Hrnciar J
Interná klinika A, NsP F. D. Roosevelta, Banská Bystrica.
Vnitr Lek. 1992 Nov;38(11):1041-4.
The term X syndrome involves several dilemmas. The terminological dilemma is that this term is used to describe microvascular angina pectoris, as well as Reaven's metabolic-hormonal syndrome and our 5H syndrome [association of hyperinsulinism with arterial hypertension, hyperlipoproteinaemia, hyperglycaemia (NIDDM) and hirsutism]. It is probable that the coronary X syndrome is frequently conditioned by the hormonal-metabolic X syndrome. The pathogenetic dilemma is that it is not clear why in microvascular angina pectoris the coronary circulation does not possess an adequate reserve for vasodilatation during exercise or in response to some pharmacological stimuli. This could condition hyperinsulinism in hypertonic subjects with NIDDM with an early disorder of paracrine endothelial relaxation mechanisms (EDRF-NO), with a predominance of vasoconstrictor mechanisms (endothelin-1). In Reaven's syndrome X it is not clear whether insulin resistance of the postreceptor type is a primary inborn phenomenon which is compensated by insulin hypersecretion or whether it is a secondary phenomenon, which develops ex post and by which the target tissues defend themselves against an excessive effect of insulin (e.g. down regulation receptors) in primary disorders of its secretion.
X综合征这一术语存在若干难题。术语方面的难题在于，该术语既用于描述微血管性心绞痛，也用于描述雷文氏代谢 - 激素综合征以及我们的5H综合征[高胰岛素血症与动脉高血压、高脂蛋白血症、高血糖（非胰岛素依赖型糖尿病）和多毛症的关联]。冠状动脉X综合征很可能常常由激素 - 代谢X综合征所引发。发病机制方面的难题在于，目前尚不清楚为何在微血管性心绞痛中，冠状动脉循环在运动期间或对某些药理刺激作出反应时不具备足够的血管舒张储备能力。这可能导致非胰岛素依赖型糖尿病的高血压患者出现高胰岛素血症，伴有旁分泌内皮舒张机制（内皮舒张因子 - 一氧化氮）早期紊乱，且以血管收缩机制（内皮素 - 1）为主导。在雷文氏X综合征中，尚不清楚受体后型胰岛素抵抗是一种原发性先天性现象，通过胰岛素分泌过多来代偿，还是一种继发性现象，它在胰岛素分泌原发性紊乱后出现，靶组织借此抵御胰岛素的过度作用（例如下调受体）。
