Chupin M, Charbonnel B, Dubin B, Remi J P, Guillon J
Diabete Metab. 1978 Dec;4(4):243-7.
Fifteen patients with non-ketotic hyperosmolar diabetic coma were investigated and compared with ketoacidotic patients. Basal plasma insulin levels were low in all patients (14.8 +/- 1.0 micronU/ml in hyperosmolar coma, 11.0 +/- 1.3 in keto-acidosis), but insulin level increased after intravenous tolbutamide (between 30 and 105 micronU/ml) in eight hyperosmolar comas. Insulin showed no increase in seven hyperosmolar comas and in none of the ketoacidotic patients. In hyperosmolar coma plasma free fatty acids (1710 +/- 197 micronEq/1), triglycerides (3,4 +/- 0,4 g/1) and cortisol levels (49,7 +/- 9,0 microgram/100 ml) were increased, must as in keto-acidosis. Growth hormone (1,7 +/- 0,1 ng/ml) was normal, unlike the case in keto-acidosis. Plasma lactate concentrations were elevated and account for the frequent mild acidosis found in hyperosmolar coma. In spite of the low peripheral "insulin/glycemia ratio", the positive response to tolbutamide in half of the hyperosmolar cases suggests a less complete pancreatic deficiency than in keto-acidosis. The plasma high free fatty acid and triglyceride levels suggest that the lack of ketosis is not due to inhibition of lipolysis but could be a consequence of inhibition of hepatic ketogenesis.
对15例非酮症高渗性糖尿病昏迷患者进行了研究，并与酮症酸中毒患者进行了比较。所有患者的基础血浆胰岛素水平均较低（高渗性昏迷患者为14.8±1.0微单位/毫升，酮症酸中毒患者为11.0±1.3微单位/毫升），但8例高渗性昏迷患者静脉注射甲苯磺丁脲后胰岛素水平升高（在30至105微单位/毫升之间）。7例高渗性昏迷患者和所有酮症酸中毒患者的胰岛素水平均未升高。在高渗性昏迷中，血浆游离脂肪酸（1710±197微当量/升）、甘油三酯（3.4±0.4克/升）和皮质醇水平（49.7±9.0微克/100毫升）均升高，与酮症酸中毒患者一样。生长激素（1.7±0.1纳克/毫升）正常，与酮症酸中毒情况不同。血浆乳酸浓度升高，这是高渗性昏迷中常见的轻度酸中毒的原因。尽管外周“胰岛素/血糖比值”较低，但高渗性昏迷患者中有一半对甲苯磺丁脲有阳性反应，这表明胰腺功能不全程度不如酮症酸中毒患者严重。血浆中高游离脂肪酸和甘油三酯水平表明，无酮症并非由于脂肪分解受抑制，而是可能由于肝酮体生成受抑制所致。
