Shah J H, DeLeon-Jones F A, Schickler R, Nasr S, Mayer M, Hurks C
Metabolism. 1986 Jul;35(7):634-9. doi: 10.1016/0026-0495(86)90170-8.
Glucose, insulin, glucagon, and cortisol responses during a five-hour oral glucose tolerance test (GTT) were evaluated in nine patients with bipolar affective disorders who were receiving lithium treatment and in seven control patients with bipolar affective disorders who were not receiving any treatment. Both the lithium-treated and the control patients were in stable mood at the time of GTT. During GTT mean nadir serum glucose of 48 +/- 2 mg/dL in the lithium-treated patients was significantly lower (P less than 0.001) than mean nadir serum glucose of 62 +/- 2 mg/dL observed in the control subjects. Seven of these nine lithium-treated patients, but none of the control patients, experienced hypoglycemic symptoms coinciding with low serum glucose concentration. In response to hypoglycemia, mean serum cortisol significantly rose (P less than 0.01) to 22 +/- 3 micrograms/dL in the lithium-treated patients, whereas mean serum cortisol levels gradually declined to 10 +/- 2 micrograms/dL in the control patients at 300 minutes. Despite symptomatic postglucose hypoglycemia, plasma glucagon levels in the lithium-treated patients were similar to those observed in the control patients. These findings suggest that chronic lithium treatment is associated with a symptomatic and biochemical hypoglycemia during GTT, which is characterized by a rise in serum cortisol but by lack of appropriate rise in plasma glucagon concentrations.
对9名正在接受锂盐治疗的双相情感障碍患者和7名未接受任何治疗的双相情感障碍对照患者，在进行5小时口服葡萄糖耐量试验（GTT）期间评估了葡萄糖、胰岛素、胰高血糖素和皮质醇的反应。在进行GTT时，锂盐治疗组和对照组患者的情绪均稳定。在GTT期间，锂盐治疗组患者的平均最低血清葡萄糖水平为48±2mg/dL，显著低于对照组观察到的平均最低血清葡萄糖水平62±2mg/dL（P＜0.001）。这9名接受锂盐治疗的患者中有7名出现了与低血糖血清浓度同时出现的低血糖症状，而对照组患者均未出现。在低血糖反应时，锂盐治疗组患者的平均血清皮质醇显著升高（P＜0.01）至22±3μg/dL，而对照组患者在300分钟时平均血清皮质醇水平逐渐降至10±2μg/dL。尽管葡萄糖后出现了有症状的低血糖，但锂盐治疗组患者的血浆胰高血糖素水平与对照组观察到的水平相似。这些发现表明，慢性锂盐治疗与GTT期间有症状和生化性低血糖有关，其特征是血清皮质醇升高，但血浆胰高血糖素浓度没有相应升高。
