Zuniga-Guarjardo S, Steiner G, Shumak S, Zinman B
Division of Endocrinology and Metabolism, Toronto General Hospital, Mount Sinai Hospital, Ontario, Canada.
Diabetes Res Clin Pract. 1991 Oct;14(1):55-61. doi: 10.1016/0168-8227(91)90053-g.
To define further the characteristics of insulin insensitivity associated with hypertriglyceridemia, the metabolic responses to the euglycemic insulin clamp were evaluated in 6 hypertriglyceridemic male patients and compared to 5 normal male controls. At baseline, the hypertriglyceridemic patients had elevated triglycerides (687 +/- 172 vs 78 +/- 7 mg/dl, P less than 0.005) and free fatty acids (702 +/- 36 vs 444 +/- 42 microM/l, P less than 0.005) concentrations. During the euglycemic insulin clamp, steady-state plasma glucose concentrations were similar in both groups (90.2 +/- 1.5 vs 88.8 +/- 2.3 mg/dl, ns) as were steady state insulin levels (142 +/- 10.1 vs 132.2 +/- 6.8 microU/ml**). The amount of glucose metabolized during the last hour of the clamp (M) was significantly reduced in the hypertriglyceridemic patient (2.9 +/- 0.4 vs 6.2 +/- 0.7 mg.min-1.kg-1, P less than 0.001). Changes in free fatty acid, glycerol, B-hydroxybutyrate, lactate and pyruvate during the euglycemic insulin clamp were similar indicating a preserved antilipolytic, antiketogenic and glycolytic intermediate (lactate + pyruvate) response to insulin and glucose infusion in the hypertriglyceridemic patients. In summary, hypertriglyceridemia is associated with insulin resistance as it relates to muscle glucose utilization. However, this is not universal, as a number of other insulin responsive pathways appear to be unaffected.
为了进一步明确与高甘油三酯血症相关的胰岛素不敏感的特征，对6名高甘油三酯血症男性患者进行了正常血糖胰岛素钳夹试验的代谢反应评估，并与5名正常男性对照者进行比较。基线时，高甘油三酯血症患者的甘油三酯（687±172对78±7mg/dl，P<0.005）和游离脂肪酸（702±36对444±42μM/l，P<0.005）浓度升高。在正常血糖胰岛素钳夹试验期间，两组的稳态血浆葡萄糖浓度相似（90.2±1.5对88.8±2.3mg/dl，无显著性差异），稳态胰岛素水平也相似（142±10.1对132.2±6.8μU/ml**）。在钳夹试验的最后一小时内代谢的葡萄糖量（M）在高甘油三酯血症患者中显著降低（2.9±0.4对6.2±0.7mg·min-1·kg-1，P<0.001）。正常血糖胰岛素钳夹试验期间游离脂肪酸、甘油、β-羟基丁酸、乳酸和丙酮酸的变化相似，表明高甘油三酯血症患者对胰岛素和葡萄糖输注的抗脂解、抗生酮和糖酵解中间产物（乳酸+丙酮酸）反应得以保留。总之，高甘油三酯血症与肌肉葡萄糖利用方面的胰岛素抵抗有关。然而，情况并非普遍如此,因为许多其他胰岛素反应途径似乎未受影响。
