Berlin I, Grimaldi A, Landault C, Cesselin F, Puech A J
Département de Pharmacologie Clinique, Hôpital Pitié-Salpêtrière, Paris, France.
J Clin Endocrinol Metab. 1994 Nov;79(5):1428-33. doi: 10.1210/jcem.79.5.7962339.
Suspected postprandial (reactive or idiopathic) hypoglycemia is characterized by predominantly adrenergic symptoms appearing after meals rich in carbohydrates and by their rare association with low blood glucose level (< 2.77 mmol/L). We studied heart rate, blood pressure, plasma insulin, C-peptide, and catecholamine responses during a 5-h oral glucose tolerance test in eight patients with suspected postprandial hypoglycemia and eight age-, sex-, and body mass index-matched healthy controls. We also evaluated beta-adrenergic sensitivity by using the isoproterenol sensitivity test. Psychological profile was assessed by the Symptom Checklist (SCL-90R) self-report symptom inventory. Patients with suspected postprandial hypoglycemia had higher beta-adrenergic sensitivity (defined as the dose of isoproterenol required to increase the resting heart rate by 25 beats/min) than controls (mean +/- SEM, 0.8 +/- 0.13 vs. 1.86 +/- 0.25 microgram isoproterenol; P = 0.002). After administration of glucose (75 g) blood glucose, plasma C-peptide, plasma epinephrine, and plasma norepinephrine responses were identical in the two groups, but plasma insulin was higher in the patients (group effect, P = 0.02; group by time interaction, P = 0.0001). Both heart rate and systolic blood pressure were significantly higher (but remained in the normal range) after glucose administration in patients with suspected postprandial hypoglycemia than in controls (group by time interactions, P = 0.004 and 0.0007, respectively). After glucose intake, seven patients had symptoms (palpitations, headache, tremor, generalized sweating, hunger, dizziness, sweating of the palms, flush, nausea, and fatigue), whereas in the control group, one subject reported flush and another palpitations, tremor, and hunger. Analysis of the SCL-90R questionnaire revealed that patients had emotional distress and significantly higher anxiety, somatization, depression, and obsessive-compulsive scores than controls. We may conclude that patients with suspected postprandial hypoglycemia have normal glucose tolerance, increased beta-adrenergic sensitivity, and emotional distress.
疑似餐后（反应性或特发性）低血糖的特征是，在摄入富含碳水化合物的餐后主要出现肾上腺素能症状，且这些症状很少与低血糖水平（<2.77 mmol/L）相关。我们对8例疑似餐后低血糖患者和8例年龄、性别及体重指数匹配的健康对照者进行了5小时口服葡萄糖耐量试验，研究了心率、血压、血浆胰岛素、C肽和儿茶酚胺的反应。我们还通过异丙肾上腺素敏感性试验评估了β-肾上腺素能敏感性。通过症状自评量表（SCL-90R）自我报告症状清单评估心理状况。疑似餐后低血糖患者的β-肾上腺素能敏感性（定义为使静息心率增加25次/分钟所需的异丙肾上腺素剂量）高于对照组（均值±标准误，0.8±0.13 vs. 1.86±0.25微克异丙肾上腺素；P = 0.002）。给予葡萄糖（75 g）后，两组的血糖、血浆C肽、血浆肾上腺素和血浆去甲肾上腺素反应相同，但患者的血浆胰岛素水平更高（组效应，P = 0.02；组×时间交互作用，P = 0.0001）。疑似餐后低血糖患者给予葡萄糖后，心率和收缩压均显著高于对照组（但仍在正常范围内）（组×时间交互作用，分别为P = 0.004和0.0007）。摄入葡萄糖后，7例患者出现症状（心悸、头痛、震颤、全身出汗、饥饿、头晕、手掌出汗、脸红、恶心和疲劳），而对照组中，1名受试者报告有脸红，另1名报告有心悸、震颤和饥饿。对SCL-90R问卷的分析显示，患者存在情绪困扰，焦虑、躯体化、抑郁和强迫症状评分显著高于对照组。我们可以得出结论，疑似餐后低血糖患者具有正常的糖耐量、增加的β-肾上腺素能敏感性和情绪困扰。
