冠心病患者红细胞胰岛素受体改变与胰岛素抵抗的关系

A preliminary study on the relationship between the changes of erythrocyte insulin receptor and insulin resistance in patients with coronary heart disease

目的 探讨冠心病患者红细胞胰岛素受体 (RBC InsR)改变及其与胰岛素抵抗 (IR)的关系。方法 采用放射性受体分析法探测 2 9例冠心病 (CHD)患者、1 6例正常人的RBC InsR改变情况 ;应用荧光偏振技术测定红细胞膜脂流动性 (RBC MF)变化 ;采用双抗体放射免疫法测定血浆胰岛素水平。结果 ①CHD患者RBC InsR结合位点数较正常对照组显著降低 ,减少的RBC InsR主要为低亲和力高容量受体 ,而高亲和力低容量受体无明显变化。受体与胰岛素的高亲和力及结合率亦明显降低。②RBC InsR的结合位点数与血浆胰岛素水平呈负相关 ,与RBC MF呈正相关。受体的高、低亲和力及结合率亦与RBC MF呈正相关。结论 冠心病患者可能存在InsR缺陷 ,其InsR缺陷可能与CHD患者的IR和高胰岛素血症有关。

Objective To investigate the changes of erythrocyte insulin receptor and insulin resistance in patients with coronary heart disease(CHD). Methods Radioreceptor assay was employed to detect the insulin binding to erythrocyte in 29 CHD patients and 16 normal controls. Fluorescence polarization technique was applied to measure the degree of membrane fluidity (MF) of erythrocytes in both groups. At the same time, the plasma insulin was also measured. Results The number of erythrocyte insulin receptor decreased significantly in CHD patients( P <0.01). The reduced receptors were the ones with low affinity and high capacity. The receptors of high affinity and low capacity were not changed ( P >0.05). Insulin receptor affinity and insulin binding were lower, too. Regression analysis suggested that the number of erythrocyte insulin receptor was negativity correlated with the fasting plasma insulin concentration and positivity correlated with the membrane fluidity of erythrocyte; insulin receptor high affinity and insulin binding were also positivity correlated with the membrane fluidity of erythrocytes. Conclusion CHD patients have insulin receptor defects. The defects of insulin receptor in CHD patients are probably related to insulin resistance and hyperinsulinemia. The decrease of membrane fluidity is probably a direct factor inducing the defects of insulin receptor and insulin resistant in CHD patients.