De Marinis L, Mancini A, De Luca A M, Fiumara C, Zuppi P, Sammartano L, Valle D
Institute of Endocrinology, Catholic University School of Medicine, Rome, Italy.
Diabetes Res. 1993;23(2):83-91.
In order to investigate the relationships between glucose metabolism, insulin secretion and endogenous opioids in obese patients, we have studied the effects of a naloxone infusion on insulin and C-peptide release after a normal meal (800 kcal) eaten at 12.00 hr in 16 obese women, aged 20-61 yr, with a BMI ranging from 25 to 37.2 kg/m2, with normal glucose tolerance (Group 1) and with NIDDM (Group 2). Naloxone was administered in a bolus of 1.6 mg i.v., followed by a continuous infusion of 4 mg in 2 hr starting immediately after feeding. In Group 1 naloxone infusion significantly increased the glucose levels, but insulin secretion was unaffected. In Group 2, naloxone infusion failed to modify significantly the postprandial levels of glucose, insulin and C-peptide. Therefore, in our study naloxone infusion seems to have beta-endorphin-like effects in non-diabetic obese subjects by increasing their glycemic levels, with no evidence of expected insulin decrease. In diabetic obese patients we observed a trend towards decrease in glycemic values during naloxone infusion, as expected, due to insulin plasma levels increase. By these data we can hypothesise a complex regulatory role of opioids in metabolic balance in obesity. In diabetic patients, naloxone can improve the surviving insulin secretion with better glucose tolerance. In non-diabetic subjects naloxone exerts its effects, probably, on peripheral organs.
为了研究肥胖患者葡萄糖代谢、胰岛素分泌与内源性阿片类物质之间的关系，我们对16名年龄在20 - 61岁、BMI范围为25至37.2 kg/m²、葡萄糖耐量正常（第1组）和患有非胰岛素依赖型糖尿病（NIDDM，第2组）的肥胖女性进行了研究，观察在12:00进食一顿正常餐（800千卡）后，静脉注射纳洛酮对胰岛素和C肽释放的影响。静脉注射1.6毫克纳洛酮推注，随后在进食后立即开始在2小时内持续输注4毫克。在第1组中，输注纳洛酮显著提高了血糖水平，但胰岛素分泌未受影响。在第2组中，输注纳洛酮未能显著改变餐后血糖、胰岛素和C肽水平。因此，在我们的研究中，输注纳洛酮似乎在非糖尿病肥胖受试者中具有类似β-内啡肽的作用，通过提高其血糖水平，且没有预期的胰岛素降低的证据。在糖尿病肥胖患者中，正如预期的那样，由于血浆胰岛素水平升高，我们观察到在输注纳洛酮期间血糖值有下降趋势。根据这些数据，我们可以推测阿片类物质在肥胖代谢平衡中具有复杂的调节作用。在糖尿病患者中，纳洛酮可以改善存活的胰岛素分泌并提高葡萄糖耐量。在非糖尿病受试者中，纳洛酮可能对外周器官发挥作用。
