中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2011年
2期
128-131
,共4页
陈适%曾正陪%童安莉%卢琳%宋爱羚%梁伟%付勇%夏维波%姜艳%茅江峰%张化冰%李伟
陳適%曾正陪%童安莉%盧琳%宋愛羚%樑偉%付勇%夏維波%薑豔%茅江峰%張化冰%李偉
진괄%증정배%동안리%로림%송애령%량위%부용%하유파%강염%모강봉%장화빙%리위
高胰岛素血症%胰岛素抗药性%Bartter综合征
高胰島素血癥%胰島素抗藥性%Bartter綜閤徵
고이도소혈증%이도소항약성%Bartter종합정
Hyperinsulinism%Insulin resistance%Bartter syndrome
目的 探讨Bartter综合征与胰岛素抵抗、葡萄糖代谢异常之间的关系.方法 选择北京协和医院2003年9月至2008年5月期间诊治的23例Bartter综合征患者[年龄(27±9)岁,空腹血钾(2.8±0.5)mmol/L],20例醛固酮瘤(APA)患者[年龄(45±11)岁,空腹血钾(3.0±0.4)mmol/L]及20例特发性醛固酮增多症(IHA)患者[年龄(51±11)岁,空腹血钾(3.4±0.2)mmol/L]作为研究对象.所有受试对象均行卧立位醛固酮试验和3 h口服葡萄糖耐量试验(3hOGTT),以稳态模型(HOMA)公式计算胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-IS).结果 Bartter综合征组与IHA组的胰岛素曲线下面积差异无统计学意义[(229.0±162.4)mIU·L-1·h比(227.7±158.6)mIU·L-1·h],明显高于APA组(121.2±81.1)mIU·L-1·h.但Bartter综合征组与APA组的HOMA-IR值差异无统计学意义(1.96±1.14比1.41±0.91),APA组HOMA-IR值显著低于IHA组(2.40±1.59).3组患者HOMA-IS值差异无统计学意义,但APA组[81.7(55.1,181.2)]有低于Bartter组[151.7(102.4,265.5)]和IHA组[131.0(76.5,184.7)]的趋势.3组患者胰岛素分泌高峰均延迟至2 h.结论 Bartter综合征患者存在高胰岛素血症.
目的 探討Bartter綜閤徵與胰島素牴抗、葡萄糖代謝異常之間的關繫.方法 選擇北京協和醫院2003年9月至2008年5月期間診治的23例Bartter綜閤徵患者[年齡(27±9)歲,空腹血鉀(2.8±0.5)mmol/L],20例醛固酮瘤(APA)患者[年齡(45±11)歲,空腹血鉀(3.0±0.4)mmol/L]及20例特髮性醛固酮增多癥(IHA)患者[年齡(51±11)歲,空腹血鉀(3.4±0.2)mmol/L]作為研究對象.所有受試對象均行臥立位醛固酮試驗和3 h口服葡萄糖耐量試驗(3hOGTT),以穩態模型(HOMA)公式計算胰島素牴抗指數(HOMA-IR)和胰島素分泌指數(HOMA-IS).結果 Bartter綜閤徵組與IHA組的胰島素麯線下麵積差異無統計學意義[(229.0±162.4)mIU·L-1·h比(227.7±158.6)mIU·L-1·h],明顯高于APA組(121.2±81.1)mIU·L-1·h.但Bartter綜閤徵組與APA組的HOMA-IR值差異無統計學意義(1.96±1.14比1.41±0.91),APA組HOMA-IR值顯著低于IHA組(2.40±1.59).3組患者HOMA-IS值差異無統計學意義,但APA組[81.7(55.1,181.2)]有低于Bartter組[151.7(102.4,265.5)]和IHA組[131.0(76.5,184.7)]的趨勢.3組患者胰島素分泌高峰均延遲至2 h.結論 Bartter綜閤徵患者存在高胰島素血癥.
목적 탐토Bartter종합정여이도소저항、포도당대사이상지간적관계.방법 선택북경협화의원2003년9월지2008년5월기간진치적23례Bartter종합정환자[년령(27±9)세,공복혈갑(2.8±0.5)mmol/L],20례철고동류(APA)환자[년령(45±11)세,공복혈갑(3.0±0.4)mmol/L]급20례특발성철고동증다증(IHA)환자[년령(51±11)세,공복혈갑(3.4±0.2)mmol/L]작위연구대상.소유수시대상균행와립위철고동시험화3 h구복포도당내량시험(3hOGTT),이은태모형(HOMA)공식계산이도소저항지수(HOMA-IR)화이도소분비지수(HOMA-IS).결과 Bartter종합정조여IHA조적이도소곡선하면적차이무통계학의의[(229.0±162.4)mIU·L-1·h비(227.7±158.6)mIU·L-1·h],명현고우APA조(121.2±81.1)mIU·L-1·h.단Bartter종합정조여APA조적HOMA-IR치차이무통계학의의(1.96±1.14비1.41±0.91),APA조HOMA-IR치현저저우IHA조(2.40±1.59).3조환자HOMA-IS치차이무통계학의의,단APA조[81.7(55.1,181.2)]유저우Bartter조[151.7(102.4,265.5)]화IHA조[131.0(76.5,184.7)]적추세.3조환자이도소분비고봉균연지지2 h.결론 Bartter종합정환자존재고이도소혈증.
Objective To analys hyperinsulinemia in Bartter syndrome. Methods Twenty-three cases of Bartter syndrome [age (27 ±9) years;fasting serum potassium(2. 8 ±0. 5)mmol/L], 20 patients of aldosterone-producing adenoma [APA, age (45 ± 11 ) years, fasting serum potassium ( 3.0 ± 0. 4 ) mmol/L], 20 patients of idiopathic hyperaldosteronism [IHA, age (51 ± 11 ) years, fasting serum potassium (3.4 ±0. 2)mmol/L] were diagnosed in Peking Union Medical College Hospital from September 2003 to May 2008. All patients underwent 3-hours oral glucose tolerance test(3hOGTT), postural stimulation test and calculated HOMA-insulin resistance ( HOMA-IR ) and HOMA-insulin sensitivity ( HOMA-IS ) by Homeostasis model.Results The insulin area under curve-(229.0±162.4)mIU·L-1·h] was singnificantly higher than APA group [(227.7±158.6)mIU·-1·h].But HOMA-IR in Bartter group were similar to APA group( 1.96 ± 1.14 vs 1.41 ± 0. 91 ), and HOMA-IR in APA group was lower than IHA group ( 1.96 ± 1.14 vs 2.40 ± 1.60, P ＜ 0. 05 ). There was no deference in HOMA-IS among three groups,but APA group had lower level. In all three groups, the peak of insulin secretion was delayed. Conclusion Bartter syndrome patients commonly present with hyperinsulinemia.
