Bøtker H E, Møller N, Ovesen P, Mengel A, Schmitz O, Orskov H, Bagger J P
Department of Cardiology, Skejby Hospital, University Hospital, Aarhus, Denmark.
Lancet. 1993 Jul 17;342(8864):136-40. doi: 10.1016/0140-6736(93)91344-l.
Patients with microvascular angina (syndrome X) may be insulin resistant. We designed a study to establish whether this is the case. 11 patients with microvascular angina were compared with 9 matched subjects with noncardiac chest pain. Patients and controls were evaluated by coronary sinus catheterisation, and by isotopic measurement of glucose turnover, indirect calorimetry, and forearm technique during a 3 h baseline period after overnight fast and during a 2 h hyperinsulinaemic euglycaemic clamp. Pace-induced increase in coronary sinus blood flow was less in patients than in controls, whereas forearm blood flow did not differ between groups. Baseline measures of glucose metabolism were normal. During the clamp, glucose production and lipolysis were equally suppressed in both groups. Mean (SE) total insulin-induced glucose uptake was significantly impaired in patients compared with controls (3.9 [0.7] vs 6.4 [0.7] mg/kg per min; p < 0.01), and insulin-stimulated glucose uptake in the forearm was significantly reduced in patients (0.88 [0.10] vs 1.6 [0.30] mmol/L; p < 0.001). Reduced oxidative and nonoxidative metabolism accounted for the defect in overall glucose uptake in patients. No correlation between changes in coronary sinus blood flow and total body glucose uptake was seen. We found that microvascular angina was associated with substantial insulin resistance. Whether this relation is causal or coincidental is as yet unsettled.
微血管性心绞痛（X综合征）患者可能存在胰岛素抵抗。我们设计了一项研究来确定是否如此。将11例微血管性心绞痛患者与9例匹配的非心源性胸痛患者进行比较。在空腹过夜后的3小时基线期以及2小时高胰岛素正常血糖钳夹期间，通过冠状窦插管、葡萄糖代谢率的同位素测量、间接测热法和前臂技术对患者和对照组进行评估。患者由起搏诱导的冠状窦血流增加低于对照组，而两组之间的前臂血流无差异。葡萄糖代谢的基线测量结果正常。在钳夹期间，两组的葡萄糖生成和脂肪分解均受到同等程度的抑制。与对照组相比，患者平均（标准误）胰岛素诱导的总葡萄糖摄取显著受损（3.9 [0.7]对6.4 [0.7] mg/kg每分钟；p<0.01），并且患者前臂胰岛素刺激的葡萄糖摄取显著降低（0.88 [0.10]对1.6 [0.30] mmol/L；p<0.001）。氧化和非氧化代谢降低是患者总体葡萄糖摄取缺陷的原因。未观察到冠状窦血流变化与全身葡萄糖摄取之间的相关性。我们发现微血管性心绞痛与严重的胰岛素抵抗有关。这种关系是因果关系还是巧合关系尚未确定。
