INSULIN RESISTANCE IS ASSOCIATED WITH LIPID AND LIPOPROTEIN ABNORMALITIES IN SUBJECTS WITH VARYING DEGREES OF GLUCOSE-TOLERANCE
INSULIN RESISTANCE IS ASSOCIATED WITH LIPID AND LIPOPROTEIN ABNORMALITIES IN SUBJECTS WITH VARYING DEGREES OF GLUCOSE-TOLERANCE
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DOI：
10.1161/01.atv.10.2.223
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发表时间：
1990-03-01
期刊：
影响因子：
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通讯作者：
MYKKANEN, L
中科院分区：
文献类型：
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作者：
LAAKSO, M;SARLUND, H;MYKKANEN, L
我们检验了胰岛素抵抗，而不是高胰岛素水平，与脂质和脂蛋白变化相关的假设，这些变化有利于动脉粥样硬化，独立于葡萄糖耐量状态。为此，我们对50名糖耐量正常的受试者、28名糖耐量受损的受试者和54名非胰岛素依赖型糖尿病（NIDDM）患者进行了研究。葡萄糖处理率（GDR）较低或胰岛素抵抗程度较高的受试者，其高密度脂蛋白（HDL）胆固醇较低，总和极低密度脂蛋白（VLDL）甘油三酯高于GDR较高的受试者（GDR最高）。这些关联与空腹胰岛素水平和其他混杂因素无关。在逐步多元线性回归分析中，GDR是与HDL胆固醇和VLDL甘油三酯水平相关的最重要的单变量，独立于年龄、肥胖、肥胖分布（腰臀比）、2小时葡萄糖水平和游离脂肪酸浓度。我们得出结论：1)通过正糖钳技术测量的胰岛素抵抗与不利于动脉粥样硬化的脂质和脂蛋白变化有关，不仅在非糖尿病受试者中（如先前的研究所示），而且在糖耐量受损和NIDDM受试者中也是如此；2)胰岛素高水平与脂质、脂蛋白不良变化的关联间接反映了胰岛素抵抗与脂质、脂蛋白水平的关联；3) HDL胆固醇和VLDL甘油三酯与胰岛素介导的葡萄糖摄取独立相关，这可能表明这些脂蛋白与胰岛素作用有单独的相互作用位点。
We tested the hypothesis that insulin resistance, rather than high insulin level, is associated with lipid and lipoprotein changes favoring atherosclerosis independently of the glucose tolerance status. To this aim, 50 subjects with normal glucose tolerance, 28 subjects with impaired glucose tolerance, and 54 subjects with noninsulin-dependent diabetes (NIDDM) were studied. Subjects with low glucose disposal rate (GDR) or a high degree of insulin resistance as measured by the euglycemic hyperinsulinemic clamp technique had lower high density lipoprotein (HDL) cholesterol and higher total and very low density lipoprotein (VLDL) triglycerides than did subjects with high GDR (highest GDR (highest GDR tertile). These associations were independent of fasting insulin level and other confounding factors. In stepwise multiple linear regression analysis, GDR was the most important single variable associated with HDL cholesterol and VLDL triglyceride level independently of age, obesity, distribution of obesity (waist/hip ratio), 2-hour glucose level, and free fatty acid concentration. We conclude: 1) insulin resistance measured by the euglycemic clamp technique is associated with adverse lipid and lipoprotein changes favoring atherosclerosis not only in nondiabetic subjects (as shown in previous studies) but also in impaired glucose tolerance and NIDDM subjects; 2) he association of high insulin level with adverse lipid and lipoprotein changes indirectly reflects the association of insulin resistance with lipid and lipoprotein levels; and 3) HDL cholesterol and VLDL triglycerides are independently associated with insulin-mediated glucose uptake, which may indicate that these lipoproteins have separate sites of interaction with insulin action.