通心络对冠心病患者血清脂联素及血脂的影响

目的探讨通心络对冠心病患者血清脂联素、血脂的影响及安全性。方法选取在我院确诊的85例冠心病合并高脂血症患者,随机分为通心络组45例(通心络0.79 g,每日3次,辛伐他汀20 mg,每晚1次口服),对照组40例(仅给予辛伐他汀20 mg,每晚1次口服),其他治疗2组无差异,观察治疗前后血脂及血清脂联素水平,并检测患者肝肾功能变化。结果 (1)治疗4周后2组血清脂联素水平均较治疗前升高,通心络组升高更为明显(P<0.05);总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)水平均下降,通心络组下降更为明显(P<0.05);(2)血清脂联素变化与LDL-C变化呈负相关(通心络组:r=0.719,P<0.01,对照组:r=0.668,P<0.05)。(3)2组不良反应情况差异无统计学意义(P>0.05)。结论辛伐他汀可升高血清脂联素水平,降低TC及LDL-C浓度,加用通心络后效果更加明显,且药物安全性好;LDL-C与脂联素的变化呈负相关。     

老年高血压病患者脂联素与白细胞介素-6、超敏C反应蛋白的相关性研究

目的探讨老年高血压病患者血清脂联素(APN)与白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)的相关性。方法选择老年高血压病患者(高血压病组64例,其中高血压1级亚组23例,2级亚组21例,3级亚组20例)。老年健康体检者(健康对照组25例),采用酶联免疫法测定APN、IL-6水平,免疫比浊法测定hs-CRP水平。结果高血压病组APN浓度[(7.8±5.6)mg/L]低于健康对照组[(9.9±3.3)mg/L](P<0.05),而IL-6水平[(59.9±7.5)ng/ml]、hs-CRP水平[(5.9±2.0)mg/L]高于健康对照组[分别为(18.7±5.4)ng/ml和(2.4±1.4)mg/L],差异均有统计学意义(P<0.05);且高血压2级、3级亚组与1级亚组比较差异亦有统计学意义(P<0.05)。相关性分析表明,APN与IL-6、hs-CRP呈负相关(分别为r=-0.577,P<0.05;r=-0.582,P<0.05)。结论老年高血压病患者的APN降低,IL-6、hs-CRP升高,APN与IL-6、hs-CRP呈负相关。     

The development of microalbuminuria is associated with raised longitudinal adiponectin levels in female but not male adolescent patients with type 1 diabetes

AIMS/HYPOTHESIS: We determined the longitudinal relationship between adiponectin levels and the development of microalbuminuria in an inception cohort of children with type 1 diabetes. METHODS: Blood samples collected annually over a median of 9.0 (range 1.3-14.9) years were assayed for adiponectin and HbA(1c) in 55 children (36 girls) with type 1 diabetes and microalbuminuria whose age of onset of diabetes was 9.4 years (range 2.2-15.4). Samples were also assayed from normoalbuminuric children (controls) matched for age, sex and duration of diabetes. RESULTS: Overall, adiponectin levels were higher in girls than in boys, but only after 11 years of age (median [range]: 15.3 [5.8-124.4] vs 11.6 [4.1-26.5] mg/l, p < 0.001). Furthermore, adiponectin levels were higher in girls with microalbuminuria than in control girls, but this was only apparent after the onset of microalbuminuria (p = 0.001, adjusted for BMI, daily insulin dose, HbA(1c) and age). In boys, adiponectin levels did not differ between those with microalbuminuria and controls. Further sex-related discordant associations with adiponectin levels were observed; in girls, adiponectin levels were positively related to HbA(1c) levels (r = 0.2, p = 0.05) and urine albumin excretion (r = 0.3, p < 0.05) and inversely related to BMI (r = -0.2, p < 0.05). These associations were absent in boys. CONCLUSIONS/INTERPRETATION: In adolescent girls with type 1 diabetes but not in boys, adiponectin levels increase with increasing urine albumin excretion and onset of microalbuminuria. Although causal links cannot be inferred, this sexual dimorphism may reflect interactive effects of hyperglycaemia and sex steroids on risk of complications and adiponectin production.     

Adiponectin and the cardiovascular system: from risk to disease

Adiponectin is known to play a role in fatty acid and glucose metabolism through a change in insulin sensitivity and activation of fuel oxidation by AMP-activated protein kinase. Adiponectin can be considered an important factor able to modulate the adipovascular axis which, through genomic and environmental influences, affects the cardiovascular risk milieu, from the pre-metabolic syndrome — through the metabolic syndrome — to the overt atherosclerotic process and its clinical manifestations. Hypoadiponectinaemia can be viewed as an early sign of a complex cardiovascular risk factor predisposing to the atherosclerosis process as well as a contributing factor accelerating the progress of the atherosclerotic plaque. In addition, adiponectin per se holds a protective role thanks to its anti-inflammatory and antiatherogenic properties. The early identification of patients “at cardiovascular risk” means in the current practice to search for indexes of metabolic derangements and pro-inflammatory status (adiponectin) from adolescence and childhood.     

Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes

Aims/hypothesis Adipokines may be important in mediating signals from adipocytes to insulin-sensitive tissue and vasculature. We studied the effect of different glucose-lowering therapies on serum levels of plasminogen activator inhibitor-1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), TNF-α, leptin, adiponectin and ghrelin in patients with type 2 diabetes.Subjects and methods Twenty-eight patients with poorly controlled type 2 diabetes who were receiving oral hypoglycaemic agents were allocated to one of the following groups, and treated for 1 year: (1) lifestyle intervention (L); (2) insulin treatment (I); and (3) combined treatment (L+I).Results Similar improvements in glycaemic control occurred in all three groups. There was a reduction in body weight of 3.0 kg (median) (95% CI −5.9 to −2.0) in group L, whereas in groups L+I and I body weight increased by 3.5 kg (95% CI 1.5–4.9) and 4.9 kg (95% CI −3.1 to 8.2), respectively. By trend analyses, group L had reduced levels of PAI-1 (p=0.002), hs-CRP (p<0.0001) and TNF-α (p=0.006), while no significant changes were observed in the levels of leptin or adiponectin. In group I, the median levels of PAI-1 (p=0.008), TNF-α (p=0.058) and leptin (p=0.004) increased. In the L+I group there was a reduction in PAI-1 levels (p=0.014) and an increase in levels of leptin (p<0.001). The differences in changes in the levels of PAI-1, hs-CRP, TNF-α and leptin between groups were also significant (all p<0.01).Conclusions/interpretation Improvement of glycaemic control through lifestyle intervention in type 2 diabetes had more beneficial effects on adipokine levels than when the same lowering of HbA_1c was achieved with insulin treatment.Electronic Supplementary Material Supplementary material on this article is available at     

Globular adiponectin augments insulin secretion from pancreatic islet beta cells at high glucose concentrations

Adiponectin plays an important role in improving insulin resistance and preventing atherosclerosis. However it has been rarely reported that adiponectin influences insulin secretion because its receptor was identified in human islet β cells. In order to investigate the direct effect of adiponectin on pancreatic islet β cells, we performed an insulin secretion test in purified rat islets, which were incubated with adiponectin (100 ng/mL) at low (3.3 mM) and high (16.7 mM) glucose concentrations. Furthermore, cell lysates were extracted from the adiponectin-treated islets for p-AMPKα assay. RTPCR and immunohistochemical examination showed both adiponectin receptor 1 (AdipoR1) and receptor 2 (A dipoR2) were expressed in islet cells and AdipoR1 was predominantly expressed. Insulin secretion was significantly increased in the presence of adiponectin for 6 h at high glucose concentration. Meanwhile, the levels of phosphorylated AMPK increased with adiponectin treatment at high glucose concentrations. It is concluded that adiponectin augments insulin secretion from pancreatic islet β cells at high glucose concentration through AMPK activation.     

老年高血压和代谢综合征血清脂联素水平变化及其意义

目的:探讨老年高血压和代谢综合症患者血清脂联素水平变化及其意义。方法:60例老年高血压患者、62例老年代谢综合症患者和30例正常老年对照者,检测血压、体重、身高、腰围、空腹血糖、胰岛素、游离脂肪酸、血清脂联素、高敏C反应蛋白、尿素氮、肌酐,计算体重指数,测尿微量蛋白。结果:(1)高血压组和代谢综合症组脂联素水平明显低于正常对照组(P<0.05),体重指数、腹围、尿微量蛋白、游离脂肪酸、血糖、胰岛素、肌酐水平均高于对照组(P<0.05);(2)直线相关分析表明,血清脂联素水平与血压、尿微量蛋白、体重指数、腰围均成负相关(r=-0.230~-0.304,P<0.05~<0.01)。结论:代谢综合症和单纯高血压老年患者脂联素水平降低,且脂联素水平与血压、BMI、腰围及尿微量蛋白呈负相关。     

代谢综合征不同组分患者血清脂联素与游离脂肪酸谱代谢参数的比较

目的研究代谢综合征（MS）患者血清脂联素水平、游离脂肪酸（FFA）谱特征及与其他糖脂代谢参数间的关系。方法用放射免疫分析法测定157例含MS不同组分的患者与43例正常对照（NC）组血清脂联素水平，同时用气相色谱/质谱（GC/MS）联用法测定其血清FFA成分。结果MS组分≥3项组患者血清脂联素水平低于MS组分两项组与NC组（P〈0.05～0.01）。同时，MS组分≥3项组患者平均血压（MBP）、BMI、WC、TG、不饱和脂肪酸（UFA）（C18：2;C20：4;C22：6;C20：3）、多不饱和脂肪酸（PUFA）、n6PUFA等高于MS组分两项组与NC组（P〈0.05～0.01），HDL-C低于MS组分两项组与NC组（P〈0.01）。在研究对象中，脂联素与BMI、WC、TG呈负相关（r=-0.204，-0.203，-0.238，P〈0.01），与HDL-C呈正相关（r=0.238，P〈0.01）。总FFA（TFFA）、PUFA均与BMI、MBP、FPG、TG呈正相关（r=0.163和0.211，0.201和0.288，0.184和0.276，0.274和0.155，P〈0.05～0.01）。结论脂联素与FFA均与MS多种组分相关。脂联素与FFA代谢紊乱、n6系PUFA升高可能在MS发病中起重要作用。     

血清脂肪细胞型脂肪酸结合蛋白及脂联素水平与冠心病的相关性

目的 探讨脂肪细胞型脂肪酸结合蛋白(A-FABP)、脂联素和A-FABP/脂联素比值与冠心病及冠状动脉病变程度的相关性.方法 经冠状动脉造影入选340例患者,分为冠心病组(211例)和非冠心病对照组(129例),用ELISA法测定血清AFABP及脂联素水平,冠状动脉病变程度用病变血管支数和Gensini积分表示.并从上述患者中选取年龄、性别、体质指数相匹配的冠心病及非冠心病者各10例,分离外周血单核细胞,佛波酯刺激为巨噬细胞后取培养上清,用ELISA法测定培养上清液A-FABP及脂联素浓度.结果 (1)冠心病组血清A-FABP水平[18.3(13.2,22.8)μg/L]较非冠心病组[16.4(13.5,20.4)μg/L]高,但差异未达到统计学意义(P=0.088);冠心病组血清脂联素水平低于非冠心病组[13.9(9.8,17.1)mg/L比19.7(14.5,27.6)mg/L,P＜0.05].(2)随着冠状动脉病变支数的增加,血清A-FABP水平呈升高、脂联素水平呈递减趋势;Gensini积分与血清A-FABP呈正相关(r=0.120,P=0.043),与脂联素呈负相关(r=-0.405,P=0.007).(3)冠心病组血清A-FABP/脂联素比值明显高于非冠心病组[(1.51±0.79)μg/mg比(0.89±0.30)μg/mg,P＜0.01];血清A-FABP/脂联素比值与Gensini积分的相关性更明显(r=0.531,P=0.000).(4)冠心病者单核源性巨噬细胞A-FABP/脂联素比值高于非冠心病者[(0.51±0.19)μg/mg比(0.36±0.11)μg/mg,P＜0.05].结论 高A-FABP和低脂联素水平可能是反映严重冠状动脉狭窄的新的血清标记物.A-FABP/脂联素比值较单独A-FABP或脂联素与冠状动脉病变的相关性更好.     

肿瘤坏死因子-α、白细胞介素-6和脂联素与2型糖尿病胰岛素抵抗的关系

目的 研究2型糖尿病（T2DM）患者肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和脂联素与胰岛素抵抗的关系.方法 选择80例T2DM患者（T2DM组）和40例健康体检者（对照组）,测定各组空腹血清TNF-α,IL-6和脂联素水平,同时分别测定各组患者体质量指数（BMI）、空腹血糖、血清胰岛素水平,计算胰岛素抵抗指数（HOMA-IR）.结果 T2DM组TNF-α、IL-6水平均明显高于对照组,脂联素水平明显低于对照组（均P＜0.05）.在T2DM组中,TNF-α和IL-6均与HOMA-IR呈正相关（P＜0.01,P＜0.05）,脂联素与HOMA-IR呈负相关（P＜0.01）.结论 IL-6、TNF-α及脂联素参与了2型糖尿病的发病过程,与胰岛素抵抗密切相关.