在健康受试者中，急性胰岛素对葡萄糖反应的降低和葡萄糖效能的降低均独立于肥胖程度导致静脉葡萄糖耐量恶化。

Both a reduced acute insulin response to glucose and lower glucose effectiveness are responsible for the worsening of intravenous glucose tolerance in healthy subjects independently of the degree of obesity.

作者信息

Araújo-Vilar D, García-Estévez D A, Cabezas-Cerrato J

机构信息

Department of Medicine, Complejo Hospitalario Universitario de Santiago, School of Medicine, University of Santiago de Compostela, Spain.

出版信息

Metabolism. 1998 Mar;47(3):313-20. doi: 10.1016/s0026-0495(98)90263-3.

DOI:10.1016/s0026-0495(98)90263-3

PMID:9500569

Abstract

The effects of the acute insulin response to glucose (AIRg), insulin sensitivity (SI), and glucose effectiveness at zero insulin (GEZI) on intravenous glucose tolerance were studied in 94 non elderly healthy subjects with a wide range of body mass index (BMI). Conrad's coefficient of glucose assimilation (KG) was calculated between 10 and 19 minutes of an intravenous glucose tolerance test. Both SI and GEZI were estimated using Bergman's minimal model. AIRg was calculated as the area under the insulin curve above basal between 0 and 10 minutes, and the suprabasal insulin effect was determined by the product of SI x AIRg. Stepwise multiple regression showed that the combined effect of SI x AIRg and GEZI explained 67% of the KG index variance. Division of the sample into tertiles according to KG shows that subjects with the lowest KG (KG < 1.32 min[-1]) had the lowest AIRg (2,832 +/- 1,362 v 6,510 +/- 4,410 [pmol x L(-1)] min, P = .0005), the lowest GEZI (0.092 +/- 0.06 v 0.179 +/- 0.09 min(-1), P = .0004), and the lowest SI x AIRg (0.014 +/- 0.008 v 0.022 +/- 0.01 min(-1), P = .00001), and were the oldest (41 +/- 10 v 31 +/- 10 years, P = .002) compared with subjects with the highest KG (KG > 1.8 min[-1]). However, no differences in SI (4.86 +/- 4.6 v 6.5 +/- 3.7 min(-1) [pmol x L(-1)],(-1) NS) or BMI (29.6 +/- 5.0 v 26.6 +/- 5.9 kg x m(-2), NS) were observed. These results did not vary when lean and obese subjects were analyzed separately. Age correlated significantly only with SI x AIRg. In conclusion, although the main factors that determine intravenous glucose tolerance are the suprabasal insulin effect and GEZI, worsening of the KG index depends on inadequate insulin secretion for the degree of insulin sensitivity and lower non-insulin-mediated glucose uptake. Age seems to be another factor in the worsening of intravenous glucose tolerance through a lower suprabasal insulin effect.

摘要

在94名体重指数（BMI）范围广泛的非老年健康受试者中，研究了急性葡萄糖胰岛素反应（AIRg）、胰岛素敏感性（SI）和零胰岛素状态下的葡萄糖效能（GEZI）对静脉葡萄糖耐量的影响。在静脉葡萄糖耐量试验的10至19分钟之间计算Conrad葡萄糖同化系数（KG）。SI和GEZI均使用Bergman最小模型进行估算。AIRg计算为0至10分钟期间胰岛素曲线高于基础值的面积，基础以上胰岛素效应由SI×AIRg的乘积确定。逐步多元回归分析显示，SI×AIRg与GEZI的联合效应解释了KG指数变异的67%。根据KG将样本分为三分位数，结果显示，KG最低（KG<1.32 min⁻¹）的受试者AIRg最低（2832±1362对6510±4410 [pmol×L⁻¹] min，P = 0.0005），GEZI最低（0.092±0.06对0.179±0.09 min⁻¹，P = 0.0004），SI×AIRg最低（0.014±0.008对0.022±0.01 min⁻¹，P = 0.00001），且与KG最高（KG>1.8 min⁻¹）的受试者相比年龄最大（41±10对31±10岁，P = 0.002）。然而，未观察到SI（4.86±4.6对6.5±3.7 min⁻¹ [pmol×L⁻¹]⁻¹，无显著性差异）或BMI（29.6±5.0对26.6±5.9 kg×m⁻²，无显著性差异）的差异。分别分析瘦体型和肥胖受试者时，这些结果并无变化。年龄仅与SI×AIRg显著相关。总之，虽然决定静脉葡萄糖耐量的主要因素是基础以上胰岛素效应和GEZI，但KG指数恶化取决于胰岛素敏感性程度下胰岛素分泌不足以及非胰岛素介导的葡萄糖摄取降低。年龄似乎是通过降低基础以上胰岛素效应导致静脉葡萄糖耐量恶化的另一个因素。