肝硬变患者血浆胰岛素和C肽—肝脏摄取胰岛素减少在糖代谢障碍中的作用

Plasma insulin and C-peptide in cirrhosis of the liver

肝脏不仅是机体维持血糖动态平衡的重要器官,同时也是糖类代谢调节激素作用的靶器官和降解场所。慢性肝病时,尤其是肝硬变时常伴有糖耐量减低和糖尿病,其病理机制目前尚不清楚。一些学者的报告指出慢性肝病时常伴有血浆胰岛素水平升高和胰岛素抵抗,我们在实验中也观察到相同结果。近来Johnston等的研究表明。

In chronic liver disease, especially in cirrhosis, decreased glucose tolerance and hepatogenic diabetes are frequently found and are often associated with insulin resistance and hyperinsulinemia. These changes are probably due to the decrease of the insulin uptake of the liver which is mediated by the specific hormone receptors on the membrane of the target cells. To clarify their relations, the delivery ability of P cells and the endogenous insuln uptake ability under basic status and after glucose stimulating status were observed in 3 groups of cirrhosis patients (16 with normal glucose tolerance, 14 with decreased glucose tolerance and 8 with hepatogenic diabetes) and a normal control group. The results revealed no marked difference in the basic levels of blood glucose and immune reaclive C-peptide (IRC) between the 3 groups and the controls. The basic immune reactive insulin (IRI) of the 3 groups was much higher than that of the controls, the highest being that of the decreased glucose tolerance group. The IRC and ΣIRC/ΣIRI of the hepatogenic diabetes group were also decreased markedly. We conclude that decrease in insulin uptake generally appear in patients with chronic liver disease,often presenting With hyperinsulinemia Marked decrease in insulin uptake and decreased glucose tolerance will eventually develop diabetes.