Cavallo-Perin P, Bruno A, Boine L, Cassader M, Lenti G, Pagano G
Institute of Internal Medicine, University of Turin, Italy.
Eur J Clin Invest. 1988 Dec;18(6):607-13. doi: 10.1111/j.1365-2362.1988.tb01275.x.
Hyperthyroidism is considered to be an insulin-resistant state, but a quantitative evaluation of some action of insulin is still lacking. We performed euglycaemic clamp at about 350 and 7000 pmol l-1 plasma insulin concentration in combination with the 3H-glucose infusion in 12 patients with Graves' disease and in 12 matched controls. Fasting plasma insulin (126 +/- 6.5 vs. 77.5 +/- 5.7 pmol l-1; P less than 0.001), C-peptide (502 +/- 36 vs. 363 +/- 41 pmol l-1; P less than 0.001) and glucagon (47 +/- 3.3 vs. 33.3 +/- 3 pmol l-1; P less than 0.01) were significantly higher in hyperthyroids than in euthyroids. Basal hepatic glucose production was significantly higher in hyperthyroids than in euthyroids (18.3 +/- 1.4 vs. 9.2 +/- 0.5 mumol l-1; P less than 0.0001), and its suppression during physiological hyperinsulinaemia was only 50% in hyperthyroids. Glucose utilization and suppression of lipolysis were normally stimulated by insulin. All parameters altered during hyperthyroidism were normalized during methimazole-induced euthyroidism. We conclude that insulin resistance involves mainly glucose rather than lipid and is selective at the hepatic level.
甲状腺功能亢进被认为是一种胰岛素抵抗状态，但对胰岛素某些作用的定量评估仍然缺乏。我们对12例格雷夫斯病患者和12例匹配的对照者进行了正常血糖钳夹试验，血浆胰岛素浓度分别约为350和7000 pmol l-1，并同时输注3H-葡萄糖。甲状腺功能亢进患者的空腹血浆胰岛素（126±6.5对77.5±5.7 pmol l-1；P<0.001）、C肽（502±36对363±41 pmol l-1；P<0.001）和胰高血糖素（47±3.3对33.3±3 pmol l-1；P<0.01）显著高于甲状腺功能正常者。甲状腺功能亢进患者的基础肝糖生成显著高于甲状腺功能正常者（18.3±1.4对9.2±0.5 μmol l-1；P<0.0001），且在生理性高胰岛素血症期间其抑制率在甲状腺功能亢进患者中仅为50%。胰岛素通常刺激葡萄糖利用和脂肪分解抑制。在甲巯咪唑诱导的甲状腺功能正常期间，甲状腺功能亢进期间改变的所有参数均恢复正常。我们得出结论，胰岛素抵抗主要涉及葡萄糖而非脂质，并且在肝脏水平具有选择性。
