Sheu W H, Jeng C Y, Young M S, Le W J, Chen Y T
Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, ROC.
Am J Med Sci. 2000 Feb;319(2):84-8. doi: 10.1097/00000441-200002000-00003.
It has been shown that insulin resistance syndrome, including glucose intolerance, dyslipidemia, and hypertension, is frequently associated with coronary artery disease (CAD). However, their relative contributions and predictive power in the development of CAD are still unclear, particularly in persons without diabetes.
We examined these risk factors between 96 patients without diabetes but with angiographically documented CAD and 96 age-, sex-, and body mass index-matched healthy control subjects. Fasting plasma lipoprotein, glucose, and insulin concentrations in response to a 75-g oral glucose tolerance test were determined, and insulin sensitivity was measured by the insulin suppression test.
Patients with CAD had significantly higher values of fasting glucose, glucose and insulin responses to oral glucose tolerance test, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride and decreased high-density lipoprotein (HDL) cholesterol concentrations compared with those of healthy people (P < 0.02-0.001). Although the steady-state plasma insulin values were similar in both groups, the steady-state plasma glucose (SSPG) concentrations were significantly higher in patients with CAD (12.2+/-0.4 versus 8.1+/-0.4 mmol/L, P < 0.001) compared with healthy subjects. When HDL < 0.9 mmol/L, LDL cholesterol > or = 4.1 mmol/L, triglyceride > or = 2.3 mmol/L, SSPG > or = 10.5 mmol/L, and presence of hypertension were defined as separate risk factors for CAD, significantly higher odds-ratio values were observed in patients with CAD compared with healthy people. From logistic multiple regression analysis, SSPG was the strongest risk, followed by lowered HDL cholesterol, elevated triglyceride and LDL cholesterol, and hypertension, to predict CAD. These 5 factors accounted for 36% of total risk for development of CAD in persons without diabetes.
Patients without diabetes with CAD have abnormal glucose metabolism, hyperinsulinemia, and insulin resistance. Degree of insulin resistance (SSPG values), plasma lipid values, and history of hypertension together accounted for one third of all risk for CAD, although degree of insulin resistance was the strongest risk factor.
研究表明，胰岛素抵抗综合征，包括糖耐量异常、血脂异常和高血压，常与冠状动脉疾病（CAD）相关。然而，它们在CAD发生发展中的相对作用和预测能力仍不明确，尤其是在无糖尿病患者中。
我们检查了96例无糖尿病但经血管造影证实患有CAD的患者与96例年龄、性别和体重指数相匹配的健康对照者之间的这些危险因素。测定了空腹血浆脂蛋白、葡萄糖和胰岛素浓度以及口服75g葡萄糖耐量试验后的胰岛素敏感性。
与健康人相比，CAD患者的空腹血糖、口服葡萄糖耐量试验后的葡萄糖和胰岛素反应、总胆固醇、低密度脂蛋白（LDL）胆固醇、甘油三酯水平显著升高，高密度脂蛋白（HDL）胆固醇浓度降低（P<0.02-0.001）。虽然两组的稳态血浆胰岛素值相似，但CAD患者的稳态血浆葡萄糖（SSPG）浓度显著高于健康受试者（12.2±0.4对8.1±0.4mmol/L，P<0.001）。当HDL<0.9mmol/L、LDL胆固醇≥4.1mmol/L、甘油三酯≥2.3mmol/L、SSPG≥10.5mmol/L以及存在高血压被定义为CAD的单独危险因素时，与健康人相比，CAD患者的比值比显著更高。从逻辑多元回归分析来看，SSPG是最强的危险因素，其次是HDL胆固醇降低、甘油三酯和LDL胆固醇升高以及高血压，用于预测CAD。这5个因素占无糖尿病患者发生CAD总风险的36%。
无糖尿病的CAD患者存在糖代谢异常、高胰岛素血症和胰岛素抵抗。胰岛素抵抗程度（SSPG值）、血脂水平和高血压病史共同占CAD所有风险的三分之一，尽管胰岛素抵抗程度是最强的危险因素。
