Russell J, Hooper M, Hunt G
Department of Psychiatry, University of Sydney, Concord, NSW, Australia.
Int J Eat Disord. 1996 Nov;20(3):307-13. doi: 10.1002/(SICI)1098-108X(199611)20:3<307::AID-EAT10>3.0.CO;2-X.
The aim of this provocation study was to examine insulin, glucose, and cortisol levels in response to a glucose load in bulimia nervosa patients and to relate this to behavior, treatment status, and depressive symptomatology.
A 3-hr glucose tolerance test was performed in 15 female patients and in 4 controls. Tests were performed at different stages of treatment and following documented engagement in the patient's usual or previous repertoire of bulimic behaviors in the 24 hr prior to testing. Insulin, glucose, and cortisol levels were assayed at baseline and at 30-min intervals following the glucose load. Presence or absence of significant depressive symptomatology was ascertained.
Three patterns of insulin response were identified: (1) an exaggerated response, (2) a normative response which resembled that of healthy controls, and (3) a blunted pattern. A reciprocal relationship between peak insulin and mean cortisol levels was seen with higher depression scores associated with blunted insulin response. Patients whose response was exaggerated binged and vomited relatively infrequently and were of stable weight. The insulin response of successfully treated patients, abstinent from binging and vomiting for 4 weeks, was similar to that of normal controls. A blunted response occurred in patients who binged and vomited more frequently, whose weight was unstable, and whose baseline eating was chaotic or nonexistent.
The exaggerated insulin response was seen as a physiological adaptation to intermittent starvation reversible with treatment, while the blunted insulin response associated with higher cortisol levels was seen to result from more constant nutritional deprivation secondary to greater disturbance of behavior.
这项激发试验的目的是检测神经性贪食症患者在接受葡萄糖负荷后胰岛素、葡萄糖和皮质醇水平，并将其与行为、治疗状态和抑郁症状相关联。
对15名女性患者和4名对照者进行了3小时葡萄糖耐量试验。试验在治疗的不同阶段进行，且在测试前24小时记录患者参与其通常或以前的贪食行为后进行。在基线以及葡萄糖负荷后每隔30分钟检测胰岛素、葡萄糖和皮质醇水平。确定是否存在明显的抑郁症状。
识别出三种胰岛素反应模式：（1）反应过度，（2）类似于健康对照者的正常反应，（3）反应迟钝模式。观察到胰岛素峰值与平均皮质醇水平之间呈反比关系，抑郁得分较高与胰岛素反应迟钝相关。反应过度的患者相对较少出现暴饮暴食和呕吐，体重稳定。成功治疗4周、停止暴饮暴食和呕吐的患者的胰岛素反应与正常对照者相似。反应迟钝出现在暴饮暴食和呕吐更频繁、体重不稳定且基线饮食混乱或不存在的患者中。
胰岛素反应过度被视为对间歇性饥饿的一种生理适应，可通过治疗逆转，而与较高皮质醇水平相关的胰岛素反应迟钝被认为是由于行为干扰更大导致更持续的营养缺乏所致。
