Nilsson P M, Lind L, Pollare T, Berne C, Lithell H O
Department of Geriatrics, Uppsala University, Sweden.
Metabolism. 1995 May;44(5):557-61. doi: 10.1016/0026-0495(95)90110-8.
Smoking is associated with an abnormal plasma lipoprotein pattern. Recently, both insulin resistance and normal insulin action have been reported in smokers. In a total of 191 hypertensive and normotensive subjects recruited from a health survey, serum lipoprotein lipids, glucose tolerance (by intravenous glucose tolerance test (IVGTT), insulin secretion, and insulin sensitivity (euglycemic insulin clamp) were compared in the 41 smokers and 150 nonsmokers. Subjects were examined in the morning during a fasting state and after abstinence from smoking for 10 to 12 hours. Smokers showed a higher level of hemoglobin A1c (HbA1c) as compared with nonsmokers, 4.9% versus 4.7% (P < .05). There were no significant differences in fasting glucose, insulin, or insulin-mediated glucose disposal. However, a number of indices of insulin sensitivity tended to show enhanced insulin action among smokers. Only lower glucose and insulin values during the late phase (40 to 90 minutes) of the IVGTT reached statistical significance. Compared with nonsmokers, smokers had an expected higher level of serum triglycerides (2.1 v 1.8 mmol/L, P < .05) and an increased low-density lipoprotein (LDL) to high-density lipoprotein (HDL) cholesterol ratio (4.5 v 3.9, P < .05). These differences between smokers and nonsmokers were similar in both hypertensives and normotensives. In conclusion, smokers examined in the abstinence phase showed no signs of impaired insulin action. Lipoprotein abnormalities and elevated HbA1c may be caused in part by the insulin resistance induced during acute smoking and therefore may be quantitatively related to the time exposed to smoking. The effect on insulin sensitivity appears to be reversible over 10 to 12 hours.
吸烟与异常的血浆脂蛋白模式相关。最近，有报道称吸烟者既存在胰岛素抵抗，也有正常的胰岛素作用。在一项健康调查招募的191名高血压和血压正常的受试者中，对41名吸烟者和150名不吸烟者的血清脂蛋白脂质、葡萄糖耐量（通过静脉葡萄糖耐量试验（IVGTT））、胰岛素分泌及胰岛素敏感性（正常血糖胰岛素钳夹法）进行了比较。受试者于早晨空腹状态下且戒烟10至12小时后接受检查。与不吸烟者相比，吸烟者的糖化血红蛋白（HbA1c）水平更高，分别为4.9%和4.7%（P < 0.05）。空腹血糖、胰岛素或胰岛素介导的葡萄糖处置方面无显著差异。然而，一些胰岛素敏感性指标显示吸烟者的胰岛素作用有增强趋势。仅IVGTT后期（40至90分钟）较低的血糖和胰岛素值达到统计学显著性。与不吸烟者相比，吸烟者的血清甘油三酯水平预期更高（2.1对1.8 mmol/L，P < 0.05），低密度脂蛋白（LDL）与高密度脂蛋白（HDL）胆固醇比值增加（4.5对3.9，P < 0.05）。吸烟者与不吸烟者之间的这些差异在高血压患者和血压正常者中相似。总之，处于戒烟阶段的吸烟者未显示出胰岛素作用受损的迹象。脂蛋白异常和HbA1c升高可能部分由急性吸烟期间诱导的胰岛素抵抗所致，因此可能与吸烟暴露时间在数量上相关。对胰岛素敏感性的影响在10至12小时内似乎是可逆的。
