Atlan-Gepner C, Bongrand P, Farnarier C, Xerri L, Choux R, Gauthier J F, Brue T, Vague P, Grob J J, Vialettes B
Service de Nutrition, Maladies Metaboliques et Endocrinologie, Hôpital Sainte Marguerite, University of Marseille, France.
Diabetes Care. 1996 Nov;19(11):1283-5. doi: 10.2337/diacare.19.11.1283.
To test the hypothesis that tumor necrosis factor (TNF)-alpha may mediate the loss and the dedifferentiation of subcutaneous fat tissue in the insulin-induced lipoatrophies of a diabetic patient who presented extensive lesions.
An in vitro exploration of cytokine production by peripheral blood mononuclear cells (PBMC) from the reported case was performed and compared with the same explorations of PBMC from three nondiabetic subjects and three diabetic patients without lipoatrophic lesions. A proliferation test and an evaluation of TNF-alpha and interleukin (IL)-6 production from PBMC in presence of insulin were studied.
The production of TNF-alpha and IL-6 by the macrophages of the patient in presence of insulin were dramatically increased in comparison with control subjects. This process needed cooperation with other lymphoid cells and was abrogated by dexamethasone.
In our reported case, a local hyperproduction of TNF-alpha from macrophages that was induced by the injected insulin could explain the dedifferentiation of the adipocytes of the subcutaneous tissue and the reversion that was induced by the local injection of dexamethasone.
检验肿瘤坏死因子（TNF）-α可能介导一名患有广泛病变的糖尿病患者胰岛素诱导性脂肪萎缩中皮下脂肪组织丢失和去分化的假说。
对该报告病例的外周血单个核细胞（PBMC）产生细胞因子的情况进行体外探究，并与三名非糖尿病受试者和三名无脂肪萎缩性病变的糖尿病患者的PBMC的相同探究结果进行比较。研究了胰岛素存在时PBMC的增殖试验以及TNF-α和白细胞介素（IL）-6产生情况的评估。
与对照受试者相比，该患者巨噬细胞在胰岛素存在时TNF-α和IL-6的产生显著增加。这一过程需要与其他淋巴细胞协同作用，且地塞米松可消除这种作用。
在我们报告的病例中，注射胰岛素诱导巨噬细胞局部过度产生TNF-α可解释皮下组织脂肪细胞的去分化以及局部注射地塞米松所诱导的逆转。
