Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
Rev Endocr Metab Disord. 2013 Mar;14(1):21-7. doi: 10.1007/s11154-012-9232-6.
Vascular endothelium is an important insulin target and plays a pivotal role in the development of metabolic insulin resistance provoked by the Western lifestyle. It acts as a "first-responder" to environmental stimuli such as nutrients, cytokines, chemokines and physical activity and regulates insulin delivery to muscle and adipose tissue and thereby affecting insulin-mediated glucose disposal by these tissues. In addition, it also regulates the delivery of insulin and other appetite regulating signals from peripheral tissues to the central nervous system thus influencing the activity of nuclei that regulate hepatic glucose production, adipose tissue lipolysis and lipogenesis, as well as food consumption. Resistance to insulin's vascular actions therefore broadly impacts tissue function and contribute to metabolic dysregulation. Moreover, vascular insulin resistance negatively impacts vascular health by affecting blood pressure regulation, vessel wall inflammation and atherogenesis thereby contributing to the burden of vascular disease seen with diabetes and metabolic syndrome. In the current review, we examined the evidence that supports the general concept of vascular endothelium as a target of insulin action and discussed the biochemical and physiological consequences of vascular insulin resistance.
血管内皮细胞是胰岛素的一个重要靶标，在由西方生活方式引起的代谢性胰岛素抵抗的发展中起着关键作用。它作为一种“第一 responder”，对环境刺激（如营养物质、细胞因子、趋化因子和体育活动）做出反应，调节胰岛素向肌肉和脂肪组织的输送，从而影响这些组织对胰岛素介导的葡萄糖摄取。此外，它还调节胰岛素和其他来自外周组织的食欲调节信号向中枢神经系统的传递，从而影响调节肝脏葡萄糖生成、脂肪组织脂肪分解和脂肪生成的核的活性，以及食物的摄入。因此，胰岛素对血管作用的抵抗广泛影响组织功能，并导致代谢失调。此外，血管胰岛素抵抗通过影响血压调节、血管壁炎症和动脉粥样硬化形成来损害血管健康，从而导致糖尿病和代谢综合征患者的血管疾病负担增加。在本综述中，我们检查了支持血管内皮细胞作为胰岛素作用靶标的一般概念的证据，并讨论了血管胰岛素抵抗的生化和生理后果。
