Bonora E, Coscelli C, Orioli S, Cambi R, Buzzelli G, Gentilini P, Butturini U
Horm Metab Res. 1984 Mar;16(3):111-4. doi: 10.1055/s-2007-1014714.
Exaggerated insulin response to oral glucose was demonstrated in peripheral blood of patients with chronic hepatic diseases. High peripheral insulin levels may be the result of pancreatic hypersecretion or decreased hepatic removal of insulin. The simultaneous assay of insulin and C-Peptide concentrations in peripheral blood enables the determination of both beta-cell activity and hepatic fractional insulin extraction. We have measured peripheral insulin and C-Peptide levels during OGTT in a group of subjects with chronic active hepatitis (CAH). These subjects showed glucose levels and incremental areas significantly higher than controls, but still in the upper range of normality. Insulin response to oral glucose was significantly greater in CAH patients than in controls, whereas C-Peptide levels and areas were quite similar in the two groups. The C-Peptide to insulin molar ratios before and after glucose, and the relations between C-Peptide and insulin incremental areas were lower in CAH patients than in controls. We conclude that the peripheral hyperinsulinemia observed in subjects with CAH is due to diminished insulin removal by the diseased liver rather than pancreatic hypersecretion.
慢性肝病患者外周血中呈现出对口服葡萄糖的胰岛素反应过度。外周胰岛素水平升高可能是胰腺分泌亢进或肝脏对胰岛素清除减少的结果。同时检测外周血中胰岛素和C肽浓度能够确定β细胞活性以及肝脏对胰岛素的提取分数。我们测定了一组慢性活动性肝炎（CAH）患者在口服葡萄糖耐量试验（OGTT）期间的外周胰岛素和C肽水平。这些患者的血糖水平和增量面积显著高于对照组，但仍处于正常范围上限。CAH患者对口服葡萄糖的胰岛素反应明显大于对照组，而两组的C肽水平和面积相当相似。CAH患者葡萄糖前后的C肽与胰岛素摩尔比以及C肽与胰岛素增量面积之间的关系低于对照组。我们得出结论，CAH患者中观察到的外周高胰岛素血症是由于患病肝脏对胰岛素的清除减少，而非胰腺分泌亢进所致。
