Nielsen S, Schmitz O, Orskov H, Mogensen C E
Medical Department M (Endocrinology and Diabetes), Aarhus Kommunehospital, Denmark.
Diabetes Care. 1995 Jun;18(6):834-42. doi: 10.2337/diacare.18.6.834.
To investigate whether insulin resistance and microalbuminuria are associated in non-insulin-dependent diabetes mellitus (NIDDM).
Insulin sensitivity was assessed using a hyperinsulinemic euglycemic clamp in 11 normoalbuminuric and 9 microalbuminuric NIDDM patients matched for sex, age, body composition, glycemic control, diabetes duration, and therapy.
Isotopically determined glucose disposal was similar in normo- and microalbuminuric patients in the basal state (mean +/- SD; 3.30 +/- 1.01 vs. 3.46 +/- 0.82 mg.kg lean body mass [LBM]-1.min-1; NS) and during hyperinsulinemia (7.16 +/- 2.65 vs. 6.63 +/- 2.88 mg.kg LBM-1.min-1;NS). No difference was observed in nonoxidative glucose disposal or lipid oxidation. Endogenous glucose production was equally suppressed by insulin (-0.08 +/- 0.99 vs. 0.30 +/- 1.12 mg.kg-1 LBM.min-1; NS). Glucose oxidation tended to be lower in the normoalbuminuric patients in the basal state (1.16 +/- 0.37 vs. 1.41 +/- 0.36 mg.kg LBM-1.min-1) and during hyperinsulinemia (2.35 +/- 0.72 vs. 2.90 +/- 0.77 mg.kg LBM-1.min-1; both P < 0.15). Urinary albumin excretion rate correlated with the insulin-stimulated glucose oxidation rate (r = 0.59, P = 0.0064), and a similar trend was seen in the basal state (r = 0.42, P = 0.063). Protein oxidation was higher in normoalbuminuric patients (1.6 +/- 0.5 vs. 1.0 +/- 0.4 mg.kg LBM-1.min-1; P = 0.017) and correlated inversely with albuminuria (r = -0.70, P = 0.0007). Serum growth hormone increased during insulin infusion; however, the increase was significantly greater in microalbuminuric patients. Plasma lipoproteins, maximal aerobic capacity, and 24-h ambulatory blood pressure were similar in the two groups.
Basal and insulin-stimulated glucose uptakes are comparable in carefully matched normo- and microalbuminuric NIDDM patients, and glucose oxidation may be positively related to albuminuria. The inverse relation between protein oxidation and albuminuria may be due to higher growth hormone levels during daily life perturbations in glucose in microalbuminuric patients.
研究非胰岛素依赖型糖尿病（NIDDM）患者中胰岛素抵抗与微量白蛋白尿是否相关。
采用高胰岛素正葡萄糖钳夹技术评估11例正常白蛋白尿和9例微量白蛋白尿的NIDDM患者的胰岛素敏感性，这些患者在性别、年龄、身体组成、血糖控制、糖尿病病程和治疗方面相匹配。
在基础状态下（均值±标准差；3.30±1.01对3.46±0.82毫克·千克去脂体重[LBM]-1·分钟-1；无显著性差异）以及高胰岛素血症期间（7.16±2.65对6.63±2.88毫克·千克LBM-1·分钟-1；无显著性差异），经同位素测定的葡萄糖处置在正常白蛋白尿和微量白蛋白尿患者中相似。在非氧化葡萄糖处置或脂质氧化方面未观察到差异。胰岛素对内源性葡萄糖生成的抑制作用相同（-0.08±0.99对0.30±1.12毫克·千克-1LBM·分钟-1；无显著性差异）。在基础状态下（1.16±0.37对1.41±0.36毫克·千克LBM-1·分钟-1）以及高胰岛素血症期间（2.35±0.72对2.90±0.77毫克·千克LBM-1·分钟-1；两者P<0.15），正常白蛋白尿患者的葡萄糖氧化倾向于较低。尿白蛋白排泄率与胰岛素刺激的葡萄糖氧化率相关（r=0.59，P=0.0064），在基础状态下也观察到类似趋势（r=0.42，P=0.063）。正常白蛋白尿患者的蛋白质氧化较高（1.6±0.5对1.0±0.4毫克·千克LBM-1·分钟-1；P=0.017），且与白蛋白尿呈负相关（r=-0.70，P=0.0007）。胰岛素输注期间血清生长激素升高；然而，微量白蛋白尿患者的升高幅度显著更大。两组患者的血浆脂蛋白、最大有氧能力和24小时动态血压相似。
在精心匹配的正常白蛋白尿和微量白蛋白尿的NIDDM患者中，基础状态和胰岛素刺激后的葡萄糖摄取相当，且葡萄糖氧化可能与白蛋白尿呈正相关。蛋白质氧化与白蛋白尿之间的负相关可能是由于微量白蛋白尿患者在日常生活中葡萄糖波动期间生长激素水平较高所致。
