Panayiotou A G, Kouis P, Griffin M, Nicolaides A N
Cyprus International Institute for Environmental and Public Health, in association with Harvard T. H. Chan School of Public Health, Cyprus University of Technology, Limassol, Cyprus -
Int Angiol. 2015 Oct;34(5):437-44. Epub 2015 Feb 12.
The aim of this study was to investigate the association between commonly used insulin resistance (IR) indices and the presence and extent of carotid and femoral atherosclerosis in a general population setting.
Cross-sectional analysis of 762 volunteers from the ongoing epidemiological Cyprus Study (46.6% male; mean age=60.5±10.2). 1) Carotid intima-media thickness (IMTcc), 2) carotid and femoral atherosclerotic plaque presence, 3) total plaque area in the carotid/femoral bifurcations (sum of the largest plaques in each carotid/femoral bifurcation-SPAcar/fem), and 4) total plaque area in both carotid and femoral bifurcations (sum of the areas of the largest plaques present in each of the four bifurcations-SPA) were measured using ultrasound at baseline. The HOMA-IR, QUICKI and McAuley indices as well as fasting insulin levels were estimated and their quartiles were used in linear and logistic regression analysis.
All IR indices studied were strongly associated with IMTcc (P<0.01for all) even after adjustment for age and sex and exclusion of diabetic subjects. However, when looking at plaque presence and size (i.e.area) only the HOMA-IR and especially the McAuley Index were associated with both carotid plaque presence (ORadj=1.17; 95%CI=1.01 to 1.36; P=0.03 and ORadj=0.86; 95%CI=0.74 to 0.99; P=0.04 respectively) and area (ORadj=0.10; 95%CI=0.008 to 0.20; P=0.03 and ORadj=-0.11; 95%CI=-0.20 to -0.009; P=0.03 respectively), after adjustment. The McAuley Index remained a significant predictor of both carotid plaque presence and area even after exclusion of diabetic subjects (P=0.04).
Our results show that while all indices were associated with carotid IMT, supporting a strong role for IR in intimal-medial thickening, only the HOMA-IR and especially the McAuley Index were associated with both carotid plaque presence and area, after adjustment. This highlights the importance of including triglyceride levels in estimating the risk for atherosclerotic plaque in the carotids as well as the possible differences in determinants for atherosclerosis between arterial sites.
本研究旨在探讨在一般人群中常用的胰岛素抵抗（IR）指标与颈动脉和股动脉粥样硬化的存在及程度之间的关联。
对正在进行的塞浦路斯流行病学研究中的762名志愿者进行横断面分析（男性占46.6%；平均年龄=60.5±10.2岁）。在基线时使用超声测量：1）颈动脉内膜中层厚度（IMTcc）；2）颈动脉和股动脉粥样硬化斑块的存在情况；3）颈动脉/股动脉分叉处的总斑块面积（每个颈动脉/股动脉分叉处最大斑块面积之和-SPAcar/fem）；4）颈动脉和股动脉分叉处的总斑块面积（四个分叉处每个最大斑块面积之和-SPA）。估算稳态模型评估的胰岛素抵抗（HOMA-IR）、定量胰岛素敏感性检查指数（QUICKI）和麦考利指数以及空腹胰岛素水平，并将其四分位数用于线性和逻辑回归分析。
即使在调整年龄和性别并排除糖尿病患者后，所有研究的IR指标均与IMTcc密切相关（所有P<0.01）。然而，在观察斑块的存在和大小（即面积）时，仅HOMA-IR尤其是麦考利指数与颈动脉斑块的存在（校正后OR=1.17；95%CI=1.01至1.36；P=0.03和校正后OR=0.86；95%CI=0.74至0.99；P=0.04）和面积（校正后OR=0.10；95%CI=0.008至0.20；P=0.03和校正后OR=-0.11；95%CI=-0.20至-0.009；P=0.03）相关，调整后。即使排除糖尿病患者，麦考利指数仍是颈动脉斑块存在和面积的重要预测指标（P=0.04）。
我们的结果表明，虽然所有指标均与颈动脉IMT相关，支持IR在内膜中层增厚中起重要作用，但调整后仅HOMA-IR尤其是麦考利指数与颈动脉斑块的存在和面积相关。这突出了在评估颈动脉粥样硬化斑块风险时纳入甘油三酯水平的重要性，以及动脉部位之间动脉粥样硬化决定因素可能存在的差异。
