Insulin: an endogenous cardioprotector.
Insulin: an endogenous cardioprotector.
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DOI：
10.1097/00075198-200310000-00007
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发表时间：
2003-10-01
影响因子：
3.3
通讯作者：
Das, Undurti N
中科院分区：
文献类型：
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作者：
Das, Undurti N
这篇综述讨论了胰岛素/葡萄糖-胰岛素-钾方案的心肌保护特性以及这种有益作用所涉及的机制。最近的几项研究表明，胰岛素不仅有助于控制高血糖和维持葡萄糖稳态，而且可能具有保护心肌免受再灌注损伤和缺血以及防止心肌细胞凋亡的独特特性。胰岛素/葡萄糖-胰岛素-钾（GIK）方案抑制肿瘤坏死因子-α、白细胞介素-6、巨噬细胞迁移抑制因子和其他促炎细胞因子和自由基的产生；并增强内皮一氧化氮和抗炎细胞因子白细胞介素4和白细胞介素10的合成。因此，胰岛素/GIK 疗法具有心脏保护作用。这也可以解释为什么胰岛素/GIK方案在败血症和败血性休克、急性心肌梗死的心肌恢复和危重疾病中有用。建议对急性心肌梗死、充血性心力衰竭、心源性休克、危重症患者输注足量胰岛素，可保护心肌完整性和功能，确保快速康复。鉴于胰岛素对促炎细胞因子和自由基合成的抑制作用，如果及时、适当地使用胰岛素/GIK方案，也可能保护其他组织和器官，并促进危重患者的康复。
This review discusses the myocardial protective property of the insulin/glucose-insulin-potassium regimen and the mechanisms involved in this beneficial action. Several recent studies suggest that insulin not only is useful to control hyperglycemia and maintain glucose homeostasis but also may have the unique property to protect the myocardium from reperfusion injury and ischemia and prevent apoptosis of myocardial cells. The insulin/glucose-insulin-potassium (GIK) regimen suppresses the production of tumor necrosis factor-alpha, interleukin-6, macrophage migration inhibitory factor and other pro-inflammatory cytokines, and free radicals; and enhances the synthesis of endothelial nitric oxide and anti-inflammatory cytokines interleukin-4 and interleukin-10. Thus, the insulin/GIK regimen brings about its cardioprotective action. This may also explain why the insulin/GIK regimen is useful in sepsis and septic shock, myocardial recovery in acute myocardial infarction, and critical illness. It is suggested that the infusion of adequate amounts of insulin to patients with acute myocardial infarction, congestive heart failure, cardiogenic shock, and critical illness preserves myocardial integrity and function and ensures rapid recovery. In view of the suppressive action of insulin on the synthesis of proinflammatory cytokines and free radicals, it is possible that the insulin/GIK regimen, when used in a timely and appropriate fashion, may also protect other tissues and organs and facilitate in the recovery of patients who are critically ill.