糖尿病における腸管グルカゴンの病態生理学的意義に関する研究
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The physiological role of gut glucagon (gut glucagon-like immunoreactivity ; Gut GLI) are not well known. The present study aims to make clear the pathophysiological role of Gut GLI on the entero-pancreatic correlation in diabetes mellitus. Gut GLI responses to an oral glucose load were observed, and especially the correlation of Gut GLI to blood glucose and pancreatic endocrine and exocrine secretion were examined. Among 43 diabetics, 24 cases were treated with sulfonylurea (SU) and 19 cases were treated with insulin. For the estimation of pancreatic B cell function, insulin and C-peptide were measured, and for A cell function pancreatic glucagon was measured by radioimmunoassay. As a parameter of exocrine pancreatic function amylase was measured. In spite of any therapeutic method in diabetics larger excretion of Gut GLI was shown compare to normal controls during 50g oral glucose tolerance test. On the other hand, few cases of diabetics showed extraordinarily low excretion of Gut GLI. Then, we classified them into two groups of high and low responders with regard to the Gut GLI responses by secretion area (Σ Gut GLI) deviating the standard normal controls mean ± 2 S.D. In both groups correlations between Gut GLI responses and pancreatic endocrine and exocrine secretions were studied. The results were observed as follows. 1) 15 high responders (62%) of Gut GLI for glucose load out of 24 SU treated diabetics, and 11 high responders (58%) out of 19 insulin treated diabetics were found. 2) 7 low responders (28%) out of 24 SU treated diabetics and 4 low responders (21%) out of 19 insulin treated diabetics were found. 3) The amount of Gut GLI secretion had no correlation to the age, duration, obese index, retinopathy and neuropathy of diabetes mellitus. 4) The amount of Gut GLI secretion was also not correlated to IRG, IRI, CPR or blood glucose levels. 5) In high Gut GLI responders, amylase secretion decreased gradually from basal to nadir at 180 minutes. On the other hand in low responders, amylase secretion decreased from basal to the minimum at 30 or 60 minutes after glucose load and recovered to basal levels at 180 minutes. Through these observations, we can not demonstrate the positive correlation of Gut GLI with pancreatic B cell function or symptoms of diabetes mellitus, although it is suggestable that Gut GLI may be regarded as a parameter of the intestinal function or digestive system which is controlled autonomic nerve.
- 神戸大学の論文
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