Blackard W G, Clore J N, Kellum J M
Department of Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond 23298-0155.
J Clin Endocrinol Metab. 1994 May;78(5):1257-60. doi: 10.1210/jcem.78.5.8175987.
Amylin/insulin secretory ratios were determined in nine morbidly obese subjects consenting to portal venous catheterization at the time of gastric bypass surgery. By subtracting recirculating insulin and amylin concentrations (arterial values) from portal venous hormone concentrations, instantaneous amylin/insulin secretory ratios could be determined before and after iv glucose administration. Baseline portal venous amylin levels were 32% higher than peripheral concentrations (7.3 +/- 0.8 vs. 5.6 +/- 0.6 pmol/L). Portal venous amylin and insulin concentrations peak 90 s after the initiation of a 2-min glucose infusion. When instantaneously secreted amylin and insulin were compared at each of the eight time points, a highly significant correlation was observed in seven of the nine subjects. However, large interindividual variations in amylin/insulin secretory ratios were observed, with molar ratios from 0.2-1.6%. The amylin/insulin secretory ratios calculated at the time of surgery varied inversely (r = -0.89; P < 0.001) with glucose disappearance rates obtained 5-7 months later after 19- to 29-kg weight loss. These data corroborate those obtained from animal studies and indicate that amylin and insulin are cosecreted in man. Despite evidence for cosecretion of amylin and insulin, the large intersubject variation in amylin/insulin secretory ratios and its inverse correlation with glucose disappearance rates suggest a constitutional factor that may either play a role in the pathogenesis of carbohydrate intolerance or result from it.
在9名同意在胃旁路手术时进行门静脉插管的病态肥胖受试者中测定了胰淀素/胰岛素分泌比率。通过从门静脉激素浓度中减去循环胰岛素和胰淀素浓度（动脉值），可以在静脉注射葡萄糖前后测定即时胰淀素/胰岛素分泌比率。门静脉基线胰淀素水平比外周浓度高32%（7.3±0.8对5.6±0.6 pmol/L）。在2分钟葡萄糖输注开始后90秒，门静脉胰淀素和胰岛素浓度达到峰值。在八个时间点的每一个点比较即时分泌的胰淀素和胰岛素时，在9名受试者中的7名中观察到高度显著的相关性。然而，观察到胰淀素/胰岛素分泌比率存在较大的个体间差异，摩尔比率为0.2 - 1.6%。手术时计算的胰淀素/胰岛素分泌比率与19至29千克体重减轻后5至7个月获得的葡萄糖消失率呈负相关（r = -0.89；P < 0.001）。这些数据证实了从动物研究中获得的数据，并表明胰淀素和胰岛素在人体中是共同分泌的。尽管有证据表明胰淀素和胰岛素共同分泌，但胰淀素/胰岛素分泌比率的较大受试者间差异及其与葡萄糖消失率的负相关表明存在一个体质因素，该因素可能在碳水化合物不耐受的发病机制中起作用，或者是由碳水化合物不耐受导致的。
