Hjalmarsen A, Aasebø U, Birkeland K, Sager G, Jorde R
Department of Pulmonary Medicine, University Hospital of Tromsø, Norway.
Diabetes Metab. 1996 Feb;22(1):37-42.
This study investigated glucose metabolism and glucose-mediated hormone responses in patients with chronic respiratory hypoxaemia. Glucose as well as insulin, glucagon, adrenaline, cortisol and growth hormone (GH) were measured before and at 30, 60 and 120 min during an oral glucose-tolerance test. The following chronic obstructive pulmonary disease (COPD) patients were studied: 10 normoxaemic (mean paO2 10.9 +/- 0.4 kPa), 10 hypoxaemic (mean paO2 7.6 +/- 0.2 kPa before, and 10.6 +/- 0.4 after 24-h oxygentherapy, and 6 hypoxaemic patients on long-term oxygen therapy (LTOT) (mean paO2 10.9 +/- 0.7 kPa before, and 7.1 +/- 0.3 after 4 h with less than 0.5 litre oxygen per minute). The hypoxaemic patients were tested both with and without (or reduced) oxygen therapy. Twenty healthy sex- and age-matched subjects served as controls. Plasma glucose at 120 min was significantly higher in LTOT patients than in controls (p < 0.01), normoxaemic patients (p < 0.01) or hypoxaemic patients (p < 0.01). The areas under the curve for plasma glucose and insulin were significantly higher in both the LTOT and hypoxaemic groups compared to controls (p < 0.01 and 0.05, respectively). Glucose values for normoxaemic COPD patients were similar to those for controls. Glucagon, adrenaline, cortisol and GH levels did not differ significantly between the groups. A 4-h low-dose or oxygen-free interval in the LTOT group or 24 h of oxygen supplementation in the hypoxaemic group did not affect glucose and hormone levels significantly. It is concluded that severely hypoxaemic COPD patients have altered glucose metabolism which cannot be readily explained by changes in gluco-regulatory hormones or short-term alterations in oxygenation.
本研究调查了慢性呼吸性低氧血症患者的葡萄糖代谢及葡萄糖介导的激素反应。在口服葡萄糖耐量试验期间，于试验前及30、60和120分钟时测量葡萄糖以及胰岛素、胰高血糖素、肾上腺素、皮质醇和生长激素（GH）。研究了以下慢性阻塞性肺疾病（COPD）患者：10名血氧正常者（平均动脉血氧分压10.9±0.4 kPa），10名低氧血症患者（治疗前平均动脉血氧分压7.6±0.2 kPa，24小时氧疗后为10.6±0.4 kPa），以及6名接受长期氧疗（LTOT）的低氧血症患者（治疗前平均动脉血氧分压10.9±0.7 kPa，4小时内每分钟吸氧少于0.5升后为7.1±0.3 kPa）。对低氧血症患者在有和没有（或减少）氧疗的情况下均进行了测试。20名年龄和性别匹配的健康受试者作为对照。LTOT患者120分钟时的血浆葡萄糖水平显著高于对照组（p<0.01）、血氧正常患者（p<0.01）或低氧血症患者（p<0.01）。与对照组相比，LTOT组和低氧血症组的血浆葡萄糖和胰岛素曲线下面积均显著更高（分别为p<0.01和0.05）。血氧正常的COPD患者的葡萄糖值与对照组相似。各组之间的胰高血糖素、肾上腺素、皮质醇和GH水平无显著差异。LTOT组4小时的低剂量或无氧间隔或低氧血症组24小时的氧补充对葡萄糖和激素水平无显著影响。结论是，严重低氧血症的COPD患者存在葡萄糖代谢改变，这不能轻易地用糖调节激素的变化或氧合的短期改变来解释。
