Nauck M A, Büsing M, Orskov C, Siegel E G, Talartschik J, Baartz A, Baartz T, Hopt U T, Becker H D, Creutzfeldt W
Department of Medicine, Georg August University, Göttingen, Germany.
Acta Diabetol. 1993;30(1):39-45. doi: 10.1007/BF00572873.
Insulin secretion is stimulated better by oral than by intravenous glucose (incretin effect). The contribution of the autonomic nervous system to the incretin effect after oral glucose in humans is unclear. We therefore examined nine type 1 diabetic (insulin-dependent) patients with end-stage nephropathy, studied after combined heterotopic pancreas and kidney transplantation, and 7 non-diabetic kidney recipients (matched for creatinine clearance and immunosuppressive medication). The release of gastric inhibitory polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) immunoreactivity and B cell secretory responses (IR insulin and C-peptide) to oral (50 g) and "isoglycaemic" intravenous glucose (identical glycaemic profile) were measured by radioimmunoassay. The difference in B cell responses between the two tests represents the contribution of the enteroinsular axis to the response after oral glucose (incretin effect). Insulin responses after the oral glucose challenge were similar in the two patient groups despite systemic venous drainage of the pancreas graft in the pancreas-kidney-transplanted group. In both groups GIP and GLP-1 increased after oral but not after intravenous glucose, and B cell secretory responses were significantly smaller (by 55.2 +/- 7.7% and 46.5 +/- 12.5%, respectively) with "isoglycaemic" intravenous glucose infusions. The lack of reduction in the incretin effect in pancreas-kidney-transplanted patients, whose functioning pancreas is denervated, indicates a lesser role for the nervous system and a more important contribution of circulating incretin hormones in mediating the enteroinsular axis in man.
口服葡萄糖比静脉注射葡萄糖更能有效刺激胰岛素分泌（肠促胰岛素效应）。自主神经系统对人体口服葡萄糖后肠促胰岛素效应的作用尚不清楚。因此，我们研究了9例终末期肾病的1型糖尿病（胰岛素依赖型）患者，这些患者在接受异位胰腺和肾脏联合移植后进行了研究，以及7例非糖尿病肾脏受者（根据肌酐清除率和免疫抑制药物进行匹配）。通过放射免疫分析法测定口服（50克）和“等血糖”静脉注射葡萄糖（相同血糖曲线）后胃抑制多肽（GIP）和胰高血糖素样肽1（GLP-1）免疫反应性以及B细胞分泌反应（胰岛素免疫反应和C肽）。两种测试之间B细胞反应的差异代表肠胰岛轴对口服葡萄糖后反应的贡献（肠促胰岛素效应）。尽管胰腺-肾脏移植组的胰腺移植物通过体循环静脉引流，但两组患者口服葡萄糖激发后的胰岛素反应相似。在两组中，口服葡萄糖后GIP和GLP-1升高，而静脉注射葡萄糖后则不升高，并且“等血糖”静脉输注葡萄糖时B细胞分泌反应明显较小（分别降低55.2±7.7%和46.5±12.5%）。胰腺-肾脏移植患者的肠促胰岛素效应没有降低，其功能正常的胰腺已去神经支配，这表明神经系统的作用较小，而循环中的肠促胰岛素激素在介导人体肠胰岛轴中起更重要的作用。
