胰岛素抵抗与冠状动脉内皮功能障碍中残留样脂蛋白颗粒之间的潜在关系。

Possible relationship between insulin resistance and remnant-like lipoprotein particles in coronary endothelial dysfunction.

作者信息

Inoue Teruo, Uchida Toshihiko, Kamishirado Hirotoshi, Sakuma Masashi, Sakai Yoshihiko, Takayanagi Kan, Hayashi Terumi, Morooka Shigenori

机构信息

Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan.

出版信息

Clin Cardiol. 2002 Nov;25(11):532-6. doi: 10.1002/clc.4960251110.

DOI:10.1002/clc.4960251110

PMID:12430784

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6654041/

Abstract

BACKGROUND

High insulin resistance and elevated remnant lipoprotein levels both correlate with impaired coronary vascular endothelial function. Hyperinsulinemia induces abnormalities of lipid metabolism. However, the correlation among insulin resistance, remnant lipoproteins, and endothelial function has not been clinically elucidated.

HYPOTHESIS

This study was designed to elucidate the correlation among insulin resistance, remnant lipoproteins, and acetylcholine (ACh)-induced coronary artery response.

METHODS

Forty-nine patients suspected of having ischemic heart disease, but without angiographically significant atherosclerotic coronary artery disease, underwent an ACh provocation test. Fasting venous blood was taken early in the morning on the day coronary angiography was performed. The insulin resistance index (IR) was determined from fasting plasma glucose and insulin concentrations, using the homeostasis model assessment (HOMA). Serum levels of remnant-like lipoprotein particle cholesterol (RLP-C) were measured.

RESULTS

Homeostasis model assessment IR was significantly higher (3.65 +/- 1.38 vs. 0.75 +/- 0.14, p < 0.05) and log-transformed HOMA (Log HOMA) was even more significantly higher (0.20 +/- 0.12 vs. -0.29 +/- 0.08, p < 0.001) in the ACh-positive group (n = 23) than in the ACh-negative group (n = 26). The serum RLP-C level was also higher in the ACh-positive group than in the ACh-negative group (4.37 +/- 0.63 vs. 2.52 +/- 0.18 mg/dl, p < 0.01). Log HOMA and RLP-C levels correlated with each other (R = 0.54, p < 0.001). Multiple regression analysis indicated that only the RLP-C level was a dependent predictor of Log HOMA in various lipid profiles.

CONCLUSIONS

Both high insulin resistance and elevated remnant lipoprotein levels correlated and might have a crucial role in the impairment of coronary vascular endothelial function, even in patients without angiographically significant coronary artery disease.

摘要

背景

高胰岛素抵抗和残余脂蛋白水平升高均与冠状动脉血管内皮功能受损相关。高胰岛素血症会引发脂质代谢异常。然而，胰岛素抵抗、残余脂蛋白与内皮功能之间的相关性尚未在临床上得到阐明。

假设

本研究旨在阐明胰岛素抵抗、残余脂蛋白与乙酰胆碱（ACh）诱导的冠状动脉反应之间的相关性。

方法

49例疑似患有缺血性心脏病但冠状动脉造影无明显动脉粥样硬化性冠状动脉疾病的患者接受了ACh激发试验。在进行冠状动脉造影的当天清晨采集空腹静脉血。使用稳态模型评估（HOMA）根据空腹血糖和胰岛素浓度确定胰岛素抵抗指数（IR）。测量血清中类残余脂蛋白颗粒胆固醇（RLP-C）水平。

结果

ACh阳性组（n = 23）的稳态模型评估IR显著高于ACh阴性组（n = 26）（3.65±1.38 vs. 0.75±0.14，p < 0.05），对数转换后的HOMA（Log HOMA）更高（0.20±0.12 vs. -0.29±0.08，p < 0.001）。ACh阳性组的血清RLP-C水平也高于ACh阴性组（4.37±0.63 vs. 2.52±0.18 mg/dl，p < 0.01）。Log HOMA与RLP-C水平相互相关（R = 0.54，p < 0.001）。多元回归分析表明，在各种血脂谱中，只有RLP-C水平是Log HOMA的独立预测因子。