Pollare T, Vessby B, Lithell H
Department of Geriatrics, Uppsala University, Sweden.
Arterioscler Thromb. 1991 Sep-Oct;11(5):1192-203. doi: 10.1161/01.atv.11.5.1192.
The relative effects of obesity, alone or in combination with insulin resistance and hyperinsulinemia (with or without diabetes), on lipoprotein concentrations, blood pressure, and other risk factors for cardiovascular disease were investigated in 28 men (mean age, 63 years). Special attention was given to lipoprotein lipase (LPL) activity in tissues and to postheparin plasma LPL activity and hepatic lipase activity and their relation to insulin resistance. The 28 men fulfilled the entrance criteria of the study so that they could be allocated to one of the four groups (seven in each group): 1) normal body weight, normal fasting insulin level, and normal glucose tolerance (controls); 2) the same as in group 1 but with moderate obesity; 3) the same as in group 2 but with fasting hyperinsulinemia; 4) the same as in group 3 but with non-insulin-dependent diabetes mellitus. Glucose infusion rate for the control group was 8.1 +/- 2.1 mg/kg body wt/min (mean +/- SD) at an insulin infusion rate of 56 milliunits/m2/min. The average values in groups 2, 3, and 4 were 6.0 +/- 0.7, 3.2 +/- 0.5, and 1.9 +/- 1.0 mg/kg body wt/min, respectively. Concentrations of very low density lipoproteins as well as blood pressure and urate concentrations were highest and those of high density lipoproteins were lowest in the two hyperinsulinemic groups (groups 3 and 4). Skeletal muscle LPL activity was 46 +/- 23, 41 +/- 25, 23 +/- 6, and 31 +/- 13 milliunits/g wet wt (mean +/- SD) in the four groups, respectively. There was a positive correlation between glucose infusion rate and muscle LPL activity (r = 0.58, p less than 0.0001). The hepatic lipase activity was positively correlated with the insulin area under the curve of the intravenous glucose tolerance test (r = 0.35, p = 0.02). Furthermore, blood pressure, free fatty acid concentration, liver enzymes, and urate concentrations were significantly correlated with glucose infusion rate at the clamp test. These data give further support for insulin resistance as an important factor behind the observed lipoprotein abnormalities and blood pressure elevations as part of the insulin resistance syndrome characteristic for obese and diabetic patients.
在28名男性（平均年龄63岁）中，研究了肥胖单独或与胰岛素抵抗及高胰岛素血症（伴或不伴糖尿病）相结合对脂蛋白浓度、血压及其他心血管疾病危险因素的相关影响。特别关注了组织中的脂蛋白脂肪酶（LPL）活性、肝素后血浆LPL活性及肝脂肪酶活性，以及它们与胰岛素抵抗的关系。这28名男性符合该研究的入选标准，因此可被分配到四组中的一组（每组7人）：1）正常体重、空腹胰岛素水平正常且葡萄糖耐量正常（对照组）；2）与第1组相同，但有中度肥胖；3）与第2组相同，但有空腹高胰岛素血症；4）与第3组相同，但有非胰岛素依赖型糖尿病。对照组在胰岛素输注速率为56毫单位/平方米/分钟时，葡萄糖输注速率为8.1±2.1毫克/千克体重/分钟（平均值±标准差）。第2、3和4组的平均值分别为6.0±0.7、3.2±0.5和1.9±1.0毫克/千克体重/分钟。在两个高胰岛素血症组（第3组和第4组）中，极低密度脂蛋白浓度、血压及尿酸盐浓度最高，而高密度脂蛋白浓度最低。四组中骨骼肌LPL活性分别为46±23、41±25、23±6和31±13毫单位/克湿重（平均值±标准差）。葡萄糖输注速率与肌肉LPL活性呈正相关（r = 0.58，p＜0.0001）。肝脂肪酶活性与静脉葡萄糖耐量试验胰岛素曲线下面积呈正相关（r = 0.35，p = 0.02）。此外，在钳夹试验中，血压、游离脂肪酸浓度、肝酶及尿酸盐浓度与葡萄糖输注速率显著相关。这些数据进一步支持了胰岛素抵抗是肥胖和糖尿病患者胰岛素抵抗综合征特征中所观察到的脂蛋白异常和血压升高背后的重要因素这一观点。
