Raynaud E, Brun J F, Pérez-Martin A, Fédou C, Mercier J
Centre hospitalier universitaire, Hôpital Lapeyronie, Montpellier.
Ann Biol Clin (Paris). 1998 Jul-Aug;56(4):407-16.
During the past decade, the potential implications of insulin resistance were recognised by clinicians ranging from endocrinologists to cardiologists. Central to this expanding interest is Reaven's hypothesis that tissue resistance to the effects of insulin is a factor linking various metabolic disorders and coronary heart disease. This review critically describes the different approaches for the evaluation of insulin sensitivity in vivo. Qualities and limitations of several investigative techniques are discussed, such as anthropometric indexes, basal biological indexes, insulin suppression tests and insulin tolerance tests. The two most widely used methods for quantifying insulin sensitivity are the euglycaemic hyperinsulinaemic clamp and the intravenous glucose tolerance test with minimal model analysis. Insulin resistance occurs in many aetiologically diverse human disorders. Genetic syndromes with extreme insulin resistance are very uncommon. Insulin resistance is frequently associated with obesity, type 2 diabetes and essential hypertension. The insulin resistance syndrome called syndrome X includes impaired insulin-mediated glucose uptake, impaired glucose tolerance, hyperinsulinaemia, hypertension, dyslipidaemia and haemostatic disorders. Finally, the clinical significance of high values of insulin sensitivity is discussed.
在过去十年中，从内分泌科医生到心脏病专家等临床医生都认识到了胰岛素抵抗的潜在影响。这种兴趣不断扩大的核心是雷文的假说，即组织对胰岛素作用的抵抗是连接各种代谢紊乱和冠心病的一个因素。这篇综述批判性地描述了体内评估胰岛素敏感性的不同方法。讨论了几种研究技术的优缺点，如人体测量指标、基础生物学指标、胰岛素抑制试验和胰岛素耐量试验。两种最广泛使用的量化胰岛素敏感性的方法是正常血糖高胰岛素钳夹技术和采用最小模型分析的静脉葡萄糖耐量试验。胰岛素抵抗发生在许多病因各异的人类疾病中。具有极端胰岛素抵抗的遗传综合征非常罕见。胰岛素抵抗常与肥胖、2型糖尿病和原发性高血压相关。被称为X综合征的胰岛素抵抗综合征包括胰岛素介导的葡萄糖摄取受损、葡萄糖耐量受损、高胰岛素血症、高血压、血脂异常和止血障碍。最后，讨论了高胰岛素敏感性值的临床意义。
