INSULIN-RESISTANCE AND HYPERINSULINEMIA IN INDIVIDUALS WITH SMALL, DENSE, LOW-DENSITY-LIPOPROTEIN PARTICLES
INSULIN-RESISTANCE AND HYPERINSULINEMIA IN INDIVIDUALS WITH SMALL, DENSE, LOW-DENSITY-LIPOPROTEIN PARTICLES
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DOI：
10.1172/jci116541
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发表时间：
1993-07-01
影响因子：
15.9
通讯作者：
KRAUSS, RM
中科院分区：
文献类型：
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作者：
REAVEN, GM;CHEN, YDI;KRAUSS, RM
以小LDL颗粒占优势为特征的受试者（模式B）的血浆甘油三酯（TG）和HDL-胆固醇浓度变化与胰岛素介导的葡萄糖摄取抵抗的存在一致。为了进一步研究这个问题，在根据梯度凝胶电泳测量的LDL峰直径分类的受试者中测量了口服葡萄糖、胰岛素介导的葡萄糖处置和脂蛋白浓度对血糖和胰岛素的反应。具有模式B的受试者具有更高的总积分血糖（P < 0.05-0.001）（20.7+/-1.0 mmol/liter.h）和胰岛素（1，743 +/-293 pmol/liter.h）口服葡萄糖与葡萄糖相比的反应（16.3+/-0.4和19.2+/-0.8 mmol/L. h）和胰岛素（856+/-60和1，222 +/-168 pmol/L. h）反应。在持续输注生长抑素、葡萄糖和胰岛素后，基于较高的稳态血糖浓度（SSPG，10.4+/-1.0，P < 0.002，vs. 7.5+/-0.7和6.0+/-0.4 mmol/L），模式B个体比中间或模式A亚类个体更具有胰岛素抵抗。模式B受试者也有较高浓度的（P < 0.001）TG（1.98+/-0.15 vs. 1.33+/-0.17和0.77+/-0.05 mmol/L）及更低（P < 0.01-0.001）HDL胆固醇（1.12+/-0.06vs. 1. 34 +/-0.05vs. 1. 45 +/-0.05mmol/L）高于中间型或模式A。最后，重要的LDL直径与SSPG（r = -0.44）、葡萄糖（r =-0.41）、胰岛素（r = -0.38）、甘油三酯（r = -0.65）、高密度脂蛋白胆固醇（r = 0.42）、收缩压（r = -0.34）、舒张压（r =-0.34）之间存在相关性（P < 0.001）。因此，模式B受试者是胰岛素抗性的，具有比模式A或中间型受试者更高的葡萄糖、胰岛素和TG、更低的HDL-胆固醇水平和更高的血压。
Subjects characterized by a predominance of small LDL particles (pattern B) have changes in plasma triglyceride (TG) and HDL-cholesterol concentrations consistent with the presence of resistance to insulin-mediated glucose uptake. To pursue this issue, plasma glucose and insulin responses to oral glucose, insulin-mediated glucose disposal, and lipoprotein concentrations were measured in subjects categorized on the basis of LDL peak diameter measured by gradient gel electrophoresis. Subjects with pattern B had higher (P < 0.05-0.001) total integrated plasma glucose (20.7+/-1.0 mmol/liter.h) and insulin (1,743+/-293 pmol/liter.h) responses to oral glucose compared with glucose (16.3+/-0.4 and 19.2+/-0.8 mmol/liter.h) and insulin (856+/-60 and 1,222+/-168 pmol/liter.h) responses in those with either pattern A or an intermediate pattern. Pattern B individuals were shown to be more insulin resistant on the basis of higher steady state plasma glucose concentrations (SSPG, 10.4+/-1.0, P < 0.002, vs. 7.5+/-0.7 and 6.0+/-0.4 mmol/liter) after a constant infusion of somatostatin, glucose, and insulin than those with either the intermediate or pattern A subclass. Pattern B subjects also had higher concentrations of (P < 0.001) TG (1.98+/-0.15 vs. 1.33+/-0.17 and 0.77+/-0.05 mmol/liter) and lower (P < 0.01-0.001) HDL cholesterol (1.12+/-0.06 vs. 1.34+/-0.05 vs. 1.45+/-0.05 mmol/liter) than those with either the intermediate or pattern A. Finally, significant (P < 0.001) correlation coefficients existed between LDL diameter and SSPG (r = -0.44); glucose (r = -0.41) and insulin (r = -0.38) responses; TG (r = -0.65) and HDL-cholesterol (r = 0.42) concentrations; and systolic (r = -0.34) and diastolic (r = -0.34) blood pressure. Thus, pattern B subjects are insulin resistant, have higher glucose, insulin, and TG, lower HDL-cholesterol levels, and higher blood pressure than those with pattern A or intermediate.