Cotrozzi G, Casini Raggi V, Relli P, Buzzelli G
Istituto di Medicina Interna, Università degli Studi di Firenze.
Ann Ital Med Int. 1997 Apr-Jun;12(2):84-91.
The liver plays a major role in the regulation of glucose metabolism: plasma glucose concentration is the result of peripheral glucose utilization and liver production. Several hormones, including insulin, glucagon, growth hormone, cortisol, and catecholamines contribute to the regulation of glucose metabolism by the liver. In this review, we examine hepatic glucose metabolism, in particular the actions of insulin and contrainsular hormones on glucose hepatic uptake and production in patients with diabetes or chronic liver disease. The most frequent patterns of hepatic involvement that take place during diabetes, i.e. nuclear glycogenesis, steatosis, portal fibrosis, and diabetic steatonecrosis, are discussed. Also considered are anomalies of glucose homeostasis observed in chronic liver disease, including glucose intolerance, diabetes, and hypoglycemias. There is a strong correlation between diabetes mellitus and the liver: diabetic patients have typical histological lesions, while several glucose metabolism alterations are commonly found in subjects with chronic liver disease. The pathogenesis of impaired glucose metabolism during chronic liver disease has not yet been fully understood: further clinical and experimental studies should clarify this issue.
血浆葡萄糖浓度是外周葡萄糖利用和肝脏生成的结果。包括胰岛素、胰高血糖素、生长激素、皮质醇和儿茶酚胺在内的多种激素参与肝脏对葡萄糖代谢的调节。在本综述中，我们研究肝脏葡萄糖代谢，特别是胰岛素和抗胰岛素激素对糖尿病或慢性肝病患者肝脏葡萄糖摄取和生成的作用。讨论了糖尿病期间最常见的肝脏受累模式，即核糖原生成、脂肪变性、门静脉纤维化和糖尿病性脂肪坏死。还考虑了慢性肝病中观察到的葡萄糖稳态异常，包括葡萄糖不耐受、糖尿病和低血糖症。糖尿病与肝脏之间存在密切关联：糖尿病患者有典型的组织学病变，而慢性肝病患者中常见几种葡萄糖代谢改变。慢性肝病期间葡萄糖代谢受损的发病机制尚未完全阐明：进一步的临床和实验研究应阐明这一问题。
