重访GIK——谈极化液心脏保护与胰岛素强化治疗

GIK revisit:Insulin cardioprotection and intensive therapy

自上世纪20年代发现胰岛素以来,胰岛素一直被用作糖尿病血糖控制的基本临床用药。最近的研究发现,胰岛素信号参与正常心血管功能的维系,而胰岛素信号的缺失(如胰岛素抵抗)可导致心血管功能障碍并参与心血管疾病的发生和发展。本课题组近期结合自身长期研究工作成果,在系统回顾相关重要文献的基础上,就胰岛素心肌保护机制及极化液(glucose-insulin-potassium solution,GIK)临床应用问题撰写综述,发表于欧洲心脏学会会刊《心血管研究》(Cardiovasc Res)。该综述全面阐释了胰岛素激活心血管内源性蛋白激酶B-内皮型一氧化氮合酶(Akt-eNOS)系统,进而通过"终效应分子"一氧化氮发挥心血管保护作用的机制,以及这一信号机制在心血管健康及缺血性心脏病等心血管疾病中的作用,重点强调胰岛素生存信号障碍在胰岛素抵抗及诱发心血管疾病中的关键作用。

Insulin has been used as an essential therapeutic agent in diabetes for glycemic management since its discovery in the 1920s. Recent studies demonstrate that insulin signalling is essential for normal cardiovascular function, while lack of it （i.e. insulin resistance） leads to cardiovascular dysfunction and disease. We recently published a review paper entitled ＂Insulin says NO to cardiovascular disease＂ in ＂＇Cardiovasc Res＂, addressing the mechanisms underlying the insulin cardioprotection and perspectives regarding its clinical applications based on our latest major findings and a thorough reference study. This review paper focuses on insulin-initiated protein kinase B endothelial nitric oxide synthase （Akt-eNOS） survival sigaalling, with nitric oxide as an end effecter delivering cardioprotection in health and disease （especially in ischaenaic heart disease）, and highlights tile impairment of this survival signalling as a key link between insulin resistance and cardiovascular disease.