The effect of muscle wasting on glucose tolerance was studied. Oral glucose tolerance testing was performed in three groups of wasted patients: myotonic dystrophy (11); amyotrophic lateral sclerosis (10); other lower motor neuron disease (four). Normal subjects (11) and non-wasted neurological disease (five) controls were studied for comparison. An average decrease of 29-36% in lean body mass was present in the wasted individuals. 2. A slightly higher plasma glucose occurred at 120 min after glucose ingestion in wasted compared with non-wasted individuals (119.2 +/- 5 vs. 99.9 +/- 4 mg/100 ml, P less than 0.05). 3. Normal insulin release was seen in all patient groups except those with myotonic dystrophy, who displayed marked hyperinsulinaemia from 30 to 240 min after glucose. This excessive insulin output was not due to a greater absolute decrease in lean body mass in the myotonic dystrophy patients than in the other wasted subjects. No significant correlation between the cumulative insulin release or peak insulin values and the absolute or height adjusted lean body mass was noted within any of the wasted or non-wasted groups. 4. In contrast to the findings of many studies, only clinically insignificant glucose intolerance was detected in ambulatory wasted patients and only patients with myotonic dystrophy had abnormal insulin release. Muscle loss appeared to exert only a slight influence on glucose regulation in these wasted patients and no typical effect of muscular atrophy on pancreatic insulin release was noted.
摘要
研究了肌肉消耗对葡萄糖耐量的影响。对三组消瘦患者进行了口服葡萄糖耐量测试：强直性肌营养不良患者（11例）；肌萎缩侧索硬化患者（10例）；其他下运动神经元疾病患者（4例）。为作比较，研究了正常受试者（11例）和非消瘦神经系统疾病患者（5例）作为对照。消瘦个体的瘦体重平均下降了29% - 36%。2. 与非消瘦个体相比，消瘦个体在摄入葡萄糖后120分钟时血浆葡萄糖略高（119.2±5 vs. 99.9±4 mg/100 ml，P<0.05）。3. 除强直性肌营养不良患者外，所有患者组均可见正常胰岛素释放，强直性肌营养不良患者在葡萄糖摄入后30至240分钟表现出明显的高胰岛素血症。这种过量的胰岛素分泌并非由于强直性肌营养不良患者的瘦体重绝对下降幅度大于其他消瘦受试者。在任何消瘦或非消瘦组中，均未发现累积胰岛素释放或胰岛素峰值与绝对或按身高调整的瘦体重之间存在显著相关性。4. 与许多研究结果相反，在非卧床的消瘦患者中仅检测到临床上无显著意义的葡萄糖耐量异常，只有强直性肌营养不良患者存在胰岛素释放异常。在这些消瘦患者中，肌肉量减少似乎仅对葡萄糖调节产生轻微影响，未发现肌肉萎缩对胰腺胰岛素释放有典型作用。
