾倒患者的胰高血糖素(GI)水平在正常范围内,但胃切除患者显著升高。4. 肠高血糖素(gutGLI)水平在正常受试者中升高不明显,但在胃切除患者和晚期倾倒患者中均显著升高。5. gutGLI水平仅在注入回肠袢时升高。但gutGLI的分泌过多对血糖曲线和血清IRI的变化无显著影响。上述结果表明,晚期倾倒综合征低血糖的发病机制可能是由于某种原因GI未分泌过多,无法预防高胰岛素血症伴高血糖引起的低血糖,且gutGLI在血糖水平调节中可能不起重要作用。