生理学胰岛素Insulin-newversion

Insulin and Glucagon,Paul Langerhans1869,Joseph Von Mering Oskar Minkowski1889,Polyphagia, Increased thirst and diuresis, along with hyperglycemia and urinary glucose in pancreas-resected dog.,Established for the first time the relations between pancreas and diabetes.,World War I1914-1918,Nicolas Paulesco,Banting, Best & Diabetic dog,J.J.R. Macleod,James B Collip,F.G.Banting,Jan. 11. 1922 - FailedJan. 23. 1922 - Done,Delta cells(IGF),Alpha cells(Glucagon),Beta cells(Insulin),Histology of Islets,Digestive Acini,Biochemistry of Insulin,Main points:,Effects of insulin (on metabolism of protein, fat and carbohydrate);Effects of Glucagon Regulations of Insulin and Glucagon secretion,Connections between metabolism of glucose, fatty acid and amino acid,Carbohydrate(Glucose),Amino acid,Fatty acid,Protein,Fat, Effect of Insulin on Metabolism,Fat Metabolism 1. Promotes fat synthesis; 2. Decreases utilization of fat; 3. Promotes transportation of fat acid into adipose cells and then storage of fat;,Carbohydrate(Glucose),Fatty acid,Fat,Summarized Effect: Enhance fat formation.,Protein Metabolism 1. Increase transcription of DNA, translation of mRNA; 2. Promote AA transported into cells; 3. Inhibit protein catabolism; 1-3 protein increased 4. Depress gluconeogenesis (amino acid glucose),Carbohydrate(Glucose),Amino acid,Protein,Summarized Effect: Increase protein,Carbohydrate Metabolism,Glucose,Insulin Deficiency,Metabolic Abnormality in glucose, fat and protein,Glucose:Hyperglycemia, urinary glucose, diuresisFat:High concentration of fatty acid, cholesterol and phospholipid in plasma; acetoacetic acid, acetone etc. (Acidosis, Ketosis and Coma)Protein:Protein Decreased in tissues but amino acid increased in plasma,Promote glycogenolysis and increase blood glucose concentration;Promote gluconeogenesis (derived from protein)Other effects of minimal importance, Effect of Glucagon,Carbohydrate(Glucose),Glucogen,Amino acid, Regulation of Insulin and Glucagon Secretion,Insulin,Glucagon,Blood Glucose,High,Low,Two Stages,2000,1,000,000,Insulin Oscillations,Regulation of Calcium and Phosphate metabolism,钙的重要性：维持神经肌肉兴奋性，骨骼肌抽搐参与骨骼的形成,中国营养学会推荐钙日需要量,婴幼儿：发育缓慢，佝偻病儿童：厌食、精力不集中中老年：骨质疏松、易骨折,钙在体内的动态平衡,破骨细胞溶骨,成骨细胞成骨,释放钙、磷；升高血钙,钙、磷沉积；降低血钙,钙磷在骨的代谢,钙磷的动态平衡关系,钙磷在肾的代谢,调节钙磷代谢的激素,甲状旁腺激素 （parathyroid，PTH） 降钙素 （Calcitonin，CT） 1,25二羟维生素D3,升高血钙,降低血钙、磷,升高血钙、降低血磷,小肠,肾,骨,Ca2+、PTH,Ca2+,Ca2+、P,分泌的调节,促进CaBP的生成、促进钙、磷吸收,促进钙、磷吸收,促进钙、磷重吸收,抑制钙、磷吸收,促进钙重吸收、抑制磷重吸收、激活1羟化酶,增加破骨细胞数量、刺激成骨细胞活动、增强PTH作用,抑制破骨细胞活动促进成骨细胞活动,促进破骨细胞活动、动员骨钙、磷入血,作 用,小肠、骨、肾,骨、肾,骨、肾、小肠,作用部位,皮肤(7-脱氢胆固醇)动物性食物,甲状腺C细胞,甲状旁腺,激素来源,1,25-(OH)2-VD3,CT,PTH,PTH、CT调节血钙水平,甲状旁腺功能亢进,一、甲状旁腺激素,来源于甲状旁腺主细胞 PTH血浆浓度：1055pg/ml,（一）PTH的生物学作用（升高血钙、降低血磷),靶器官：骨、肾、小肠,1、PTH对骨的作用动员骨钙、磷入血，升高血钙 快速效应(Minutes) ：刺激骨细胞和成骨细胞将骨液中的钙转运至血液中。 迟发效应(Hours-Days-Weeks )：加强破骨细胞活动，溶骨而促进钙、磷入血。,2、PTH对肾脏的作用 促进肾远曲小管、集合管对钙的重吸收尿钙，血钙 抑制近曲小管对磷的重吸收尿磷 ，血磷 激活1羟化酶使25-OH-D3转变为1,25-二羟D3,3、PTH促进小肠对钙、磷吸收,血钙水平的作用,（二） PTH分泌的调节,血钙PTH血钙PTH,磷血钙PTH血镁 PTH 儿茶酚胺 PTH 生长抑素 PTH ,其他因素的作用,二、降钙素,由甲状腺滤泡间和滤泡上皮细胞间的C细胞分泌靶器官：骨、肾,（一）CT的生物学作用：降低血钙,1、对骨的作用破骨细胞活动成骨细胞活动,溶骨成骨,促进骨骼生长降低血钙,2、对肾的作用抑制肾小管对钙、磷、镁等的吸收。,特点： 作用快速：利于钙沉积和骨骼生长； 利于控制高钙饮食后血钙水平 对儿童血钙调节作用大，对成人弱,（二）CT分泌的调节,血钙水平的作用：血钙CT 血钙CT,三、1, 25-二羟维生素D3, 皮肤中的7-脱氢胆固醇, 动物性食物,紫外线,VD3原,VD3（胆钙化醇）,1、生成及调节,25-羟化酶（肝）,25- (OH)-VD3,1-羟化酶（肾）,1,25-(O