Insulin resistance and hyperinsulinemia: you can't have one without the other.
Insulin resistance and hyperinsulinemia: you can't have one without the other.
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胰岛素抵抗和高胰岛素血症：没有另一个人。
DOI：
10.2337/dc08-0045
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发表时间：
2008-07
期刊：
影响因子：
16.2
通讯作者：
Reaven, Gerald M.
中科院分区：
文献类型：
--
作者：
Kim, Sun H.;Reaven, Gerald M.
最近，有人提出，胰岛素抵抗和高胰岛素血症可以孤立存在，并对心血管疾病（CVD）有不同的影响。为了评估这一建议，我们评估了健康非糖尿病人群中胰岛素敏感性和胰岛素反应之间的不一致程度。研究设计和方法-通过测定446例受试者在胰岛素抑制试验期间的稳态血糖（SSPG）浓度来定量胰岛素敏感性。在75 g口服葡萄糖激发后计算积分胰岛素反应。我们分析了胰岛素抵抗和胰岛素反应之间的相关性，并通过胰岛素敏感性的四分位数来量化胰岛素反应的四分位数比例。然后，我们比较了在相同胰岛素敏感性四分位数内但在不同胰岛素反应四分位数内的个体之间的CVD危险因素，以评估胰岛素抵抗和高胰岛素血症的不同临床影响。胰岛素抵抗与胰岛素反应呈高度相关（r = 0.76，P < 0.001）。大多数（95%）胰岛素抵抗最严重的个体（最高SSPG四分位数）处于最高胰岛素反应四分位数（71%）或第二高（24%）。同样，92%的胰岛素敏感性最高的个体（最低SSPG四分位数）处于最低的两个胰岛素反应四分位数。在胰岛素敏感性四分位数相同但胰岛素反应不同的个体之间，CVD危险因素的差异很小。结论：虽然胰岛素抵抗和高胰岛素血症并不完全相关，但在非糖尿病人群中很少单独存在。很难辨别高胰岛素血症对与胰岛素抵抗相关的CVD危险因素的独立影响。
OBJECTIVE—Recently, it has been suggested that insulin resistance and hyperinsulinemia can exist in isolation and have differential impacts on cardiovascular disease (CVD). To evaluate this suggestion, we assessed the degree of discordance between insulin sensitivity and insulin response in a healthy, nondiabetic population. RESEARCH DESIGN AND METHODS—Insulin sensitivity was quantified by determining the steady-state plasma glucose (SSPG) concentration during an insulin suppression test in 446 individuals. The integrated insulin response was calculated after a 75-g oral glucose challenge. We analyzed the correlation between insulin resistance and insulin response in addition to quantifying the proportion in quartiles of insulin response by quartiles of insulin sensitivity. Then we compared CVD risk factors between individuals within the same insulin sensitivity quartile but within different insulin response quartiles to evaluate the differential clinical impact of insulin resistance and hyperinsulinemia. RESULTS—Insulin resistance and insulin response were highly correlated (r = 0.76, P < 0.001). A majority (95%) of the most insulin-resistant individuals (top SSPG quartile) were either in the highest insulin response quartile (71%) or second highest (24%). Similarly, 92% of the most insulin-sensitive individuals (lowest SSPG quartile) were in the lowest two insulin response quartiles. There were minimal differences in CVD risk factors between individuals with different insulin responses but within the same insulin sensitivity quartile. CONCLUSIONS—Although not perfectly related, insulin resistance and hyperinsulinemia rarely exist in isolation in a nondiabetic population. It is difficult to discern an independent impact of hyperinsulinemia on CVD risk factors associated with insulin resistance.
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