Titov V N
The Federal state budget scientific institution "The Russian cardiologic R&D production complex" of Minzdrav of Russia, 121552, Moscow, Russia.
Klin Lab Diagn. 2017;62(11):644-654. doi: 10.18821/0869-2084-2017-62-11-644-654.
It is valid to consider effect of nicotinic acid as an insulin-mimetic one. The uniformity of biologic effect of exogenous nicotinic acid and endogenous insulin permits to become aware that a) the hypo-lipidemic activity of insulin, inhibition of lipolysis in phylogenetically late insulin-dependent adipocytes and decreasing of content of unesterified fatty acids in blood plasma are considered as a basis of hypoglycemic effect of insulin; b) nicotinic acid similar to insulin blocks lipolysis too but in hormoneindependent visceral fatty cells. The counter-insular effect is manifested in vivo by exogenous and endogenous palmitic saturated fatty acid by force of physical chemical characteristics. The biological role of insulin consists in regulation of metabolism of fatty acids mainly unesterified fatty acids and in absorption of glucose by all insulin-dependent cells. It is supposed that contractile cells (myocytes and cardiomyocytes) cumulate glycogen for implementing glucose as a substrate in synthesis in situ de novo of ῲ-9 oleic mono-saturated fatty acid. The insulin initiates synthesis because mitochondria process this mono-saturated fatty to β-oxidation with the highest constant of reaction velocity. This is conditioned by physical chemical characteristics of oleic mono-saturated fatty acid, positioning of double bond in the chain of fatty acid; this ensures maximal efficiency of ATP gaining. In phylogenesis, the low efficient palmitic alternative of metabolism of fatty acids is formed the earliest. At the later stages of phylogenesis the cells, under becoming of motion function, worked out more efficient alternative of ATP synthesis from exogenous ῲ-9 oleic monosaturated fatty acid. At the late stages of phylogenesis, under becoming of biological function of locomotion (motion at the expense of contraction of cross-striated skeletal myocytes) insulin began to activate absorption of glucose by cells with subsequent synthesis of endogenous ῲ-9 oleic mono-saturated fatty acid out of it. The aphysiological effect of environment factors in the form of derangement of biological function of trophology (feeding), surplus of palmitic unesterified fatty acids in food serve as a main cause of such a high rate of functional derangement - insulin resistance syndrome in populations. Hence, there is no reason to call it diabetes mellitus type II.
将烟酸的作用视为类似胰岛素的作用是合理的。外源性烟酸和内源性胰岛素生物效应的一致性使人认识到：a）胰岛素的降血脂活性、对系统发育较晚的胰岛素依赖型脂肪细胞中脂肪分解的抑制以及血浆中未酯化脂肪酸含量的降低被视为胰岛素降糖作用的基础；b）与胰岛素类似，烟酸也能阻断脂肪分解，但作用于不依赖激素的内脏脂肪细胞。由于物理化学特性，外源性和内源性棕榈酸饱和脂肪酸在体内表现出抗胰岛素作用。胰岛素的生物学作用主要在于调节脂肪酸代谢，主要是未酯化脂肪酸的代谢，以及所有胰岛素依赖细胞对葡萄糖的吸收。据推测，收缩细胞（肌细胞和心肌细胞）积累糖原，以便在原位重新合成ω-9油酸单不饱和脂肪酸时将葡萄糖作为底物。胰岛素启动合成，因为线粒体将这种单不饱和脂肪酸进行β氧化，反应速度常数最高。这是由油酸单不饱和脂肪酸的物理化学特性、脂肪酸链中双键的位置决定的；这确保了获得ATP的最大效率。在系统发育过程中，最早形成的是效率较低的棕榈酸脂肪酸代谢替代途径。在系统发育的后期，随着运动功能的出现，细胞发展出了从外源性ω-9油酸单不饱和脂肪酸合成ATP的更有效替代途径。在系统发育的后期，随着运动生物学功能的出现（通过横纹肌细胞收缩进行运动），胰岛素开始激活细胞对葡萄糖的吸收，随后从中合成内源性ω-9油酸单不饱和脂肪酸。营养生物学功能紊乱（喂养）形式的环境因素的非生理效应、食物中棕榈酸未酯化脂肪酸的过量是人群中如此高的功能紊乱率——胰岛素抵抗综合征的主要原因。因此，没有理由将其称为II型糖尿病。
