Yoshida T, Ninomiya K, Matsumoto T, Baatar D, Bandoh T, Kitano S
First Department of Surgery, Oita Medical University, Japan.
Hepatogastroenterology. 1998 Mar-Apr;45(20):468-71.
BACKGROUND/AIMS: The aim of this study was to investigate glucagon and insulin metabolism in order to clarify the mechanisms that lead to hyperglucagonemia and hyperinsulinemia in cirrhosis.
Splanchnic output and metabolic clearance rates were studied in 16 cirrhotic patients and 5 non-cirrhotic controls. Splanchnic glucagon and insulin output into the portal circulation were calculated by the difference between portal venous and systemic arterial concentration multiplied by portal plasma flow. The metabolic clearance rate was calculated as the ratio of output to systemic arterial concentration. Portal blood flow was measured by continuous local thermodilution.
Arterial glucagon levels were higher in cirrhotics than in controls. Glucagon output was triple of that found in controls (52.4 +/- 7.0 vs 17.7 +/- 2.9 ng/min, p < 0.05). Both groups exhibited similar metabolic clearance rates of glucagon. Systemic arterial insulin values were higher in cirrhotics than in non-cirrhotics. Insulin output was not significantly different between the two groups. However, metabolic clearance of insulin in cirrhotics was reduced to one half of the rate found in controls (237.0 +/- 39.8 vs. 450.5 +/- 17.5 mL/min, p < 0.05).
Hyperglucagonemia in cirrhotic patients results from increased pancreatic output, while hyperinsulinemia results from decreased insulin clearance.
背景/目的：本研究旨在调查胰高血糖素和胰岛素代谢情况，以阐明肝硬化患者发生高胰高血糖素血症和高胰岛素血症的机制。
对16例肝硬化患者和5例非肝硬化对照者进行了内脏输出量和代谢清除率的研究。通过门静脉与体动脉浓度之差乘以门静脉血浆流量来计算门静脉循环中胰高血糖素和胰岛素的内脏输出量。代谢清除率计算为输出量与体动脉浓度之比。采用连续局部热稀释法测量门静脉血流量。
肝硬化患者的动脉胰高血糖素水平高于对照组。胰高血糖素输出量是对照组的三倍（52.4±7.0对17.7±2.9纳克/分钟，p<0.05）。两组的胰高血糖素代谢清除率相似。肝硬化患者的体动脉胰岛素值高于非肝硬化患者。两组间胰岛素输出量无显著差异。然而，肝硬化患者的胰岛素代谢清除率降至对照组的一半（237.0±39.8对450.5±17.5毫升/分钟，p<0.05）。
肝硬化患者的高胰高血糖素血症是由于胰腺输出增加所致，而高胰岛素血症是由于胰岛素清除率降低所致。
