Kalhan S C, Denne S C, Patel D M, Nuamah I F, Savin S M
Perinatal Emphasis Research Center, Case Western Reserve University, Cleveland, OH.
Metabolism. 1994 Mar;43(3):378-84. doi: 10.1016/0026-0495(94)90108-2.
The effect of diabetes in pregnancy on leucine turnover and oxidation was examined in 12 insulin-dependent diabetic (IDDM) subjects and 12 gestationally diabetic (GDM) subjects during the third trimester of pregnancy. The data were compared with those in normal pregnant women studied during the same time period and reported previously. Eight of the IDDM subjects were on continuous subcutaneous insulin infusion (insulin pump), and four were on conventional twice-daily insulin treatment. Of the GDM group, seven were on insulin therapy and five were on dietary management. Leucine kinetics were quantified using [1-13C]leucine tracer in combination with respiratory calorimetry and measurement of lean body mass using the H2[18O] dilution method. In addition, glucose kinetics were measured in insulin-treated subjects using [6,6(2)H2]glucose tracer. Despite rigorous metabolic control, fasting plasma glucose (IDDM 5.5 +/- 1.9 mmol/L [P < .05], GDM 4.7 +/- 1.3 [P < .01], controls 3.6 +/- .6, mean +/- SD) and hemoglobin A1 ([HbA1] IDDM 7.9 +/- 1.9%, GDM 7.5% +/- 2.1%) levels were higher in diabetic subjects. Although total insulin levels were higher in insulin-treated diabetic subjects, free-insulin concentrations were similar in all groups. Rates of excretion of urinary urea nitrogen and respiratory quotients were also similar. The rate of glucose turnover was lower in insulin-treated subjects compared with normals. Leucine flux, a measure of the rate of protein breakdown, and leucine oxidation were higher in IDDM and insulin-treated GDM subjects. The rate of leucine oxidation was increased in conventionally managed IDDM and insulin-treated GDM subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
在妊娠晚期，对12名胰岛素依赖型糖尿病（IDDM）患者和12名妊娠期糖尿病（GDM）患者进行了研究，以探讨妊娠糖尿病对亮氨酸周转和氧化的影响。将这些数据与同期研究并先前报道的正常孕妇的数据进行比较。12名IDDM患者中有8名采用持续皮下胰岛素输注（胰岛素泵）治疗，4名采用传统的每日两次胰岛素治疗。在GDM组中，7名接受胰岛素治疗，5名采用饮食管理。使用[1-13C]亮氨酸示踪剂结合呼吸热量测定法和采用H2[18O]稀释法测量瘦体重来量化亮氨酸动力学。此外，使用[6,6(2)H2]葡萄糖示踪剂在接受胰岛素治疗的患者中测量葡萄糖动力学。尽管进行了严格的代谢控制，但糖尿病患者的空腹血糖（IDDM为5.5±1.9 mmol/L[P<.05]，GDM为4.7±1.3[P<.01]，对照组为3.6±.6，均值±标准差）和糖化血红蛋白A1（[HbA1]，IDDM为7.9±1.9%，GDM为7.5%±2.1%）水平更高。虽然接受胰岛素治疗的糖尿病患者的总胰岛素水平较高，但所有组的游离胰岛素浓度相似。尿尿素氮排泄率和呼吸商也相似。与正常人相比，接受胰岛素治疗的患者的葡萄糖周转率较低。IDDM患者和接受胰岛素治疗的GDM患者的亮氨酸通量（蛋白质分解速率的指标）和亮氨酸氧化较高。在采用传统治疗的IDDM患者和接受胰岛素治疗的GDM患者中，亮氨酸氧化速率增加。（摘要截选至250词）
