Insulin trong hội chứng vành cấp: một bài tổng hợp có góc nhìn hiện đại

Springer Science and Business Media LLC - Tập 30 - Trang 493-504 - 2016
Michael C. Y. Nam1, Christopher D. Byrne2, Juan Carlos Kaski3, Kim Greaves1
1Department of Cardiology, Sunshine Coast Hospital and Health Services, University of the Sunshine Coast and University of Queensland, Brisbane, Australia
2Nutrition & Metabolism, Institute for Developmental Sciences, National Institute for Health Research Biomedical Research Centre, University of Southampton and Southampton, University Hospital Southampton, Southampton General Hospital, Southampton, UK
3Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK

Tóm tắt

Vai trò của insulin trong điều trị hội chứng vành cấp tính (ACS) đã được nghiên cứu rộng rãi trong suốt 100 năm qua. Chỉ định hiện tại cho việc sử dụng nó trong ngữ cảnh này là điều trị tăng đường huyết, không phụ thuộc vào bệnh tiểu đường, vì nó liên quan đến kết quả xấu. Các lý thuyết ban đầu cho rằng glucose có lợi trong bối cảnh thiếu máu cơ tim và insulin là cần thiết để cho phép tế bào tiếp nhận glucose. Tuy nhiên, các nghiên cứu thử nghiệm giả thuyết này với việc sử dụng insulin thường quy trong ACS đã cho kết quả thất vọng và do đó, sự quan tâm nghiên cứu đã giảm sút. Chúng tôi đề xuất rằng tác dụng giãn mạch ít được biết đến nhưng quan trọng của insulin đã bị một số nghiên cứu bỏ qua và xứng đáng được xem xét thêm. Các báo cáo trước đó đã chỉ ra rằng tình trạng tăng insulin đi kèm với đường huyết bình thường cải thiện dự trữ lưu lượng máu cơ tim. Với điều này trong tâm trí, bài tổng hợp này xem xét vai trò của insulin trong bối cảnh ACS từ quan điểm của một chất giãn mạch hơn là một điều chỉnh chuyển hóa. Chúng tôi thảo luận về tầm quan trọng của thời gian điều trị, liều insulin được sử dụng, các vấn đề liên quan đến hạ đường huyết và đề kháng insulin, và cách chúng có thể đã ảnh hưởng đến kết quả của các thử nghiệm chính. Cuối cùng, chúng tôi đề xuất các thiết kế nghiên cứu mới cho phép xác định các điều kiện giãn mạch tối ưu để sử dụng insulin như liệu pháp hỗ trợ trong thời gian thiếu máu cơ tim.

Từ khóa

#insulin #hội chứng vành cấp tính #điều trị #tăng đường huyết #giãn mạch #nghiên cứu

Tài liệu tham khảo

Malmberg K. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (diabetes mellitus, insulin glucose infusion in acute myocardial infarction) study group. BMJ. 1997;314(7093):1512–5. Rana OA, Byrne CD, Greaves K. Intensive glucose control and hypoglycaemia: a new cardiovascular risk factor? Heart. 2014;100(1):21–7. Vriesendorp TM, van Santen S, DeVries JH, de Jonge E, Rosendaal FR, Schultz MJ, Hoekstra JB. Predisposing factors for hypoglycemia in the intensive care unit. Crit Care Med. 2006;34(1):96–101. Kosiborod M, Inzucchi SE, Krumholz HM, Xiao L, Jones PG, Fiske S, Masoudi FA, Marso SP, Spertus JA. Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation. 2008;117(8):1018–27. van der Horst IC, Nijsten MW, Vogelzang M, Zijlstra F. Persistent hyperglycemia is an independent predictor of outcome in acute myocardial infarction. Cardiovasc Diabetol. 2007;6:2. Opie LH, Jonnessen A, Yellon DM. The glucose hypothesis: updated or outdated? Role of insulin. Cardiovasc J S Afr. 2004;15:S1. Rana OBC, Kerr D, Coppini D, Zouwail S, Senior R, Begley J, Walker JJ, Greaves K. Acute hypoglycaemia decreases myocardial blood flow Reserve in Patients with Type 1 diabetes mellitus and in healthy humans. Circulation. 2011;124:1548–56. Durante A, Camici PG. Novel insights into an "old" phenomenon: the no reflow. Int J Cardiol. 2015;187:273–80. van der Horst IC, Zijlstra F. Potential beneficial mechanisms of insulin (glucose-potassium) in acute myocardial infarction. Neth Hear J. 2005;13(6):233–8. Sundell JKJ. Insulin and myocardial blood flow. Cardiovasc Res. 2003;57:312–9. Rogers WJ, Russell Jr RO, McDaniel HG, Rackley CE. Acute effects of glucose-insulin-potassium infusion on myocardial substrates, coronary blood flow and oxygen consumption in man. Am J Cardiol. 1977;40(3):421–8. McNulty PH, Pfau S, Deckelbaum LI. Effect of plasma insulin level on myocardial blood flow and its mechanism of action. Am J Cardiol. 2000;85(2):161–5. Legtenberg RJ, Houston RJ, Oeseburg B, Smits P. Physiological insulin concentrations protect against ischemia-induced loss of cardiac function in rats. Comp Biochem Physiol A Mol Integr Physiol. 2002;132(1):161–7. Sodi-Pallares D, Testelli MR, Fishleder BL, Bisteni A, Medrano GA, Friedland C, De Micheli A. Effects of an intravenous infusion of a potassium-glucose-insulin solution on the electrocardiographic signs of myocardial infarction. A preliminary clinical report. Am J Cardiol. 1962;9:166–81. Oliver MF, Kurien VA, Greenwood TW. Relation between serum-free-fatty acids and arrhythmias and death after acute myocardial infarction. Lancet. 1968;1(7545):710–4. Oliver MF, Opie LH. Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias. Lancet. 1994;343(8890):155–8. Opie LH, Tansey M, Kennelly BM. Proposed metabolic vicious circle in patients with large myocardial infarcts and high plasma-free-fatty-acid concentrations. Lancet. 1977;2(8044):890–2. Brown MJ, Brown DC, Murphy MB. Hypokalemia from beta2-receptor stimulation by circulating epinephrine. NEJM. 1983;309(23):1414–9. Obeid AI, Verrier RL, Lown B. Influence of glucose, insulin, and potassium on vulnerability to ventricular fibrillation in the canine heart. Circ Res. 1978;43(4):601–8. Fath-Ordoubadi F, Beatt KJ. Glucose-insulin-potassium therapy for treatment of acute myocardial infarction: an overview of randomized placebo-controlled trials. Circulation. 1997;96(4):1152–6. Diaz R, Paolasso EA, Piegas LS, Tajer CD, Moreno MG, Corvalan R, Isea JE, Romero G. Metabolic modulation of acute myocardial infarction. The ECLA (Estudios Cardiologicos Latinoamerica) collaborative group. Circulation. 1998;98(21):2227–34. Krljanac G, Vasiljevic Z, Radovanovic M, Stankovic G, Milic N, Stefanovic B, Kostic J, Mitrovic P, Radovanovic N, Dragovic M, Marinkovic J, Karadzic A. Effects of glucose-insulin-potassium infusion on ST-elevation myocardial infarction in patients treated with thrombolytic therapy. Am J Cardiol. 2005;96(8):1053–8. van der Horst IC, Zijlstra F, AW v ‘t H, Doggen CJ, MJ d B, Suryapranata H, Hoorntje JC, Dambrink JH, Gans RO, Bilo HJ. Glucose-insulin-potassium infusion inpatients treated with primary angioplasty for acute myocardial infarction: the glucose-insulin-potassium study: a randomized trial. JACC. 2003;42(5):784–91. Pache J, Kastrati A, Mehilli J, Bollwein H, Ndrepepa G, Schuhlen H, Martinoff S, Seyfarth M, Nekolla S, Dirschinger J, Schwaiger M, Schomig A. A randomized evaluation of the effects of glucose-insulin-potassium infusion on myocardial salvage in patients with acute myocardial infarction treated with reperfusion therapy. Am Heart J. 2004;148(1):e3. Mehta SR, Yusuf S, Diaz R, Zhu J, Pais P, Xavier D, Paolasso E, Ahmed R, Xie C, Kazmi K, Tai J, Orlandini A, Pogue J, Liu L. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: the CREATE-ECLA randomized controlled trial. JAMA. 2005;293(4):437–46. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA. 2006;295(13):1519–30. Diaz R, Goyal A, Mehta SR, Afzal R, Xavier D, Pais P, Chrolavicius S, Zhu J, Kazmi K, Liu L, Budaj A, Zubaid M, Avezum A, Ruda M, Yusuf S. Glucose-insulin-potassium therapy in patients with ST-segment elevation myocardial infarction. JAMA. 2007;298(20):2399–405. Timmer JR, Svilaas T, Ottervanger JP, Henriques JP, Dambrink JH, van den Broek SA, van der Horst IC, Zijlstra F. Glucose-insulin-potassium infusion in patients with acute myocardial infarction without signs of heart failure: the glucose-insulin-potassium study (GIPS)-II. JACC. 2006;47(8):1730–1. Selker HP, Beshansky JR, Sheehan PR, Massaro JM, Griffith JL, D’Agostino RB, Ruthazer R, Atkins JM, Sayah AJ, Levy MK, Richards ME, Aufderheide TP, Braude DA, Pirrallo RG, Doyle DD, Frascone RJ, Kosiak DJ, Leaming JM, Van Gelder CM, Walter GP, Wayne MA, Woolard RH, Opie LH, Rackley CE, Apstein CS, Udelson JE. Out-of-hospital administration of intravenous glucose-insulin-potassium in patients with suspected acute coronary syndromes: the IMMEDIATE randomized controlled trial. JAMA. 2012;307(18):1925–33. Ceremuzynski L, Budaj A, Czepiel A, Burzykowski T, Achremczyk P, Smielak-Korombel W, Maciejewicz J, Dziubinska J, Nartowicz E, Kawka-Urbanek T, Piotrowski W, Hanzlik J, Cieslinski A, Kawecka-Jaszcz K, Gessek J, Wrabec K. Low-dose glucose-insulin-potassium is ineffective in acute myocardial infarction: results of a randomized multicenter Pol-GIK trial. Cardiovasc Drugs Ther. 1999;13(3):191–200. Deedwania P, Kosiborod M, Barrett E, Ceriello A, Isley W, Mazzone T, Raskin P. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association diabetes Committee of the Council on nutrition, physical activity, and metabolism. Circulation. 2008;117(12):1610–9. Malmberg K, Ryden L, Wedel H, Birkeland K, Bootsma A, Dickstein K, Efendic S, Fisher M, Hamsten A, Herlitz J, Hildebrandt P, MacLeod K, Laakso M, Torp-Pedersen C, Waldenstrom A. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005;26(7):650–61. Cheung NW, Wong VW, McLean M. The hyperglycemia: intensive insulin infusion in infarction (HI-5) study: a randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care. 2006;29(4):765–70. Nerenberg KA, Goyal A, Xavier D, Sigamani A, Ng J, Mehta SR, Diaz R, Kosiborod M, Yusuf S, Gerstein HC. Piloting a novel algorithm for glucose control in the coronary care unit: the RECREATE (REsearching coronary REduction by appropriately targeting euglycemia) trial. Diabetes Care. 2012;35(1):19–24. Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, Krumholz HM. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation. 2005;111(23):3078–86. Pinto DS, Skolnick AH, Kirtane AJ, Murphy SA, Barron HV, Giugliano RP, Cannon CP, Braunwald E, Gibson CM. U-shaped relationship of blood glucose with adverse outcomes among patients with ST-segment elevation myocardial infarction. JACC. 2005;46(1):178–80. Trovati M, Anfossi G, Cavalot F, Vitali S, Massucco P, Mularoni E, Schinco P, Tamponi G, Emanuelli G. Studies on mechanisms involved in hypoglycemia-induced platelet activation. Diabetes. 1986;35(7):818–25. Suys B, Heuten S, De Wolf D, Verherstraeten M, de Beeck LO, Matthys D, Vrints C, Rooman R. Glycemia and corrected QT interval prolongation in young type 1 diabetic patients: what is the relation? Diabetes Care. 2006;29(2):427–9. Camici PG, Crea F. Coronary microvascular dysfunction. NEJM. 2007;356(8):830–40. Sundell J, Nuutila P, Laine H, Luotolahti M, Kalliokoski K, Raitakari O, Knuuti J. Dose-dependent vasodilating effects of insulin on adenosine-stimulated myocardial blood flow. Diabetes. 2002;51(4):1125–30. Sobrevia L, Nadal A, Yudilevich DL, Mann GE. Activation of L-arginine transport (system y+) and nitric oxide synthase by elevated glucose and insulin in human endothelial cells. J Physiol. 1996;490(Pt 3):775–81. Weaver WD, Cerqueira M, Hallstrom AP, Litwin PE, Martin JS, Kudenchuk PJ, Eisenberg M. Prehospital-initiated vs hospital-initiated thrombolytic therapy. The myocardial infarction triage and intervention trial. JAMA. 1993;270(10):1211–6. SWEET-ACS: intensified multifactorial intervention on hyperglycemic patients with acute coronary syndromes (trial did not complete) (2007). https://wwwclinicaltrialsregistereu/ctr-search/trial/2007–000543-98/ITed Despres JP. Abdominal obesity and cardiovascular disease: is inflammation the missing link? Can J Cardiol. 2012;28(6):642–52. Lexis CP, van der Horst-Schrivers AN, Lipsic E, Valente MA, Muller Kobold AC, de Boer RA, van Veldhuisen DJ, van der Harst P, van der Horst IC. The effect of metformin on cardiovascular risk profile in patients without diabetes presenting with acute myocardial infarction: data from the Glycometabolic intervention as adjunct to primary coronary intervention in ST elevation myocardial infarction (GIPS-III) trial. BMJ Open Diabetes Res Care. 2015;3(1):e000090. Liga RRD, Sampietro T, Vecoli C, Todiere G, Caselli C, Rossi G, L’Abbate A, Neglia D. Insulin resistance is a major determinant of myocardial blood flow impairment in anginal patients. Eur J Nucl Med Mol Imaging. 2013;40:1905–13. Sundell J, Laine H, Luotolahti M, Kalliokoski K, Raitakari O, Nuutila P, Knuuti J. Obesity affects myocardial vasoreactivity and coronary flow response to insulin. Obes Res. 2002;10(7):617–24. Sondergaard HM, Bottcher M, Marie Madsen M, Schmitz O, Hansen SB, Nielsen TT, Botker HE. Impact of type 2 diabetes on myocardial insulin sensitivity to glucose uptake and perfusion in patients with coronary artery disease. J Clin Endocrinol Metab. 2006;91(12):4854–61. Marano L, Bestetti A, Lomuscio A, Tagliabue L, Castini D, Tarricone D, Dario P, Tarolo GL, Fiorentini C. Effects of infusion of glucose-insulin-potassium on myocardial function after a recent myocardial infarction. Acta Cardiol. 2000;55(1):9–15. Bucciarelli-Ducci C, Bianchi M, De Luca L, Battagliese A, Di Russo C, Proietti P, Vizza CD, Fedele F. Effects of glucose-insulin-potassium infusion on myocardial perfusion and left ventricular remodeling in patients treated with primary angioplasty for ST-elevation acute myocardial infarction. Am J Cardiol. 2006;98(10):1349–53. Lesch M, Teichholz LE, Soeldner JS, Gorlin R. Ineffectiveness of glucose, potassium, and insulin infusion during pacing stress in chronic ischemic heart disease. Circulation. 1974;49(6):1028–37. Thadani U, Chiong MA, Parker JO. Effects of glucose-insulin-potassium infusion on the angina response during treadmill exercise. Cardiology. 1979;64(6):333–49. Timmer JR, Ottervanger JP, de Boer M-J, Dambrink J-HE, Hoorntje JCA, Gosselink ATM, Suryapranata H, Zijlstra F, van’t Hof AWJ, Zwolle Myocardial Infarction Study G. Hyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarction. JACC. 2005;45(7):999–1002. Lautamaki R, Airaksinen KE, Seppanen M, Toikka J, Harkonen R, Luotolahti M, Borra R, Sundell J, Knuuti J, Nuutila P. Insulin improves myocardial blood flow in patients with type 2 diabetes and coronary artery disease. Diabetes. 2006;55(2):511–6. Yellon DM, Downey JM. Preconditioning the myocardium: from cellular physiology to clinical cardiology. Physiol Rev. 2003;83(4):1113–51. Duncker DJ, Bache RJ. Regulation of coronary vasomotor tone under normal conditions and during acute myocardial hypoperfusion. Pharmacol Ther. 2000;86(1):87–110.