胰岛素抵抗及其新型评价指标与心血管疾病相性研究进展

Research Progress of the Correlation between Insulin Resistance and Its Novel Evaluation Indicators with Cardiovascular Disease

随着人们生活水平的不断提高,心血管疾病(cardiovascular disease, CVD)目前已经排在全球致死疾病中的首位,对人类健康产生了严重威胁,同时也是当前全世界经济负担最重的疾病。2型糖尿病(type 2 diabetes mellitus, T2DM)是各种CVD的独立危险因素,包括冠心病,心力衰竭(heart failure, HF),中风,外周动脉疾病(peripheral arterial disease, PAD)等。T2DM患者发生CVD的风险较高,极易致使患者出现微血管病变或者大血管病变,其中冠状动脉病变在血管病变中危害性最大。胰岛素抵抗(insulin resistance, IR)是T2DM和CVD的共同病理生理基础,评估IR状态对CVD的防治大有裨益。目前评估IR的方法种类繁多,葡萄糖钳夹技术(glucose clamp technique, GCT)、胰岛素稳态模型技术(homeostatic model assessment of insulin resistance, HOMA-IR)等传统评价方式以其独特的优势使其在某些方面仍然不可替代,但是这些传统评估方法也存在一定的局限性,比如程序步骤相对繁琐复杂、可重复性差、对受试者依从性要求较高等使其不适用于大规模的、常规的临床评估。近年来涌现出诸多新型评估IR的方法,可以通过简单的常规生化测试计算,其在一定程度上弥补了传统IR评估方法的缺点且评估效能不亚于传统评价指标。本文主要阐述IR及其新型评价指标与CVD相关性研究进展。With the continuous improvement of people’s living standards, cardiovascular disease (CVD) has now ranked as the leading cause of death globally, posing a serious threat to human health and being the most economically burdensome disease worldwide. Type 2 diabetes mellitus (T2DM) is an independent risk factor for various cardiovascular diseases, including coronary heart disease, heart failure, stroke, and peripheral arterial disease. Patients with T2DM have a higher risk of developing cardiovascular diseases and are prone to microvascular and macrovascular complications, with coronary artery disease being the most harmful among vascular complications. Insulin resistance (IR) is the common pathophysiological basis of T2DM and CVD, and assessing IR status is beneficial for the prevention and treatment of CVD. Currently, there are many methods for evaluating IR, including the glucose clamp technique (GCT) and the homeostatic model assessment of insulin resistance (HOMA-IR), which have unique advantages and remain unreplaceable in some aspects, but these traditional assessment methods also have certain limitations, such as relatively complex procedural steps, poor reproducibility, and high requirements for the subjects’ compliance, which make them unsuitable for large-scale, routine clinical assessment. In recent years, many novel methods for evaluating IR have emerged, which can be calculated through simple routine biochemical tests. To some extent, these new IR evaluation methods have made up for the shortcomings of traditional IR evaluation methods and have comparable evaluation efficacy to traditional indicators. This article mainly discusses the research progress of the correlation between IR and its novel evaluation indexes with cardiovascular diseases.