高葡萄糖钳夹技术的建立  

The establishment of the hyperglycemic clamp technique

作　　者：朱敏[1] 贾伟平 包玉倩[1] 陆俊茜[1] 项坤三[1] 

机构地区：[1]交通大学附属第六人民医院内分泌代谢科

出　　处：《中国糖尿病杂志》2004年第1期23-27,共5页Chinese Journal of Diabetes

基　　金：上海市科技发展基金 ( 0 1 41 1 90 1 2 )

摘　　要：目的　在国内建立检测胰岛素 (Ins)分泌功能的精确方法 :高葡萄糖钳制技术。　方法　对 2 5名居住上海地区的正常中国人 (男 16名 ,女 9名 )进行高葡萄糖钳夹实验。空腹平卧后两侧上肢静脉埋管。一侧持续输注 2 0 %葡萄糖溶液 ,通过负反馈调节机制使血糖始终维持在较基础血糖升高 7.9mmol/L的水平。另一侧静脉定时取血测定Ins水平 ,以获得双相Ins分泌值 ,评价胰岛 β细胞功能。　结果　 (1)受试者血浆葡萄糖浓度在钳夹开始后的指定时间内 (14min)能达到实验所要求的高糖平台 [(12 .86± 0 .11)mmol/L] ,并能维持此水平至实验结束 ;(2 )在维持高糖平台期间 ,每 5min检测的血糖变异系数为 4.2 % ;(3 )可观察到持续高糖水平下双相Ins的分泌形态 ,第一时相Ins分泌为 (2 47.8± 2 3 .5)mU/L ,第二时相为 (72 .8± 6.1)mU/L。 (4)高糖钳夹可同时获得个体的Ins敏感性 (ISI) 19.9± 2 .4,但较正糖钳夹值为高。　结论　 (1)成功建立了高葡萄糖钳夹技术 ,评价了正常个体的双相Ins分泌及最大Ins分泌。 (2 )高葡萄糖钳夹能同时了解机体的胰岛素抵抗 (IR)情况 。ObjectiveTo establish hyperglycemic clamp tech ni que, a method for the precise measurement of insulin secretion.Methods Hyperglycemic clamp research were conducted on 25 normal glucose toler ance Chinese individuals from Shanghai, 16 men, and 9 women. The subjects were f asting. Intra-catheters were placed in both upper limbs veins. One side was for infusion of 20% glucose solution continually to keep plasma glucose 7.9 mmol/L higher than basic glucose state during the test by negative feedback principle. The other side was for the collection of blood samples to obtain insulin value a nd two-phases insulin secretion so as to evaluate β cell function.Re sults(1)The plasma glucose concentration of the individuals reached a hyperglycemic plateau in prescriptive time (14 minutes)(12.86±0.11 mmol/L)a nd kept the level during the whole test. (2)Throughout the hyperglycemic clamp process, the variance coefficient of plasma glucose which was determined every 5 minutes was 4.2%. (3)It was observed that two-phases of insulin secretions were present during persistent hyperglycemic state with phase 1 of (247.8±23 .5) mU/L, and phase 2 of (72.8±6.1) mU/L.(4)It was obtained that insulin sens itivity index (19.93±2.43) in hyperglycemic clamp was higher than that in eugl ycemic clamp.Conclusions(1)Hyperglycemic clamp technique i s established successfully . It may evaluate the two-phases insulin release and maximum insulin secretion in normal individuals. (2) Hyperglycemic clamp can also evaluate insulin resistance and observe the discrepancy of insulin sensitiv ity in different populations simultaneously.

关 键 词：葡萄糖钳夹技术 胰岛素 INS 分泌功能 诊断 

分 类 号：R587.1[医药卫生—内分泌]