• 作者： 吳敏雄; 陳橈通; 葉振聲; 陳振傑; 郭清輝
• 作者服務機構： 榮民總醫院﹑內科部﹑新陳代謝科; 國防醫學院暨陽明醫學院﹑內科學系
• 中文摘要： 16位正常人隨機分成二組，分別接受葡萄糖固定法（glucose clamp）之檢查以探討人體對胰島素之廓清率和敏感度有無晨昏之差異。其中一組接受低劑量胰島素之注射（8mU/M/min），而另一組則接受高劑量胰島素之注射（40mU/M/min）。每一位正常人在空腹9～10小時後分別接受二次葡萄糖固定法之檢查，一次是在土午八點，另一次則是在晚上六點，實驗結果顯示在二種胰島素劑量注射下，正常人對胰島素之廓清率有晨昏之差異，而此差異在注射低劑量胰島素組更加明顯（高劑量胰島素組之胰島素廓清率，早上為791±54m1/min/M晚上為947±53m1/min/M；p<0.01；低劑量組之晨昏胰島素之廓清率則分別為411±32m1/min/M和716±87m1/min/M；p<0.001）。葡萄糖固定檢查時，到達平穩狀態之葡萄糖注射速率和血清中游離胰島素濃度之比值（M/Fl）來代表人體對胰島素之敏感度時，我們發現只有在低劑量胰島素注射組才有晨昏敏感度之差異，（早土14.6±2.4，下午10.5±1.1；p<0.05）。結論是人體對胰島素之敏感度在低劑量生理濃度時，以早上較為敏感。而人體對胰島素之廓清率，則不論胰島素注射濃度之高低都顯示晚土較高。至於產生此種對胰島素敏感度和廓清率之晨昏差異之根本機轉，則有待進一步之研究。
• 英文摘要： Sixteen normal healthy volunteers were randomized into two groups, receiving either low dosesinsulin infusion clamp study (8mU/M/min) or high dose (40mU/M/min) to determine the diurnal insulinclearance and sensitivity. Each subject received the assigned dose of insulin clamp twice; one in the morn-ing (0800-1000) and the other in the evening (1800-2000), each with a precedent 9 hours of fasting, respec-tively. The results showed that there were diurnal variation of serum insulin clearance in the high dosestudy (AM:791±54ml/min/M, PM：947±53m1/min/M, P<0.01), and this trend was more prominent inthe small dose study (AM:411±32m1/min/M, PM:716±87ml/min/M, P<0.001). Diurnal variation ofinsulin sensitivity as judged by dividing glucose infusion rate by the ambient serum free insulin level (M/FIration), was only noted in the low dose insulin infusion clamp study (AM:14.6±2.4, PM:10.5±1.1, p<0.05). In summary, at low physiological levels of insulin the insulin sensitivity is better in the morning,whereas at both high and low insulin levels the insulin clearance of normal subject is greater in the evening.The mechanism of this diurnal variation of insulin clearance and sensitivity awaits further studies.
• 中文關鍵字： insulin clamp; insulin clearance; insulin sensitivity; diurnal variation; normal subjects
• 英文關鍵字： --