HYPERINSULINEMIA IN PATIENTS WITH CHEST PAIN AND NORMAL CORONARY ARTERIES

最近有报道称，胰岛素对葡萄糖负荷的反应过度， X综合征患者（劳力性心绞痛，缺血性ST反应 运动，正常冠状动脉）。 为了评估 高胰岛素血症对非糖尿病胸部病变患者血管的影响 疼痛综合征和血管造影正常的冠状动脉，我们测量 65名患者和16名健康对照者的血浆胰岛素水平相似， 年龄、性别和体重。 在34例患者和对照组中，前臂 通过阻抗体积描记法测量血管阻力。 虽然 胸痛患者的空腹胰岛素水平相似， 冠状动脉造影正常的患者和对照组， 显著更高的峰值胰岛素反应（153/-+77 vs 87/-+40（mu）U/ml， p>0.01）。 基线和缺血后5分钟前臂 对照组患者的血管阻力相似， 糖负荷后尽管高胰岛素血症的胸痛患者 冠状动脉造影正常 患者中 胸痛与冠状动脉正常之间无相关性 高胰岛素血症的存在和严重程度，以及 高血压，冠状动脉微血管功能障碍，微血管收缩 对麦角新碱的反应）或对运动的EKG反应。因此虽然 高胰岛素血症在胸痛患者中很常见， EKG对运动的反应，胰岛素水平升高对运动的影响， 冠状动脉和全身血管系统尚不清楚。

Excess insulin responses to glucose load have recently been reported in patients with syndrome X (effort angina, ischemic-appearing ST responses to exercise, normal coronary arteries). To assess the prevalence in vascular effects of hyerinsulenemia in non-diabetic patients with chest pain syndromes and angiographically normal coronary arteries, we measured plasma insulin levels in 65 patients and 16 healthy controls of similar age, gender and weight. In a subset of 34 patients and controls, forearm vascular resistance was measured by impedance plethysmography. Although fasting insulin levels were similar for the patients with chest pain and angiographically normal coronary arteries and controls, patients had significantly higher peak insulin responses (153/-+77 vs 87/-+40 (mu)U/ml, p>0.01) to glucose 75 gm. Baseline and 5 minute post-ischemic forearm vascular resistances were similar for controls in patients both before and after glucose load despite hyperinsulemneia in the patients with chest pain and angiographically normal coronary arteries. Among the patients with chest pain and normal coronary arteries there was no correlation between the presence and severity of hyperinsulenemia, and the presence of hypertension, coronary microvascular dysfunction microvascular constrictor response to ergonovine) or EKG responses to exercise. Thus, although hyperinsulenemia is common in patients with chest pain regardless of the EKG response to exercise, the impact of increased insulin levels on the coronary and systemic vasculature is unclear.