胰高糖素负荷的血c-AMP及血糖值与肝硬化患者肝功能状况的关系

CORRELATION BETWEEN THE PLASMA c-AMP AND BLOOD GLUCOSE AFTER A GLUCAGON LOADING ADMINISTRATION AND LIVER FUNCTION CONDITION IN CIRRHOTIC PATIENTS

目的 :了解胰高糖素负荷后的血c-AMP及血糖反应值与肝硬化患者肝功能状况的关系。方法 :38例肝硬化患者按Child -Pugh肝功能分级 ,分为A级 (10例 )、B级 (14例 )及C级 (14例 )三个亚组。 11例健康者为对照组。清晨空腹静卧 ,套管针肘静脉穿刺并固定 15min后采集基础血c -AMP及血糖标本 ,即刻以每公斤体重 2 .5 μg胰高糖素快速静脉注射 ,分别于注射后 5、10、15、30及 4 5min采集血c -AMP及血糖标本。以放射免疫法测定血浆c-AMP浓度 ,以葡萄糖氧化酶法测定血糖浓度。结果 :肝硬化各组的血浆c -AMP峰值浓度及血糖峰值浓度均显著低于对照组 (P <0 .0 0 1～ 0 .0 5 ) ,且随肝硬化严重程度增加而降低。血c -AMPP/B值及血糖P/B值 ,肝硬化总体为 7.5 6± 3.4 5和 1.2 2± 0 .6 4mmol/l,A级为 9.5 2± 2 .6 3和 2 .13± 0 .2 0mmol/L ,B级为 8.11± 2 .5 5和 1.17± 0 .2 9mmol/L ,C级为 5 .2 0± 4 73.79和 0 .6 3± 0 .2 4mmol/l,均显著低于对照组的 16 .2 7± 4 .72和 2 .5 0± 0 .4 8mmol/l(P <0 .0 0 1～ 0 .0 5 ) ,且随肝硬化严重程度的增加而降低。血c -AMPP/B值及血糖P -B值与血清白蛋白浓度呈显著正相关 (r =0 .5 8,P <0 .0 0 1;r =0 .79,P <0 .0 0 1) ,与血清总胆红素浓度 (R =0 .4 3,P <0 .0 1;R

Objective:To investigate the correlation between the plasma c-AMP and the blood glucose after a glucagon loading administration and the liver function condition in cirrhotic patients.Methods:We classified 38 cirrhotic patients into A, B and C three subgroup (grade A: 10 patients; grade B: 14 patients; grade C: 14 patients) according to Child-Pugh score. The 38 cirrhotic patients and another 11 normal controls were given rapidly intravenous injection of glucagon (2.5μg/kg body wt) via a cannula after over night fasting. Venous blood samples of c-AMP and blood glucose were obtained from the cannula before the injection and after the injection 5,10, 15, 30 and 45 minutes. The RIA was uscd to analyze the plasma c-AMP concentrations.Results:The plasma c-AMP peak values and the blood glucose peak values in all cirrhotic groups were significantly lower than those in the controls ( P <0.001～0.05). And the more retrograde the liver function, the lower the plasma c-AMP peak values and the blood glucose peak values. The plasma c-AMP P/B (c-AMP peak values/c-AMP baseline values)and the BG P-B ( blood glucose peak values minus blood glucose baseline values ) in total cirrhotic group (7.56±3.45; 1.22±0.64mmol/l), grade A (9.52±2.63; 2.13±0.20mmol/l), grade B (8.11±2.55; 1.17±0.29mmol/l) and grade C (5.20 ± 3.79; 0.63 ± 0.24mmol/l) were significantly lower than that in the controls ( 16.27 ±4.72; 2.50±0.48mmol/L)( P <0.001～0.05). And the more retrograde the liver function, the lower the plasma c-AMP P/B and the BG P-B . The plasma c-AMP P/B and the BG P-B had a significant correlation with ALB (r=0.58, P <0.001; r=0.79, P <0.001), TBIL (r= -0.43, P <0.01; r=-0.68, P <0.001), prolonged PT(r= - 0.67, P <0.001; r= - 0.69, P <0.001),R 15ICG (r= - 0.45, P <0.005; r= -0.52, P <0.001)and Child-Pugh score(r=-0.61, P <0.001; r=-0.89, P <0.001).Conclusions:The plasma c-AMP P/B and the BG P-B after a glucagon loading administration had a significant correlation with the liver function condition in cirrhotic patients.