Vinet Agnes, Obert Philippe, Dutheil Frederic, Diagne Lamine, Chapier Robert, Lesourd Bruno, Courteix Daniel, Walther Guillaume
Avignon University (A.V., P.O., L.D., G.W.), LAPEC EA4278, F-84000 Avignon, France; School of Exercise Science (P.O., F.D., D.C.), Australian Catholic University, Melbourne, 3065 Australia; Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions (F.D., B.L., D.C.), EA3533, F-63000 Clermont-Ferrand, France; University Hospital of Clermont-Ferrand (F.D., B.L.), CHU G. Montpied, F-63000 Clermont-Ferrand, France; and Omental (R.C.)-Thermalia Center, F-63140 Châtelguyon, France.
J Clin Endocrinol Metab. 2015 Feb;100(2):442-50. doi: 10.1210/jc.2014-2704. Epub 2014 Oct 29.
Impaired insulin-dependent vasodilation might contribute to microvascular dysfunction of metabolic syndrome (MetS). The aims of this study were to assess the insulin vasoreactivity in MetS, and to evaluate the effects of a lifestyle program. DESIGN, SETTING, PARTICIPANTS, AND OUTCOME MEASURES: Laser Doppler measurements were used to assess cutaneous blood flux (CBF) and flowmotion in response to iontophoresis of insulin and acetylcholine (ACh) in 38 MetS and 18 controls. Anthropometric, plasma insulin, glycemia, and inflammatory markers were measured. MetS subjects (n = 24) underwent a 6-month lifestyle intervention (M6) with a 3-week residential program (D21).
The absolute and relative peak insulin and ACh CBF were significantly higher in controls than in MetS subjects. Significant inverse correlations were found between peak insulin CBF and glycemia, insulin and glycated hemoglobin, active plasminogen activator inhibitor-1 (PAI-1), C-reactive protein (CRP), and IL-6. With respect to flowmotion, MetS subjects showed lower values in total spectrum CBF and in all its components (except respiratory one). At D21 and M6, peak insulin CBF increased and was no longer different from control values whereas peak ACh CBF did not change. From D21, all the different components and the total CBF spectrum became similar to the control values. The changes in peak insulin CBF and in endothelial component between M6 and baseline were inversely correlated with the change in CRP and PAI-1.
The local vasodilatory effects to insulin and its overall flowmotion are impaired in MetS subjects in relation to inflammation. The lifestyle intervention reversed this insulin-induced vascular dysfunction in parallel to decreased inflammation level.
胰岛素依赖的血管舒张功能受损可能导致代谢综合征（MetS）的微血管功能障碍。本研究旨在评估MetS患者的胰岛素血管反应性，并评估生活方式干预计划的效果。
设计、地点、参与者和观察指标：采用激光多普勒测量法，评估38例MetS患者和18例对照者在胰岛素和乙酰胆碱（ACh）离子导入后皮肤血流量（CBF）和血流运动情况。测量人体测量学指标、血浆胰岛素、血糖和炎症标志物。24例MetS患者接受为期6个月的生活方式干预（M6），其中包括为期3周的住院计划（D21）。
对照组胰岛素和ACh引起的CBF绝对峰值和相对峰值显著高于MetS患者。胰岛素CBF峰值与血糖、胰岛素和糖化血红蛋白、活性纤溶酶原激活物抑制剂-1（PAI-1）、C反应蛋白（CRP）和白细胞介素-6之间存在显著负相关。关于血流运动，MetS患者在总频谱CBF及其所有成分（呼吸成分除外）中的值较低。在D21和M6时，胰岛素CBF峰值增加，与对照值不再有差异，而ACh CBF峰值未改变。从D21开始，所有不同成分和总CBF频谱变得与对照值相似。M6与基线之间胰岛素CBF峰值和内皮成分的变化与CRP和PAI-1的变化呈负相关。
与炎症相关，MetS患者对胰岛素的局部血管舒张作用及其整体血流运动受损。生活方式干预在降低炎症水平的同时，逆转了这种胰岛素诱导的血管功能障碍。
