Insulin resistance syndrome in preeclampsia
Insulin resistance syndrome in preeclampsia
复制标题
DOI：
10.1055/s-2007-1016251
复制
发表时间：
1998-01-01
期刊：
影响因子：
--
通讯作者：
Kaaja, R
中科院分区：
文献类型：
--
作者：
Kaaja, R
由于在先兆子痫中发现的脂质、脂蛋白和其他代谢过程的变化，如高胰岛素血症和高尿酸血症，与胰岛素抵抗综合征的主要特征相似，因此已经提出胰岛素抵抗可能是这种代谢变化的共同特征。几个小组，使用正常血糖高胰岛素钳夹或静脉葡萄糖耐量试验（伯格曼的最小模型技术），已证明在怀孕后期的胰岛素抵抗。先兆子痫的妇女有较高的空腹胰岛素水平，但也夸大高胰岛素血症，在响应口服葡萄糖耐量试验，这是一致的，增加胰岛素抵抗先兆子痫。在先兆子痫期间尚未进行胰岛素敏感性的直接测量（钳夹或最小模型）。增加的胰岛素抵抗可以激活交感神经系统并导致内皮素受体表达的增加，这两种事件都导致血压升高。高胰岛素血症也可诱导高胰岛素血症，导致内皮功能障碍和前列环素产生减少。这种高胰岛素血症可以持续长达17年后先兆子痫怀孕，并可能有助于妇女的心血管疾病的风险增加。胰岛素抵抗可能不是先兆子痫的原因，但却是发病因素之一，尤其是在遗传易感的妇女中。
Because changes in lipids, lipoprotein, and other metabolic processes, such as hyperinsulinemia and hyperuricemia, found in preeclampsia resemble the main features of the insulin resistance syndrome, it has been proposed that insulin resistance may be the common denominator for such metabolic changes. Several groups, using euglycemic-hyperinsulinemic clamping or intravenous glucose tolerance tests (Bergman's minimal model technique), have demonstrated insulin resistance during late pregnancy. Women with preeclampsia had higher fasting insulin levels, but also exaggerated hyperinsulinemia, in response to an oral glucose tolerance test, which is consistent with increased insulin resistance in preeclampsia. No direct measurement of insulin sensitivity (clamp or minimal model) has as yet been performed during preeclampsia. Increased insulin resistance can activate the sympathetic nervous system and lead to an increase in expression of receptors for endothelin, both of which events lead to increased blood pressure. Hyperinsulinemia can also induce hypertriglyceridemia, lending to endothelial dysfunction and reduction of prostacyclin production. This hyperinsulinemia can persist for as long as 17 years after preeclamptic pregnancy and may contribute to a woman's increased risk for cardiovascular disease. Insulin resistance may not be the cause of preeclampsia, but is one of the pathogenetic factors, especially in genetically predisposed women.