冠状动脉循环功能障碍在胰岛素耐药性,葡萄糖耐受性受损和2型糖尿病中
John O Prior1, Manuel J Quiñones, Miguel Hernandez-Pampaloni
1Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, Calif 90095-6948, USA.
Circulation
|April 27, 2005
概括
冠状动脉内皮功能障碍随着胰岛素抵抗和碳水化合物不耐受性增加而恶化. 这种氧化介导的血管运动障碍是与糖尿病相关的心血管事件的关键因素.
科学领域:
- 心血管生理学心血管生理学
- 代谢综合征是代谢综合征的一种.
- 内皮细胞功能 内皮细胞功能
背景情况:
- 异常的冠状动脉内皮反应与糖尿病中的心血管事件有关.
- 胰岛素抵抗是一种可能影响冠状动脉循环的谱.
- 了解这些变化对于管理糖尿病心血管风险至关重要.
研究的目的:
- 调查冠状动脉循环异常在胰岛素抵抗的全谱.
- 确定这些异常的严重程度是否与先进的胰岛素耐药性相关.
- 评估与葡萄糖代谢相关的内皮依赖和独立血管运动.
主要方法:
- 使用正子发射断层扫描和13N-氨评估的心肌血流 (MBF).
- 冠状动脉功能通过药理性血管扩张 (总血管扩张能力) 和冷压测试 (内皮依赖血管运动) 进行评估.
- 研究包括胰岛素敏感 (IS) 个体,胰岛素耐药 (IR),葡萄糖耐受性受损 (IGT) 和2型糖尿病 (DM) 患者,有或没有高血压.
主要成果:
- 在正常血糖组 (IS,IR,IGT) 中,总血管扩张能力类似,但在正常血压 (-17%) 和高血压 (-34%) 的DM患者中降低.
- 内皮依赖的血管运动在IR显著减少 (-56%),并在IGT和DM患者中进一步减少 (-85%至-120%).
- 氧化介导的血管运动呈现逐渐下降,胰岛素抵抗和碳水化合物不耐受性越来越严重.
结论:
- 功能性冠状动脉循环异常,特别是在氧化介导的血管运动中,随着胰岛素抵抗和碳水化合物不耐受性的增加,逐渐恶化.
- 减弱的总血管扩张能力与糖尿病中更明显的临床代谢异常有关.
- 这些发现强调了胰岛素抵抗对冠状动脉内皮功能和心血管健康的有害影响.
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