糖尿病患者におけるアルギニン負荷試験時の血漿成長ホルモン反応:糖尿病性網膜症との関連を主とした多変量解析による検討

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In 107 patients with non-insulin dependent diabetes (NIDDM), plasma growth hormone (GH) responses during standard arginine test (0.5g/kg of body weight) were studied and analyzed in comparison with those in 17 normal subjects. The indices of the responsiveness of GH, peak value of GH, sum of GH values (ΣGH), area of GH curve (∫ GH), sum of GH values above fasting level (ΣΔGH) and area of GH curve above fasting level (∫ΔGH) during the test (2hr) were calculated. Data were also analyzed with multiple regression analysis using stepwise method for variable selection.<BR>Basal level of GH was significantly higher in diabetic patients than in normal subjects (2.1±1.7 vs. 1.6±0.5ng/ml, mean±SD, p<0.05), and ΣGH and ∫GH were also higher in diabetic patients. There was a significantly positive correlation between fasting plasma glucose (FPG) and basal level of GH (r=0.24, n=107, p<0.05), and the indices of GH responses except ΔGH and GH peak value (r=0.24 to 0.31, p<0.05 to 0.01). Some indices of GH responses (ΣΔGH, ΣGH, ∑ΔGH and f GH) were significantly higher in the poor control group (patients with FPG above 180mg/d1, n=29) of diabetic patients than in the good control group (patients with FPG below 140mg/d1, n=59), or in the group with no abnormal findings of retinopathy (n=46). During the follow-up of retinopathy for 2.5 years on the average, progression of retinopathy was found in 21 out of 107 patients. Significantly higher GH, and GH in the patients with increasing severity of retinopathy were revealed retrospectively compared to the patients without it. However, there were no significant differences in these parameters between both groups matched by FPG or severity of retinopathy.<BR>Multiple regression analysis to the basal GH level and GH responses during arginine infusion as criterion variables of various predictor variables (total 44 factors : biochemical laboratory data, indices of glucose and insulin response to oral glucose load, indices of glucose response to arginine, age, age of the onset, obese index, duration of retinopathy, neuropathy, and therapy) were performed in 86 patients using forward and backward method for variable selection. Basal plasma level of GH showed close positive association with therapy and proteinuria and negative association with age and obesity. Five of 6 indices of GH responsiveness showed significant relationship with retinopathy. The following significant association was observed : The therapy was significantly related to peak value of GH, LGH and ΣΔGH; FPG to f ΔGH, I ΔGH and f GH; blood pressure to ΔGH and ΣΔGH; sex to ΣΔGH and ∑ΔGH; age, duration of the illness, serum alkali-phosphatase and beta lipoprotein to peak value of GH; serum creatinine and PSP values to f GH.<BR>On the other hand, multiple regression analysis of the above factors of diabetic retinopathy graded by Scott's classification revealed a close positive association with neuropathy, GH responses to arginine and FPG, and negative association with obesity and serum level of alkali phosphatase.<BR>These findings suggest a deficiency of the suppressive mechanism due to raised glucose level of GH response in diabetics, and a strong association of GH response to arginine with the appearance or severe development of retinopathy.
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糖尿病患者におけるアルギニン負荷試験時の血漿成長ホルモン反応:糖尿病性網膜症との関連を主とした多変量解析による検討

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