Karhapää P, Voutilainen E, Kovanen P T, Laakso M
Department of Medicine, Kuopio University Hospital, Finland.
Arterioscler Thromb. 1993 Jan;13(1):41-7. doi: 10.1161/01.atv.13.1.41.
High levels of very low density lipoprotein triglycerides and low levels of high density lipoprotein cholesterol have been found to be associated with insulin resistance measured by the euglycemic clamp technique. In contrast, the association of isolated hypercholesterolemia with insulin resistance has not been systematically studied. Therefore, we performed two separate studies designed to investigate the degree of insulin resistance in familial hypercholesterolemia (FH) (study 1) and nonfamilial hypercholesterolemia (non-FH) (study 2). Study 1 included eight young adults with FH and 13 corresponding control subjects. Fasting blood glucose, insulin, and C-peptide levels were similar in FH patients and control subjects during an oral glucose tolerance test. During the euglycemic hyperinsulinemic (1,200-1,300 pmol/l) clamp studies, FH patients and control subjects had similar rates of whole-body glucose uptake (73 +/- 6 versus 70 +/- 3 mumol/kg per minute, respectively; p = NS). Glucose oxidation, glucose nonoxidation, lipid oxidation, suppression of free fatty acid levels, and potassium disposal were similar in both groups. Study 2 included 25 middle-aged non-FH patients and 18 corresponding control subjects. Glucose, insulin, and C-peptide responses in an oral glucose tolerance test were similar in both groups. During the euglycemic hyperglycemic clamp studies, non-FH patients and control subjects had similar rates of whole-body glucose uptake (61 +/- 3 versus 58 +/- 3 mumol/kg per minute, p = NS). In addition, glucose oxidation, glucose nonoxidation, lipid oxidation, and suppression of free fatty acid levels as well as potassium disposal were similar in non-FH patients and control subjects. We conclude that FH and non-FH are not insulin-resistant states.
已发现高水平的极低密度脂蛋白甘油三酯和低水平的高密度脂蛋白胆固醇与通过正常血糖钳夹技术测量的胰岛素抵抗相关。相比之下，单纯高胆固醇血症与胰岛素抵抗的关联尚未得到系统研究。因此，我们进行了两项独立研究，旨在调查家族性高胆固醇血症（FH）（研究1）和非家族性高胆固醇血症（非FH）（研究2）患者的胰岛素抵抗程度。研究1纳入了8名患有FH的年轻成年人和13名相应的对照受试者。在口服葡萄糖耐量试验期间，FH患者和对照受试者的空腹血糖、胰岛素和C肽水平相似。在正常血糖高胰岛素血症（1200 - 1300 pmol/l）钳夹研究中，FH患者和对照受试者的全身葡萄糖摄取率相似（分别为73±6与70±3 μmol/kg每分钟；p = 无显著性差异）。两组的葡萄糖氧化、葡萄糖非氧化、脂质氧化、游离脂肪酸水平抑制和钾处置情况相似。研究2纳入了25名中年非FH患者和18名相应的对照受试者。两组在口服葡萄糖耐量试验中的葡萄糖、胰岛素和C肽反应相似。在正常血糖高血糖钳夹研究中，非FH患者和对照受试者的全身葡萄糖摄取率相似（61±3与58±3 μmol/kg每分钟，p = 无显著性差异）。此外，非FH患者和对照受试者在葡萄糖氧化、葡萄糖非氧化、脂质氧化、游离脂肪酸水平抑制以及钾处置方面相似。我们得出结论，FH和非FH并非胰岛素抵抗状态。
