合并OSAHS的老年急性脑梗死患者同型半胱氨酸和胰岛素抵抗临床分析

目的研究合并阻塞性睡眠呼吸暂停综合征(OSAHS)的老年急性脑梗死(ACI)患者血清同型半胱氨酸(Hcy)及稳态模型胰岛素抵抗指数(HOMA-IR)水平,分析老年ACI患者OSAHS、Hcy和HOMA-IR相互关系。方法根据年龄和睡眠呼吸监测数据,将患者分为老年ACI+OSAHS组(n=21)、老年ACI组(n=30)、中年ACI+OSAHS组(n=28)和中年ACI组(n=34),检测并比较各组血清Hcy、胰岛素抵抗指数(HOMA-IR)等各指标。结果老年ACI+OSAHS组较其余3组的Hcy和HOMA-IR均升高,差异有统计学意义(P0.05);中年ACI+OSAHS组较中年ACI组Hcy和HOMA-IR增高,差异有统计学意义(P0.05)。Hcy与年龄、AHI、平均腰围、BMI、HOMAIR均呈正相关;多元线性回归分析显示AHI与年龄、Hcy、HOMA-IR、BMI呈正相关。结论随年龄的增加,合并OSAHS的急性脑梗死患者Hcy和HOMA-IR水平随之升高;OSAHS可能通过升高Hcy及增加胰岛素抵抗导致ACI。     

吡格列酮对STZ诱导糖尿病大鼠肌肉组织胰岛素抵抗的作用

[目的]观察吡格列酮（Pioglitazone,Piog）对DM大鼠肌肉组织的病理学影响以及免疫球蛋白在肌肉组织表达的变化,探讨其是否通过免疫调节机制来减轻胰岛素抵抗（Insulin resistance,IR）。[方法]雄性SD大鼠72只,由链脲佐菌素（streptozocin,STZ）诱导造成DM模型后随机分为Piog干预组（Piog组）、环孢菌素A干预组（CsA组）、无干预组（DM组）,每组24只。另取24只雄性SD大鼠设为正常对照组（NOR组）。所有大鼠给药16周后处死。处死前测定各组大鼠空腹血糖和胰岛素,计算胰岛素抵抗指数HOME-IR。对各组大鼠的肌肉组织,采用HE染色、Mallory氏磷钨酸苏木素染色法观察的病理学改变;免疫组织化学法观察免疫球蛋白的异常沉积。[结果]与NOR组相比,DM组血糖和HOME-IR明显升高。Piog能明显降低HOME-IR。与NOR组相比DM组大鼠肌肉组织肌纤维束明显变窄,肌纤维间的间隙变大,间质增生,肌纤维局部有空泡样改变;Piog组大鼠肌肉组织组的病理学与正常组接近,与CsA组无明显差别。NOR组IgA、IgG和IgM在肌肉组织中均无明显阳性表达,DM组大鼠组有较强的阳性表达,Piog组也有阳性表达,但明显低于DM组。[结论]DM大鼠肌肉组织存在IR和免疫损伤。Piog能明显改善DM大鼠肌肉组织的病理学结构,并减少免疫球蛋白在肌肉组织的表达和沉积,对DM大鼠肌肉组织的免疫损伤具有明显保护作用。     

多囊卵巢综合征患者血清脂肪细胞因子与胰岛素抵抗的相关性研究

目的 探讨PCOS患者血清脂肪细胞因子与胰岛素敏感性的相关性.方法 将PCOS患者60例分为肥胖组PCOS36例、非肥胖组PCOS24例,将同期就诊的男方因素不孕症患者(正常体重)26例作对照组.进行内分泌代谢指标测定,采用空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)评估胰岛素敏感性;并应用酶联免疫吸附法测定血清游离脂肪酸(FFA)、瘦素及C反应蛋白(CRP),放射免疫法测定血清脂联素(APN)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6.结果 (1)肥胖组PCOS的血清APN为(10±7)mg/L,低于非肥胖组PCOSE(17±9)mg/L]和对照组,均P＜0.01;FFA为(548±105)μmol/L,高于非肥胖组PCOS[(427±67)μmoL/L]和对照组,P＜0.01;血清瘦素水平为(42±21)μg/L,高于非肥胖组PCOS[(24±13)μg/L]和对照组,均P＜0.01.非肥胖组PCOS与对照组间APN、FFA和瘦素差异无统计学意义.血清IL-6肥胖组PCOS[(173 4-184)ng/L]和非肥胖组PCOS[(184±44)ng/L]均高于对照组(P＜0.05、P＜0.01);血清TNF-α非肥胖组PCOS[(0.97±0.33)μg/L]和肥胖组PCOS[(0.82 4-0.21)μg/L]均高于对照组(P＜0.01,P＜0.05);非肥胖组PCOS TNF-α高于肥胖组(P＜0.05).非肥胖组和肥胖组的PCOS患者血清中CRP高于对照组,但差异无统计学意义(P＞0.05).(2)瘦素与人体质量指数(BMI)、腰臀比及HOMA-IR呈正相关(P＜0.01),APN与BMI、腰臀比及HOMA-IR呈负相关(P＜0.01).(3)BMI和TNF-α是FINS的独立影响因素,APN是除FINS、空腹血葡萄糖、BMI外,对HOMA-IR的独立影响因素.结论 炎性因子可能参与了非肥胖型PCOS患者IR的发生;而肥胖型PCOS IR的进一步加重可能与其脂肪组织分泌瘦素、FFA增多及分泌APN减少相关.     

高脂喂养apoE~(-/-)小鼠组织成纤维细胞生长因子21及其受体的改变

目的 探讨在环境和遗传因素共同诱导的胰岛素抵抗状态下组织成纤维细胞生长因子21(FGF-21)及其受体(FGFR)的变化.方法 雄性apoE~(-/-)小鼠,随机分为普通喂养组(NF组,n=20)和高脂喂养组(HF组,n=20),喂养16周.以3-[~3H]-葡萄糖为示踪剂的扩展胰岛素钳夹技术评价小鼠胰岛素敏感性和糖代谢变化.用实时荧光定量PCR法检测肝脏和脂肪组织FGF-21、FGFR1、FGFR2、FGFR3和FGFR4以及β-klotho mRNA表达,用Western印迹法测定血浆和组织FGF-21蛋白水平.结果 HF组小鼠空腹血糖、血浆胰岛素、甘油三酯、游离脂肪酸和胆固醇水平明显升高(均P<0.01).在钳夹稳态时,HF组血浆胰岛素水平明显高于NF组(P<0.01),HF组葡萄糖输注率(GIR)明显低于NF组(P<0.01).在钳夹结束时,HF组葡萄糖清除率(G_(Rd))明显低于NF组(P<0.01).钳夹稳态期,NF和HF组肝糖输出率(HGP)分别被抑制约70%和51%(均P<0.01).HF组肝和脂肪组织FGF-21和β-klotho mRNA水平均明显高于NF组(均P<0.01).HF组肝和脂肪组织FGFR1和FGFR3 mRNA的表达明显较NF组显著增高(P<0.01和P<0.05).FGFR4 mRNA水平在HF组肝组织中的表达明显高于NF组(P<0.05).HF组血浆FGF-21蛋白水平明显高于NF组(P<0.01),肝和脂肪组织FGF-21蛋白水平也显著升高(均P<0.05).结论 高脂喂养apoE~(-/-)小鼠FGF-21、β-Klotho及FGFR1和FGFR3水平显著升高,它们可能是FGF-21调节糖脂代谢的主要作用靶点.     

Nonalcoholic fatty liver disease in asymptomatic Brazilian adolescents

AIM： To evaluate the prevalence and clinical characteristics of Nonalcoholic fatty liver disease （NAFLD） among asymptomatic Brazilian adolescents. METHODS： Transversal observational study included asymptomatic adolescents with central obesity from private and public schools in Salvador-Bahia, northeastern Brazil. The children answered a questionnaire that in- cluded age, gender, race, and medical history, and were submitted to a complete physical exam and abdominal ultrasound. Biochemical exams included： ALT, AST, GGT, C reactive protein （CRP）, fasting glucose, insulin, cholesterol and triglycerides. Criteria for NAFLD included： the presence of steatosis in ultrasound and/or high level of ALT, negative or occasional historic of intake of alcohol （4 140 g/wk）, negative investigation for hepatitis A, B, C, auto-immune hepatitis, Wilson disease and hemochro-matosis.RESULTS： From October, 2005 to October, 2006, the study included 1801 subjects between 11 and 18 years of age and a mean age of 13.7± 2.0 years. One hun- dred ninety-nine had central obesity. The prevalence of NAFLD was 2.3%, most of whom were male and white. Insulin resistance （IR） was observed in 22.9% of them and had positive correlations with ALT and GGT （P 〈 0.05）. Elevated CRP was observed in 6.9% of the cases; however, it was not associated with WC, IR or liver enzymes. CONCLUSION： The prevalence of NAFLD in Brazilian adolescents was low. The ethnicity may have influence this frequency in the population studied, which had a large proportion of African descendents.     

Early diabetic neuropathy： Triggers and mechanisms

Peripheral neuropathy, and specifically distal peripheral neuropathy (DPN), is one of the most frequent and troublesome complications of diabetes mellitus. It is the major reason for morbidity and mortality among diabetic patients, It is also frequently associated with debilitating pain. Unfortunately, our knowledge of the natural history and pathogenesis of this disease remains limited. For a long time hyperglycemia was viewed as a major, if not the sole factor, responsible for all symptomatic presentations of DPN. Multiple clinical observations and animal studies supported this view. The control of blood glucose as an obligatory step of therapy to delay or reverse DPN is no longer an arguable issue. However, while supporting evidence for the glycemic hypothesis has accumulated, multiple controversies accumulated as well.It is obvious now that DPN cannot be fully understood without considering factors besides hyperglycemia. Some symptoms of DPN may develop with little, if any, correlation with the glycemic status of a patient. It is also clear that identification of these putative non-glycemic mechanisms of DPN is of utmost importance for our understanding of failures with existing treatments and for the development of new approaches for diagnosis and therapy of DPN. In this work we will review the strengths and weaknesses of the glycemic hypothesis, focusing on clinical and animal data and on the pathogenesis of early stages and triggers of DPN other than hyperglycemia.     

Déficits en micronutriments dans le surpoids et l’obésité : conséquences métaboliques et cliniques

Due to deleterious dietary habits, micronutrient deficiencies occur frequently in overweight or obesity. These deficiencies are involved in obesity-induced metabolic alterations such as insulinresistance (zinc, selenium, chromium, vitamin C, vitamin D), inflammation (zinc, selenium, iron, vitamin D), oxidative stress (zinc, selenium, vitamin C, vitamin E, carotenoids) while vitamin B, vitamin D and iron deficiencies result in decreased energetic rate and vitamin B9 and B12 low status in altered methyl cycle. Consequently, the risk of diabetes type 2, cardiovascular or inflammatory or neurodegenerative diseases is increased. To identify and take in charge micronutrient deficiencies in obese or overweight patients should be systematic despite the lack of specific nutritional recommendations for obese individuals who represent an increasing segment of the general population, with a special focus on bariatric surgery candidates.     

Leptin to adiponectin ratio – A surrogate biomarker for early detection of metabolic disturbances in obesity

Aim

To study if the leptin to adiponectin (L:A) ratio, can be a potential biomarker for postprandial triglyceride clearance, insulin resistance (IR) or leptin resistance (LR) in apparently healthy obese, and obese individuals with established metabolic disease.

2型糖尿病患者体脂分布与胰岛素抵抗及下肢血管病变的关系

目的应用双能x线吸收法（DEXA）测量2型糖尿病患者体脂分布情况并分析其与胰岛素抵抗、下肢血管病变的关系。方法选取2010年12月至2011年5月山西省人民医院内分泌科住院或门诊收治的2型糖尿病患者123例作为观察组,测量其腰围、身高、体重、血压,使用DEXA测量躯干脂肪比例,检测空腹胰岛素（FINS）、空腹血糖（FPG）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、糖化血红蛋白（HbAle）,并与同期健康体检的112名健康人（对照组）做横断面对照。根据是否患有糖尿病和是否肥胖将总体对象分为4组：肥胖糖尿病组（DMOB组,78例,男41例,女37例）、非肥胖糖尿病组（DMNOB组,45例,男23例,女22例）、肥胖对照组（OB组,69名,男35名,女34名）及非肥胖对照组（NOB组,43名,男21名,女22名）。计量资料比较行独立样本t检验,采用多重线性回归分析评估腰围、体质指数（BMI）、躯干脂肪比例对稳态模型胰岛素抵抗指数（HOMA-IR）的影响。结果DMOB、DMNOB、OB、NOB组躯干脂肪比例分别为38％±4％、24％±6％、38％±5％、26％±6％。DMOB组HOMA-IR均较DMNOB、OB、NOB组显著增高,差异有统计学意义（分别为2．1±1．0、1．6±0．8、1．6±0．4、1．3±0．4,F=1．518,P〈0．05）;DMOB组收缩压（SBP）、舒张压（DBP）、TC、TG均较DMNOB组增高（t=2．173～3．058,均P〈0．05）。DMNOB组DBP、HbAlc、TC、TG及LDL-C均较OB及NOB组增高（F=0．569～47．704,均P〈0．05）。多重线性回归分析发现观察组BMI、躯干脂肪比例均为HOMA-IR的影响因素（OR=1．749、1．987,均P〈0．05）。Spearman相关性分析显示躯干脂肪比例、腰围、BMI、SBP、糖尿病病程、TG、LDL-C、HbAle、FPG、FINs、HOMA-IR与糖尿病患者下肢血管病变的严重程度呈正相关（r=0．232-0．470,均P〈0．05）。结论DEXA测量的躯干脂肪比例可评价腹型肥胖,其在一定程度上影响2型糖尿病患者胰岛素抵抗的程度,且与2型糖尿病患者下肢血管病变程度相关。     

妊娠期糖尿病血清视黄醇结合蛋白4和胰岛素抵抗指数变化的相关性

目的：探讨妊娠期糖尿病（GDM）血清视黄醇结合蛋白4（RBP4）的表达变化及其与胰岛素抵抗指数的关系。方法选择在上海市浦东医院门诊行常规产前检查并分娩的GDM孕妇35例（GDM组）,根据治疗方式分为改善饮食组20例和胰岛素组15例。选择同期在本院门诊产前检查并住院分娩正常孕妇30例（对照组）。分别测定3组血清RBP4,空腹血糖（FPG）和空腹胰岛素（FINS）水平,并计算稳态模型的胰岛素抵抗指数（HOMA-IR）,研究RBP4和HOMA-IR的相关性。结果 GDM组BMI、新生儿出生体重、血清RBP4、FINS、FPG及HOMA-IR[（27.6±2.1）kg/cm2、（3.6±0.5）kg、（29.1±1.4）mg/L、（11.6±2.3）mU/L、（5.3±1.4）mmol/L、（3.1±0.4）]高于对照组[（26.7±1.2）kg/cm2、（3.4±0.6）kg、（19.6±1.9）mg/L、（8.0±0.7）mU/L、（4.7±0.8）mmol/L、（1.7±0.2）];胰岛素组BIM、血清RBP4、FINS水平及HOMA-IR[（28.2±2.7）kg/cm2、（30.0±1.4）mg/L、（13.1±3.6）mU/L、（3.8±0.4）]均高于改善饮食组[（27.3±1.5）kg/cm2、（28.1±1.4）mg/L、（10.8±1.8）mU/L、（2.4±0.3）];差异均有统计学意义。血清RBP4和HOMA-IR正相关（r＝0.486）。结论 GDM血清RBP4水平和胰岛素抵抗密切相关。