INSULIN-RESISTANCE IN CHRONIC HEART-FAILURE
INSULIN-RESISTANCE IN CHRONIC HEART-FAILURE
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DOI：
10.1093/oxfordjournals.eurheartj.a060425
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发表时间：
1994-11-01
影响因子：
39.3
通讯作者：
OLIVER, MF
中科院分区：
文献类型：
--
作者：
SWAN, JW;WALTON, C;OLIVER, MF
本研究旨在探讨慢性心力衰竭患者是否存在胰岛素敏感性异常。对10例男性重度慢性心力衰竭患者和10例正常对照组的糖代谢和胰岛素抵抗进行了检测。在0.5g·kg(-1)静脉葡萄糖耐量试验后测定血糖、胰岛素和C-肽浓度。心力衰竭患者的平均空腹血糖浓度与对照组相似，但平均空腹血浆胰岛素浓度(P=0.002)和C肽浓度(P=0.02)显著高于对照组。两组的血糖反应曲线相似，但心衰组的增量血浆胰岛素反应曲线明显更大(P=0.004)。心力衰竭患者的平均胰岛素敏感性降低73%(P=0.003)。这些结果表明，与匹配的健康组相比，严重慢性心力衰竭患者存在高胰岛素血症和胰岛素抵抗。这种胰岛素抵抗和高胰岛素血症可能导致心脏功能的进行性恶化，以及与心力衰竭相关的疲劳和运动耐量下降的临床特征。旨在克服或减少胰岛素抵抗的干预措施值得进一步研究。
The objective of this study was to investigate the existence of abnormalities of insulin sensitivity in patients with chronic heart failure. Glucose metabolism and insulin resistance were assessed in 10 male patients with sever, chronic heart failure and in 10 matched control subjects. Glucose, insulin and C-peptide concentration profiels were measured following a 0.5 g.kg(-1) intravenous glucose tolerance test. Insulin sensitivity (inversely related to insulin resistance) was estimated by minimal modelling analysis of the glucose and insulin profiles.Heart failures patietns had similar mean fasting plasma glucose concentration to controls but a significantly greater mean fasting plasma insulin concentration (P=0.002) and C-peptide concentration (P=0.02). Plasma glucose response profile was similar in the two groups but the incremental plasma insulin response profile of the heart failure group was significantly greater (P=0.004). Mean insulin sensitivity was 73% lower in the heart failure patients (P=0.003).These findings show that patients with severe chronic heart failure are hyperinsulinaemic and insulin resistant compared with a matched healthy group. This insulin resistance and hyperinsulinaemia may contribute to the progressive deterioration in myocardial function and associated clinical features of fatigue and reduced exercise tolerance seen in heart failure. Interventions designed to overcome or reduce insulin resistance warrant further investigation.