Insulin: in search of a syndrome
Insulin: in search of a syndrome
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DOI：
10.1046/j.1464-5491.2002.00794.x
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发表时间：
2002-09-01
影响因子：
3.5
通讯作者：
Balkau, B
中科院分区：
文献类型：
--
作者：
Ferrannini, E;Balkau, B
胰岛素抵抗综合征被定义为空腹血浆胰岛素浓度高的受试者中高血压、血脂异常和糖耐量受损的聚集。后者通常被视为全身葡萄糖处理的胰岛素抵抗的替代指标。尽管高胰岛素血症和胰岛素抵抗彼此相关，但这种关联性并不是很强。在欧洲胰岛素抵抗研究组 (EGIR) 的数据汇集项目中，我们获得了 1,308 名不同年龄和体重指数的非糖尿病受试者的钳夹衍生胰岛素敏感性（作为 M 值）和空腹血浆胰岛素浓度。在该队列中，高胰岛素血症（作为非肥胖人群中空腹血浆胰岛素分布的上四分位数）和胰岛素抵抗（作为同一亚组中 M 值的下四分位数）各自在整个人群中的比例约为 40%，但仅识别出部分重叠（60%）的个体子集。当将患有胰岛素抵抗但无高胰岛素血症的受试者（n = 198）与患有高胰岛素血症但无胰岛素抵抗的受试者（n = 267）进行比较时，各自的临床表型出现显着差异。因此，具有“纯粹”胰岛素抵抗的受试者具有更集中的脂肪分布，并呈现出过度脂肪分解和内源性葡萄糖产生的证据。相比之下，患有“纯”高胰岛素血症的受试者脂肪分解、内源性葡萄糖产生和胰岛素清除受到抑制，收缩压值较高，血清高密度脂蛋白胆固醇浓度较低。两种表型唯一共同的异常是血清甘油三酯浓度升高。该分析表明，高胰岛素血症和胰岛素抵抗在非糖尿病人群中识别出部分不同的个体亚组，并表明高胰岛素血症和胰岛素抵抗在胰岛素抵抗综合征的组成部分方面具有不同的致病潜力。
The insulin resistance syndrome has been defined as the clustering of hypertension, dyslipidaemia and impaired glucose tolerance in subjects with high fasting plasma insulin concentrations. The latter are usually taken as a surrogate measure of insulin resistance of whole-body glucose disposal. Although hyperinsulinaemia and insulin resistance are reciprocally related to one another, the association is not very strong. In the data-pooling project of the European Group for the study of Insulin Resistance (EGIR), clamp-derived insulin sensitivity (as the M value) and fasting plasma insulin concentrations were available in 1,308 non-diabetic subjects with a wide range of age and body mass index. In this cohort, hyperinsulinaemia (as the upper quartile of fasting plasma insulin distribution in the non-obese segment of the population) and insulin resistance (as the bottom quartile of M value in the same subgroup) were each present in similar to40% of the whole population, but identified only partially overlapping (60%) subsets of individuals. When the subjects with insulin resistance but without hyperinsulinaemia (n = 198) were compared with the subjects with hyperinsulinaemia but without insulin resistance (n = 267), significant differences emerged in the respective clinical phenotypes. Thus, subjects with 'pure' insulin resistance had a more central fat distribution and presented evidence of excessive lipolysis and endogenous glucose production. In contrast, subjects with 'pure' hyperinsulinaemia had suppressed lipolysis, endogenous glucose production and insulin clearance, higher values of systolic blood pressure and lower values of serum HDL-cholesterol concentrations. The only abnormality common to both phenotypes was the presence of raised serum triglycerides concentrations.This analysis indicates that hyperinsulinaemia and insulin resistance identify partially different subgroups of individuals in a non-diabetic population, and suggests that hyperinsulinaemia and insulin resistance carry distinct pathogenic potential in terms of the components of the insulin resistance syndrome.