Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine.
Department of Public Health, Juntendo University Graduate School of Medicine.
Circ J. 2017 Sep 25;81(10):1447-1453. doi: 10.1253/circj.CJ-17-0192. Epub 2017 May 30.
Insulin resistance is strongly associated with metabolic syndrome (MetS), but it is not known how this association is influenced by the autonomic nervous system, which controls insulin secretion.Methods and Results:The subjects were 2,016 individuals aged 30-79 years enrolled between 2009 and 2012. MetS was determined using the harmonized MetS definition, which includes waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol, and fasting glucose. The homeostasis model assessment index for insulin resistance (HOMA-IR) and Gutt's insulin sensitivity index (ISI) were calculated based on fasting and 2 h-post-load glucose and insulin concentrations in a 75-g oral glucose tolerance test. The 5-min heart rate variability (HRV) was evaluated using time-domain indices of standard deviations of NN intervals (SDNN) and root mean square of successive differences (RMSSD). Power spectral analysis yielded frequency-domain measures for HRV: high-frequency (HF) power, low-frequency (LF) power and LF/HF. Multivariable adjusted logistic models showed that the highest quartiles for SDNN, RMSSD, LF, and HF vs. the lowest quartiles had a significant association with MetS. RMSSD, HF, and LF/HF remained significantly associated with MetS after adjustment for HOMA-IR (or ISI). Additive interactions between the levels of high LF/HF and high HOMA-IR (or low ISI) were significantly positive.
Sympathovagal imbalance as evidenced by low HF and high LF/HF modified the association of insulin resistance or low insulin sensitivity with MetS.
胰岛素抵抗与代谢综合征（MetS）密切相关，但尚不清楚自主神经系统如何影响这种关联，因为自主神经系统控制胰岛素分泌。
该研究对象为 2009 年至 2012 年间招募的 2016 名年龄在 30-79 岁的个体。MetS 采用经协调的 MetS 定义进行确定，该定义包括腰围、血压、甘油三酯、高密度脂蛋白胆固醇和空腹血糖。基于空腹和 75g 口服葡萄糖耐量试验中 2 小时后负荷葡萄糖和胰岛素浓度，计算胰岛素抵抗的稳态模型评估指数（HOMA-IR）和 Gutt 的胰岛素敏感性指数（ISI）。使用 NN 间期标准差（SDNN）和连续差异均方根（RMSSD）的时域指数评估 5 分钟心率变异性（HRV）。功率谱分析得出 HRV 的频域指标：高频（HF）功率、低频（LF）功率和 LF/HF。多变量调整后的逻辑模型显示，SDNN、RMSSD、LF 和 HF 的最高四分位数与最低四分位数相比，与 MetS 具有显著相关性。在调整 HOMA-IR（或 ISI）后，RMSSD、HF 和 LF/HF 与 MetS 仍显著相关。高 LF/HF 水平和高 HOMA-IR（或低 ISI）之间的附加交互作用呈显著正相关。
低 HF 和高 LF/HF 表明交感神经-副交感神经失衡，改变了胰岛素抵抗或低胰岛素敏感性与 MetS 的关联。
