Yudkin J S
University College London Medical School, Whittington Hospital, UK.
Ann Med. 1996 Oct;28(5):433-8. doi: 10.3109/07853899608999104.
In population studies both hyperinsulinaemia, a marker for insulin resistance, and microalbuminuria have been shown to predict coronary heart disease. Insulin resistance clusters with several standard cardiovascular risk factors, as well as with abnormalities of fibrinolysis, with small, dense, low-density lipoprotein patterns, and with elevated concentrations of proinsulin-like molecules. This makes the independence of the relationship with coronary heart disease difficult to disentangle. Microalbuminuria is associated with a number of abnormalities of risk factors, but the relationship with coronary heart disease does not appear to be explained by these associations. The two conditions, insulin resistance and microalbuminuria, are associated, and together appear to be a very powerful predictor of cardiovascular risk. There is evidence that endothelial dysfunction may lead to impaired insulin action, as well as to capillary albumin leak, and the proposal is made that these associations, with each other and with coronary heart disease, are features of a common antecedent. The role of growth retardation in endothelial function, and in determining cardiovascular risk in adulthood is a subject of intense interest.
在人群研究中，高胰岛素血症（胰岛素抵抗的一个标志物）和微量白蛋白尿均已被证明可预测冠心病。胰岛素抵抗与多种标准心血管危险因素聚集在一起，同时也与纤溶异常、小而密的低密度脂蛋白模式以及胰岛素原样分子浓度升高有关。这使得其与冠心病关系的独立性难以厘清。微量白蛋白尿与多种危险因素异常相关，但与冠心病的关系似乎无法用这些关联来解释。胰岛素抵抗和微量白蛋白尿这两种情况相互关联，并且共同似乎是心血管风险的一个非常有力的预测指标。有证据表明内皮功能障碍可能导致胰岛素作用受损以及毛细血管白蛋白渗漏，有人提出这些相互之间以及与冠心病的关联是一个共同前提的特征。生长迟缓在内皮功能以及成年期心血管风险决定中的作用是一个备受关注的课题。
