Independent association of type 2 diabetes and coronary artery disease with myocardial insulin resistance
Independent association of type 2 diabetes and coronary artery disease with myocardial insulin resistance
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DOI：
10.2337/diabetes.51.10.3020
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发表时间：
2002-10-01
期刊：
影响因子：
7.7
通讯作者：
Camici, PG
中科院分区：
文献类型：
--
作者：
Iozzo, P;Chareonthaitawee, P;Camici, PG
经典的心血管危险因素的聚集不足以解释糖尿病患者过多的冠状动脉疾病（CAD），慢性高血糖和胰岛素抵抗（IR）是明显的罪魁祸首。全身和骨骼肌IR是2型糖尿病患者的特征，但它是否延伸到正常收缩的心肌是有争议的。我们在一个病例对照系列（n = 55）中研究了2型糖尿病是否与独立于CAD的心肌IR相关，该病例对照系列包括男性非糖尿病和糖尿病（2型和1型）患者，有或无血管造影证实的CAD。正常血糖（5.6 mmol/l）、生理性高胰岛素血症（40 mU）期间的基线血流量（O-15-水）和胰岛素刺激的葡萄糖摄取（F-18-氟脱氧葡萄糖）。最小值（-1）。m（-2）胰岛素钳夹）。骨骼肌葡萄糖摄取减少与CAD和2型糖尿病相关。在基线灌注正常的区域，非CAD 2型糖尿病患者胰岛素介导的心肌葡萄糖摄取减少（0.36 +/- 0.14 mumol . min（-1）。g（-1））和非糖尿病CAD患者（0.44 +/- 0.15 mumol . min（-1）9 1）与健康对照组（0.61 ± 0.08）或非CAD 1型糖尿病患者（0.80 ± 0.13; CAD和糖尿病患者均P < 0.001）相比。无论是基础骨骼肌，也不基础心肌血流量不同的各组，骨骼肌和心肌IR直接相关的全身IR。我们得出结论，2型糖尿病是专门与心肌IR是独立的和非加性的血管造影CAD和成比例的骨骼肌和全身IR。
Clustering of classical cardiovascular risk factors is insufficient to account for the excess coronary artery disease (CAD) of patients with diabetes, and chronic hyperglycemia and insulin resistance (IR) are obvious culprits. Whole-body and skeletal muscle IR is characteristic of patients with type 2 diabetes, but whether it extends to the normally contracting cardiac muscle is controversial. We investigated whether type 2 diabetes is associated with myocardial IR independent of CAD in a case-control series (n = 55) of male nondiabetic and diabetic (type 2 and type 1) patients with or without angiographically documented CAD. Baseline blood flow (O-15-water) and insulin-stimulated glucose uptake (F-18-fluoro-deoxyglucose) during euglycemic (5.6 mmol/l), physiological hyperinsulinemia (40 mU . min(-1) . m(-2) insulin clamp) were measured by positron emission tomography in skeletal muscle and normally contracting myocardium. Skeletal muscle glucose uptake was reduced in association with both CAD and type 2 diabetes. In regions with normal baseline perfusion, insulin-mediated myocardial glucose uptake was reduced in non-CAD type 2 diabetic (0.36 +/- 0.14 mumol . min(-1) . g(-1)) and nondiabetic CAD patients (0.44 +/- 0.15 mumol . min(-1) 9 1) in comparison with healthy control subjects (0.61 +/- 0.08) or with non-CAD type 1 diabetic patients (0.80 +/- 0.13; P < 0.001 for both CAD and diabetes). Neither basal skeletal muscle nor basal myocardial blood flow differed across groups; both skeletal muscle and myocardial IR were directly related to whole-body IR. We conclude that type 2 diabetes is specifically associated with myocardial IR that is independent of and nonadditive with angiographic CAD and proportional to skeletal muscle and whole-body IR.