Is insulin resistance the cause of the metabolic syndrome?
Is insulin resistance the cause of the metabolic syndrome?
复制标题
DOI：
10.1080/07853890500415358
复制
发表时间：
2006-01-01
影响因子：
4.4
通讯作者：
Ferrannini, E
中科院分区：
文献类型：
--
作者：
Ferrannini, E
根据最初关于围绕胰岛素抵抗而聚集的心血管危险因素(主要是葡萄糖耐量异常、血脂异常和高血压)的描述，代谢综合征最近被升级为具有心血管疾病固有预测价值的疾病实体的状态。在病理生理学方面，胰岛素抵抗(葡萄糖代谢)和随之而来的代偿性高胰岛素血症与糖耐量异常、血脂异常、高血压和血管功能障碍各有因果关系。本文对其生理机制进行了简要的综述。然而，仅有胰岛素抵抗/高胰岛素血症不足以导致这些异常，需要其他致病因素(例如，葡萄糖耐受性B细胞功能障碍)。另一方面，代谢综合征是从一系列统计学关联演变而来的，这些统计关联被认为带有过量的心血管风险。在现有的各种定义中，出于预测价值或实际易用性的原因，使用了物理、代谢和临床变量的混合。这些变量属于不同的表型，分别为上游、中间和近端，与临床疾病的关系。由此产生的“综合症”通常缺乏令人信服的概念结构，可能反映了从中提取它们的特定数据集，并且可能具有有限的适用性。虽然显性糖尿病、临床高血压和坦率的血脂异常常常同时出现在同一患者身上，但具有独特的、可能的病因和被证明为危险指标的亚临床综合征仍有待确定。
Following up on original descriptions of clustering of cardiovascular risk factors (chiefly, glucose intolerance, dyslipidaemia and hypertension) around the presence of insulin resistance, the metabolic syndrome has recently been upgraded to the status of a disease entity with an inherent predictive value for cardiovascular disease. In pathophysiological terms, insulin resistance (of glucose metabolism) and the attendant compensatory hyperinsulinaemia are causally related to each of glucose intolerance, dyslipidaemia, high blood pressure and vascular dysfunction. The physiological mechanisms are concisely reviewed here. However, insulin resistance/hyperinsulinaemia alone is insufficient to cause these abnormalities, for which other pathogenic factors (e.g. B-cell dysfunction for glucose intolerance) are required. The metabolic syndrome, on the other hand, has evolved from a set of statistical associations believed to carry an excess of cardiovascular risk. In the various existing definitions, a mixture of physical, metabolic and clinical variables have been used on grounds of predictive value or practical ease. These variables belong to different phenotypes, which are upstream, intermediate and proximal, respectively, in their relation to clinical disease. The resulting 'syndromes' usually lack a cogent conceptual structure, may reflect the particular data set from which they are extracted and may be of limited applicability. While overt diabetes, clinical hypertension and frank dyslipidaemia are often present together in the same patient, a subclinical syndrome with a distinct, probable aetiology and a proven power as a risk indicator remains to be identified.