Prevalence of insulin resistance in metabolic disorders - The Bruneck Study
Prevalence of insulin resistance in metabolic disorders - The Bruneck Study
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DOI：
10.2337/diabetes.47.10.1643
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发表时间：
1998-10-01
期刊：
影响因子：
7.7
通讯作者：
Muggeo, M
中科院分区：
文献类型：
--
作者：
Bonora, E;Kiechl, S;Muggeo, M
胰岛素抵抗在最常见的代谢紊乱中的患病率仍然是一个不确定的问题。我们评估了Bruneck研究框架内确定的糖耐量受损（IGT）、NIDDM、血脂异常、高尿酸血症和高血压受试者的胰岛素抵抗患病率。该研究包括一般人群的年龄和性别分层随机样本（n = 888;年龄40-79岁）。通过稳态模型评估（HOMA（IR））估计胰岛素抵抗，并在85例受试者中对正常血糖-高胰岛素钳夹进行初步验证。HOMA（IR）分布的前五分位数的下限（即，2.77）作为胰岛素抵抗的阈值。胰岛素抵抗的患病率在IGT受试者中为65.9%，在NIDDM受试者中为83.9%，在高胆固醇血症受试者中为53.5%，在高甘油三酯血症受试者中为84.2%，在低HDL胆固醇受试者中为88.1%，在高尿酸血症受试者中为62.8%，在高血压受试者中为58.0%。合并葡萄糖耐受不良（IGT或NIDDM）、血脂异常（高胆固醇血症和/或高甘油三酯血症和/或低HDL胆固醇）、高尿酸血症和高血压（n = 21）的受试者中胰岛素抵抗的患病率为95.2%。在孤立的高胆固醇血症、高血压或高尿酸血症中，胰岛素抵抗的患病率并不高于非肥胖的正常受试者。相当数量的受试者（n = 85，占整个人群的9.6%）存在胰岛素抵抗，但无IGT、NIDDM、血脂异常、高尿酸血症和高血压。这些基于人群的研究结果表明：1）在高胆固醇血症和低HDL胆固醇状态下，胰岛素抵抗与NIDDM一样常见，而在高胆固醇血症、高尿酸血症和高血压中不太常见; 2）绝大多数患有多种代谢疾病的受试者都是胰岛素抵抗; 3）在孤立的高胆固醇血症、高尿酸血症或高血压中，胰岛素抵抗并不比单独偶然预期的更频繁;和4）在一般人群中，即使没有任何主要代谢紊乱，也可以发现胰岛素抵抗。
The prevalence of insulin resistance in the most common metabolic disorders is still an undefined issue. We assessed the prevalence rates of insulin resistance in subjects with impaired glucose tolerance (IGT), NIDDM, dyslipidemia, hyperuricemia, and hypertension as identified within the frame of the Bruneck Study. The study comprised an age- and sex-stratified random sample of the general population (n = 888; aged 40-79 years). Insulin resistance was estimated by homeostasis model assessment (HOMA(IR)), preliminarily validated against a euglycemic-hyperinsulinemic clamp in 85 subjects. The lower limit of the top quintile of HOMA(IR) distribution (i.e., 2.77) in nonobese subjects with no metabolic disorders (n = 225) was chosen as the threshold for insulin resistance. The prevalence of insulin resistance was 65.9% in IGT subjects, 83.9% in NIDDM subjects, 53.5% in hypercholesterolemia subjects, 84.2% in hypertriglyceridemia subjects, 88.1% in subjects with low HDL cholesterol, 62.8% in hyperuricemia subjects, and 58.0% in hypertension subjects. The prevalence of insulin resistance in subjects with the combination of glucose intolerance (IGT or NIDDM), dyslipidemia (hypercholesterolemia and/or hypertriglyceridemia and/or low HDL cholesterol), hyperuricemia, and hypertension (n = 21) was 95.2%. In isolated hypercholesterolemia, hypertension, or hyperuricemia, prevalence rates of insulin resistance mere not higher than that in nonobese normal subjects. An appreciable number of subjects (n = 85, 9.6% of the whole population) was insulin resistant but free of IGT, NIDDM, dyslipidemia, hyperuricemia, and hypertension. These results from a population-based study documented that 1) in hypertriglyceridemia and a low HDL cholesterol state, insulin resistance is as common as in NIDDM, whereas it is less frequent in hypercholesterolemia, hyperuricemia, and hypertension; 2) the vast majority of subjects with multiple metabolic disorders are insulin resistant; 3) in isolated hypercholesterolemia, hyperuricemia, or hypertension, insulin resistance is not more frequent than can be expected by chance alone; and 4) in the general population, insulin resistance can be found even in the absence of any major metabolic disorders.