Watarai T, Yamasaki Y, Ikeda M, Kubota M, Kodama M, Tsujino T, Kishimoto M, Kawamori R, Hori M
Department of Internal Medicine and Therapeutics, Osaka University School of Medicine, Suita City, Japan.
Endocr J. 1999 Oct;46(5):629-38. doi: 10.1507/endocrj.46.629.
The aim of this study was to clarify whether insulin resistance contributes to atherosclerosis in patients with non-insulin-dependent diabetes mellitus (NIDDM). Fifty-three NIDDM patients (36 males and 17 females, 53+/-10 years old (mean+/-SD)) were studied. As an index of atherosclerosis, we measured the average thickness (IMT) as well as basal thickness excluding the maximum thickness and the height of the maximum thickness of the carotid artery wall. Euglycemic hyperinsulinemic glucose clamp was conducted for 90 min to evaluate average glucose infusion rate (GIR) as an index of insulin sensitivity in the peripheral tissues. For another 180 min after intake of oral glucose load with 0.3 g/kg, the euglycemic hyperinsulinemic clamp was continued to measure ratio of splanchnic glucose uptake (SGU) as an index of insulin sensitivity of the liver. The patients were separated into three activity groups according to the grade of their leisure-time physical activity. GIR (r = -0.32, p < 0.05) but not SGU (r=0.139) showed a significant inverse relationship with IMT. Multivariant regression analysis indicated that age and total cholesterol remain as independent risk factors for basal thickness and GIR as only independent risk factor for the height of the maximum thickness. Paralleling the degrees of habitual exercise (low, moderate, and high active group), GIR was higher (6.19+/-1.02, 6.38+/-1.38, 7.44+/-1.80, respectively) and IMT was lower (1.34+/-0.33 mm, 1.20+/-0.31 mm, and 1.12+/-0.29 mm, respectively) in male NIDDM as well as in female NIDDM. These data suggest that insulin resistance in the peripheral tissues but not the splanchnic tissues may independently contribute to carotid arterial wall thickness and especially to plaque lesion, and that habitual exercise might reduce insulin resistance leading to attenuation of atherosclerosis.
本研究的目的是阐明胰岛素抵抗是否会导致非胰岛素依赖型糖尿病（NIDDM）患者发生动脉粥样硬化。我们对53例NIDDM患者（36例男性和17例女性，年龄53±10岁（均值±标准差））进行了研究。作为动脉粥样硬化的指标，我们测量了颈动脉壁的平均厚度（IMT）以及不包括最大厚度的基础厚度和最大厚度的高度。进行90分钟的正常血糖高胰岛素葡萄糖钳夹试验，以评估平均葡萄糖输注率（GIR），作为外周组织胰岛素敏感性的指标。在摄入0.3g/kg口服葡萄糖负荷后再持续180分钟，继续进行正常血糖高胰岛素钳夹试验，以测量内脏葡萄糖摄取率（SGU），作为肝脏胰岛素敏感性的指标。根据患者休闲时间身体活动的程度将其分为三个活动组。GIR（r = -0.32，p < 0.05）与IMT呈显著负相关，而SGU（r = 0.139）与IMT无显著相关性。多变量回归分析表明，年龄和总胆固醇仍然是基础厚度的独立危险因素，而GIR是最大厚度高度的唯一独立危险因素。与习惯性运动程度（低、中、高活动组）平行，男性和女性NIDDM患者的GIR均较高（分别为6.19±1.02、6.38±1.38、7.44±1.80），IMT均较低（分别为1.34±0.33mm、1.20±0.31mm和1.12±0.29mm）。这些数据表明，外周组织而非内脏组织的胰岛素抵抗可能独立导致颈动脉壁厚度增加，尤其是斑块病变，并且习惯性运动可能会降低胰岛素抵抗，从而减轻动脉粥样硬化。
