Piédrola G, Novo E, Serrano-Gotarredona J, Escobar-Morreale H F, Villa E, Luna J D, García-Robles R
Department of Endocrinology, Hospital Ramon y Cajal, Madrid, Spain.
J Hypertens. 1996 Dec;14(12):1477-82. doi: 10.1097/00004872-199612000-00015.
To elucidate whether insulin resistance is present in coronary artery disease (CAD) at diagnosis and to study its relationship with other known cardiovascular risk factors.
We evaluated the incidence of insulin resistance in 40 newly diagnosed CAD patients. Fifteen healthy subjects were used as a control group. The patients and controls had no previous history of metabolic disorders, and were not being administered any medication that might have affected their insulin sensitivity. Immediately after diagnosis of CAD, a standard 75 g oral glucose-tolerance test (OGTT) and an insulin suppression test (IST) were performed on separate days. The IST consisted of a constant infusion of glucose, insulin and somatostatin for 150 min; insulin resistance was estimated by determining the steady-state plasma glucose (SSPG) concentrations during the last 60 min of the test. The insulin sensitivity index (ISI) was calculated by the formula ISI = (glucose infusion rate/SSPG]x10(3).
Insulin resistance, defined by an ISI below the normal range derived from the control group, was present in 82.5% of the CAD patients. As a group, the patients with CAD displayed lower ISI (means +/- SD:29.23 +/- 11.23 versus 50.33 +/- 9.37 dl/kg per min, P < 0.001) than did controls. Serum triglycerides and uric acid were higher and high-density lipoprotein cholesterol levels were lower in patients than they were in controls. No differences were observed in fasting plasma insulin, glucose, total and low-density lipoprotein cholesterol concentration. An abnormal OGTT result was observed in 27 patients. The ISI was low in 88.8% of the patients with an abnormal OGTT result and in 69% of the 13 patients with a normal OGTT result.
Insulin resistance and even impaired glucose tolerance are common findings in CAD at diagnosis. The changes in the lipid profile and in uric acid levels paralleled the changes in insulin sensitivity. These results suggest that insulin resistance might play a role in the development of coronary atherosclerosis and that its early diagnosis might be important in the prophylaxis of CAD.
阐明冠状动脉疾病（CAD）在诊断时是否存在胰岛素抵抗，并研究其与其他已知心血管危险因素的关系。
我们评估了40例新诊断的CAD患者中胰岛素抵抗的发生率。15名健康受试者作为对照组。患者和对照组既往无代谢紊乱病史，且未服用任何可能影响其胰岛素敏感性的药物。在CAD诊断后立即在不同日期进行标准的75克口服葡萄糖耐量试验（OGTT）和胰岛素抑制试验（IST）。IST包括持续输注葡萄糖、胰岛素和生长抑素150分钟；通过测定试验最后60分钟内的稳态血浆葡萄糖（SSPG）浓度来估计胰岛素抵抗。胰岛素敏感性指数（ISI）通过公式ISI =（葡萄糖输注速率/SSPG）×10³计算。
以低于对照组得出的正常范围的ISI定义的胰岛素抵抗存在于82.5%的CAD患者中。作为一个群体，CAD患者的ISI（平均值±标准差：29.23±11.23 vs 50.33±9.37 dl/kg每分钟，P < 0.001）低于对照组。患者的血清甘油三酯和尿酸较高，高密度脂蛋白胆固醇水平低于对照组。空腹血浆胰岛素、葡萄糖、总胆固醇和低密度脂蛋白胆固醇浓度无差异。27例患者OGTT结果异常。OGTT结果异常的患者中88.8%的ISI较低，OGTT结果正常的13例患者中69%的ISI较低。
胰岛素抵抗甚至糖耐量受损在CAD诊断时是常见的发现。血脂谱和尿酸水平的变化与胰岛素敏感性的变化平行。这些结果表明胰岛素抵抗可能在冠状动脉粥样硬化的发展中起作用，其早期诊断可能对CAD的预防很重要。
