Foley M R, Landon M B, Gabbe S G, O'Dorisio T M, Waxman M, Leard R, Iams J D
Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus.
Am J Obstet Gynecol. 1993 Jan;168(1 Pt 1):100-5. doi: 10.1016/s0002-9378(12)90894-7.
Our objective was to elucidate the pathophysiologic effects and potential reversibility of terbutaline-induced changes in carbohydrate metabolism.
We prospectively evaluated serum glucose, insulin, glucagon, C-peptide, and pancreatic polypeptide levels in response to a 100 gm glucose challenge (oral 3-hour glucose tolerance test) in 17 obstetric patients without complications who were given terbutaline (5 mg orally every 4 hours) for 5 consecutive days between 24 and 32 weeks' gestation. Each patient served as her own control, with day 1 representing pretreatment, day 7 the treatment phase, and day 14 the posttreatment evaluation. Body mass index and posttreatment serum terbutaline levels were also measured.
A significant initial treatment effect (day 1 versus 7) was observed for glucose (elevated), insulin (elevated), insulin/glucose ratio (elevated), and pancreatic polypeptide (elevated). A significant delayed treatment effect (day 1 versus 14) was also observed for insulin (elevated), insulin/glucose ratio (elevated), and pancreatic polypeptide (elevated). Body mass index directly correlated with postchallenge measures of insulin, insulin/glucose ratio, pancreatic polypeptide, and C-peptide. Posttreatment serum terbutaline levels directly correlated with pancreatic polypeptide, but not with other parameters.
Our data support a dose-independent, terbutaline-induced glucose intolerance mediated by glucagon and caused by diminished insulin sensitivity.
我们的目的是阐明特布他林诱导的碳水化合物代谢变化的病理生理效应及潜在可逆性。
我们前瞻性评估了17例无并发症的产科患者在妊娠24至32周期间连续5天接受特布他林（每4小时口服5毫克）后，对100克葡萄糖负荷（口服3小时葡萄糖耐量试验）的反应，包括血清葡萄糖、胰岛素、胰高血糖素、C肽和胰多肽水平。每位患者均作为自身对照，第1天代表治疗前，第7天为治疗阶段，第14天为治疗后评估。还测量了体重指数和治疗后血清特布他林水平。
观察到葡萄糖（升高）、胰岛素（升高）、胰岛素/葡萄糖比值（升高）和胰多肽（升高）有显著的初始治疗效应（第1天与第7天相比）。胰岛素（升高）、胰岛素/葡萄糖比值（升高）和胰多肽（升高）也有显著的延迟治疗效应（第1天与第14天相比）。体重指数与胰岛素、胰岛素/葡萄糖比值、胰多肽和C肽的负荷后测量值直接相关。治疗后血清特布他林水平与胰多肽直接相关，但与其他参数无关。
我们的数据支持由胰高血糖素介导且由胰岛素敏感性降低引起的与剂量无关的特布他林诱导的葡萄糖不耐受。
