Hikita N, Tsuchihashi K, Nakata T, Ura N, Shimamoto K
Second Department of Internal Medicine, Sapporo Medical University School of Medicine.
J Cardiol. 1998 Nov;32(5):291-300.
Insulin resistance is known to be important in the aggravation of established coronary risk factors, but it is unclear whether insulin resistance might cause coronary artery disease as diabetes mellitus. To evaluate the relationship between insulin resistance and coronary atherosclerosis, the angiographic semiquantitative score of coronary atherosclerosis was investigated in 216 patients (175 males, 41 females) with coronary artery disease and the varying degrees of glucose metabolism including insulin resistance. Insulin resistance was estimated by plasma insulin level at 120 min after the 75g oral glucose tolerance test. Patients were divided into 3 groups according to the levels of glucose metabolism: 37 patients with treated diabetes mellitus, 48 with glucose intolerance and non-treated diabetes, and 131 with normal glucose tolerance. Multivessel disease was more frequently seen in the treated diabetes group (67.6%) than in the glucose intolerance and non-treated diabetes groups (43.8%) and in the normal glucose tolerance group (40.5%). The severity of coronary artery stenosis (8.5 +/- 3.9 vs 7.6 +/- 3.7 vs 6.6 +/- 3.7) and calcification (6.5 +/- 6.3 vs 3.3 +/- 3.3 vs 4.0 +/- 4.8) were significantly higher in the treated diabetes group than in other groups. Distal coronary lesions were significantly more frequent in the treated diabetes group (61.1% vs 17.6% vs 27.4%) than in other groups. Half of the patients in the normal glucose tolerance group had hyperinsulinemia. Multivessel disease was significantly more frequent in the insulin resistant subgroup than in the insulin non-resistant subgroup (59.4% vs 25.0%, p = 0.011). The severity of coronary artery stenosis was significantly higher in the insulin resistant subgroup than in the insulin non-resistant subgroup (8.6 +/- 3.9 vs 5.6 +/- 3.0, p < 0.001), but the severity of coronary artery calcification was not significant. Distal coronary lesions showed a tendency to increase in the insulin resistant subgroup (37.5% vs 12.0%, p = 0.081). These results suggest that insulin resistance is an important risk factor for coronary artery disease in patients with normal glucose tolerance, and is related to the severity and multiplicity of coronary atherosclerosis as in patients with diabetes.
胰岛素抵抗在加重已有的冠状动脉危险因素方面很重要，但尚不清楚胰岛素抵抗是否会像糖尿病那样引发冠状动脉疾病。为了评估胰岛素抵抗与冠状动脉粥样硬化之间的关系，我们对216例（175例男性，41例女性）患有冠状动脉疾病且伴有不同程度糖代谢包括胰岛素抵抗的患者进行了冠状动脉粥样硬化的血管造影半定量评分。胰岛素抵抗通过75克口服葡萄糖耐量试验后120分钟的血浆胰岛素水平来评估。根据糖代谢水平将患者分为3组：37例接受治疗的糖尿病患者，48例糖耐量异常且未治疗的糖尿病患者，以及131例糖耐量正常的患者。多支血管病变在接受治疗的糖尿病组（67.6%）中比在糖耐量异常且未治疗的糖尿病组（43.8%）和糖耐量正常组（40.5%）中更常见。接受治疗的糖尿病组冠状动脉狭窄的严重程度（8.5±3.9 vs 7.6±3.7 vs 6.6±3.7）和钙化程度（6.5±6.3 vs 3.3±3.3 vs 4.0±4.8）显著高于其他组。接受治疗的糖尿病组冠状动脉远端病变明显比其他组更常见（61.1% vs 17.6% vs 27.4%）。糖耐量正常组中有一半患者存在高胰岛素血症。胰岛素抵抗亚组的多支血管病变明显比胰岛素非抵抗亚组更常见（59.4% vs 25.0%，p = 0.011）。胰岛素抵抗亚组冠状动脉狭窄的严重程度显著高于胰岛素非抵抗亚组（8.6±3.9 vs 5.6±3.0，p < 0.001），但冠状动脉钙化的严重程度无显著差异。冠状动脉远端病变在胰岛素抵抗亚组中有增加的趋势（37.5% vs 12.0%，p = 0.081）。这些结果表明，胰岛素抵抗是糖耐量正常患者冠状动脉疾病的重要危险因素，并且与糖尿病患者一样与冠状动脉粥样硬化的严重程度和多发性有关。
