Knip M, Lautala P, Leppäluoto J, Akerblom H K, Kouvalainen K
J Pediatr. 1983 Oct;103(4):603-11. doi: 10.1016/s0022-3476(83)80599-x.
To study the role of enteroinsular hormones in fetal macrosomia and neonatal hypoglycemia in infants of diabetic mothers, we measured plasma concentrations of free and total immunoreactive insulin, C-peptide, pancreatic glucagon, enteroglucagon, and gastric inhibitory polypeptide at birth in 35 IDMs and 35 infants of normal mothers. Twenty fasting adults of normal weight were also studied. Sixteen IDMs were macrosomic at birth; 17 developed neonatal hypoglycemia over the first postnatal hours. The IDMs had ten times higher concentrations of free IRI than the normal infants in cord blood. Free IRI concentrations were related to the severity of maternal diabetes, with the infants of white class D to F mothers having the highest levels. The IDMs with macrosomia had a twofold increase in the concentrations of free IRI when compared with IDMs of normal weight. There was a significant correlation between the birth weight ratio and the concentrations of free IRI. The IDMs who developed neonatal hypoglycemia had considerably higher concentrations of free IRI than did normoglycemic IDMs. The decrease of blood glucose over the first postnatal hours correlated strongly with the free IRI concentrations in the cord blood. The IDMs had a threefold increase of the C-peptide concentrations over those in normal infants. Six IDMs had a molar ratio of C-peptide to free IRI of less than 1. Both the IDMs and normal infants had substantially higher concentrations of enteroglucagon and lower concentrations of GIP than did the fasting adults. Our data provide direct evidence that IDMs are markedly hyperinsulinemic at birth and that ambient hyperinsulinemia plays a crucial role in the development of fetal macrosomia and neonatal hypoglycemia. Moreover, the observed discrepancy in the relative increase of free IRI and C-peptide, combined with the low molar ratio of C-peptide to IRI, suggests a decreased metabolic clearance of insulin or transplacental passage of insulin from the maternal circulation in infants of mothers with insulin-treated diabetes.
为研究肠胰岛激素在糖尿病母亲婴儿的巨大儿和新生儿低血糖中的作用，我们测定了35例糖尿病母亲婴儿（IDMs）和35例正常母亲婴儿出生时血浆中游离和总免疫反应性胰岛素、C肽、胰高血糖素、肠高血糖素和胃抑制多肽的浓度。还研究了20名体重正常的空腹成年人。16例IDMs出生时为巨大儿；17例在出生后最初几小时内发生新生儿低血糖。IDMs脐带血中游离胰岛素免疫反应性（IRI）浓度比正常婴儿高10倍。游离IRI浓度与母亲糖尿病的严重程度相关，D至F级白人母亲的婴儿水平最高。巨大儿IDMs的游离IRI浓度比正常体重的IDMs增加了两倍。出生体重比与游离IRI浓度之间存在显著相关性。发生新生儿低血糖的IDMs的游离IRI浓度比血糖正常的IDMs高得多。出生后最初几小时血糖的下降与脐带血中游离IRI浓度密切相关。IDMs的C肽浓度比正常婴儿增加了三倍。6例IDMs的C肽与游离IRI的摩尔比小于1。IDMs和正常婴儿的肠高血糖素浓度均显著高于空腹成年人，而胃抑制多肽浓度则低于空腹成年人。我们的数据提供了直接证据，表明IDMs出生时明显高胰岛素血症，且周围高胰岛素血症在巨大儿和新生儿低血糖的发生中起关键作用。此外，观察到的游离IRI和C肽相对增加的差异，以及C肽与IRI的低摩尔比，表明胰岛素治疗的糖尿病母亲的婴儿中胰岛素的代谢清除率降低或胰岛素从母体循环经胎盘转运。
