Insulin resistance in chronic heart failure: Relation to severity and etiology of heart failure
Insulin resistance in chronic heart failure: Relation to severity and etiology of heart failure
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DOI：
10.1016/s0735-1097(97)00185-x
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发表时间：
1997-08-01
影响因子：
24
通讯作者：
Coats, AJS
中科院分区：
文献类型：
--
作者：
Swan, JW;Anker, SD;Coats, AJS
目标。我们试图评估慢性心力衰竭(CHF)患者的胰岛素敏感性及其与疾病严重程度的关系。外周肌肉的变化影响心力衰竭的进展。这种影响可能是由于胰岛素和葡萄糖代谢的慢性紊乱，影响骨骼肌和心肌的能量状态。我们调查了79名男性-38名CHF患者，21名有冠状动脉造影证据的非CHF患者和20名健康对照组-胰岛素敏感性，并评估了其与疾病严重程度、病因和激素状态的关系(所有受试者的年龄和体重指数都相似)。通过对0.5g/kg体重静脉注射葡萄糖耐量试验中血糖、胰岛素和曲线的最小建模分析来评估胰岛素敏感性。与对照组相比，充血性心力衰竭患者的平均空腹血糖水平相似，但胰岛素水平升高(67比29pmol/L，p<；0.002)，平均胰岛素敏感性降低58%(2.01vs.4.84min(-1)/pmol/mlx10(5)，p<；0.0001)。峰值氧耗量(Vo(2))(r=0.63)、空腹甘油三酯(r=-0.62)和年龄(r=-0.46，P均<0.001)是预测胰岛素敏感性的独立指标。静息去甲肾上腺素和肾上腺素水平、左心室射血分数和心力衰竭病因与胰岛素敏感性无关。冠心病但无心衰患者的平均胰岛素敏感性中等(3.30min(-1)/pmoL/mlx10(5)[-32%，p=0.042比对照组；+113%，p=0.0023比缺血性心脏病所致的心衰患者])。在对所有79名受试者进行的多因素分析中，年龄(p=0.0006)、甘油三酯(p=0.0023)、空腹胰岛素(p=0.0037)和充血性心力衰竭(p=0.018)是胰岛素敏感性受损的独立预测因素(调整后联合R-2=0.53p<；0.0001)。CHF与显著的胰岛素抵抗有关，表现为空腹和刺激性高胰岛素血症。晚期心力衰竭(就峰值Vo，降低而言)与胰岛素抵抗增加有关，但这不是通过心功能不全或儿茶酚胺水平增加直接调节的。(C)1997年由美国心脏病学会主办。
Objectives. We attempted to assess insulin sensitivity in patients with chronic heart failure (CHF) and its relation to disease severity.Background. Peripheral muscular changes influence the progression of heart failure. This effect may be due to chronic disturbances of insulin and glucose metabolism that affect the energy status of skeletal and myocardial muscle.Methods. We investigated insulin sensitivity in 79 men-38 patients with CHF, 21 patients with angiographic evidence of coronary artery disease without CHF and 20 healthy control subjects-and assessed its relation to disease severity, etiology and hormonal status (all subjects had a similar age and body mass index). Insulin sensitivity was estimated by minimal modeling analysis of the glucose and insulin and profiles during a 0.5-g/kg body weight intravenous glucose tolerance test.Results. Compared with control subjects, patients with CHF had similar mean fasting glucose but increased insulin levels (67 vs. 29 pmol/liter, p < 0.002) and a 58% reduced mean insulin sensitivity (2.01 vs. 4.84 min(-1)/pmol/ml x 10(5), p < 0.0001). Peak oxygen consumption (Vo(2)) (r = 0.63), fasting triglycerides (r = -0.62) and age (r = -0.46, all p < 0.001) predicted insulin sensitivity independently. Rest norepinephrine and epinephrine levels, left ventricular ejection fraction and heart failure etiology were not related to insulin sensitivity. Patients with coronary artery disease but no CHF had an intermediate mean insulin sensitivity (3.30 min(-1)/pmol/ml x 10(5) [-32%, p = 0.042 vs. control subjects; +113%, p = 0.0023 vs. patients with CHF due to ischemic heart disease]). In multivariate analyses of all 79 subjects, age (p = 0.0006), triglycerides (p = 0.0023), fasting insulin (p = 0.0037) and the presence of CHF (p = 0.018) were independent predictors of impaired insulin sensitivity (adjusted joint R-2 = 0.53, p < 0.0001).Conclusions. CHF is associated with marked insulin resistance, characterized by both fasting and stimulated hyperinsulinemia. Advanced heart failure (in terms of reduced peak Vo,) is related to increased insulin resistance, but this is not directly mediated through ventricular dysfunction or increased catecholamine levels. (C) 1997 by the American College of Cardiology.