抵抗素与胰岛素抵抗及2型糖尿病微血管病变的关系

目的 探讨血浆抵抗素与胰岛素抵抗及2型糖尿病微血管病变之间的相互关系.方法 随机抽选60例临床确诊的2型糖尿病患者,按有无微血管并发症分为2组:微血管并发症组30例和无微血管并发症组30例,以24例同期体检的健康志愿者作为对照组.采用双抗体夹心酶联免疫吸附试验测定所选84例实验对象的血浆抵抗素浓度,放射免疫分析法测定胰岛素,氧化酶法测定血糖,全自动生化分析仪检测血脂.结果 (1)微血管并发症组组血浆抵抗素浓度高于无微血管并发症组及对照组(P<0.05)差异有统计学意义;(2)60例病例的Pearson相关分析得出:血浆抵抗素浓度与FINS、HbAlc、HOMA-IR、TC、LDL-C正相关,与FPG、TG、BMI、HDL-C均无相关性.结论 空腹血浆抵抗素水平在2型糖尿病有微血管病变者中显著升高,并与2型糖尿病患者血糖控制不良的程度有关、与2型糖尿病脂代谢紊乱相关,在2型糖尿病微血管病的发生、发展中可能起一定作用.     

不同糖耐量人群及糖尿病患者血浆内脂素与血糖及胰岛功能的关系研究

目的探讨不同糖耐量人群血浆内脂素的变化及其与体重指数(BMI)、腰围、血糖、胰岛素抵抗指数、胰岛B细胞功能、血脂等的关系。方法2006年4月至2006年10月在南京医科大学第一附属医院门诊常规健康体检及糖尿病初次就诊者95名,按WHO1999糖尿病诊断标准分为初诊2型糖尿病组(53例)、糖耐量减退组(7例)、正常糖耐量组(35名);以WHO1998肥胖诊断标准分为超重或肥胖组(50名)、正常体重组(45名)。检测受试者BMI、腰围、血压,测定空腹血浆内脂素、血糖、血脂、胰岛素等。结果初诊2型糖尿病患者空腹血浆内脂素明显高于正常糖耐量组(P<0.01)。超重或肥胖组与正常体重组间血浆内脂素差异无显著性意义。人群中血浆内脂素与空腹血糖(r=0.338,P<0.01)、餐后2h血糖(r=0.340,P<0.01)、胰岛素抵抗指数(r=0.227,P<0.05)呈正相关,与胰岛素分泌指数(HOMA-B)呈负相关(r=-0.296,P<0.05)。在2型糖尿病组,血浆内脂素与糖化血红蛋白(HbA1c)呈正相关(r=0.356,P<0.01)。多元线性逐步回归分析表明,餐后2h血糖是影响血浆内脂素的独立相关因素。结论初诊2型糖尿病患者血浆内脂素显著升高,可能是机体针对体内血糖增高、胰岛功能受损所发生的一种代偿效应。     

2型糖尿病合并高尿酸血症患者动脉粥样硬化的影响因素

目的研究2型糖尿病合并高尿酸血症(HUADM)患者颈动脉内膜中层厚度(IMT)与脂联素、C反应蛋白(CRP)的关系。方法选择2型糖尿病患者85例,按血尿酸水平分为:HUADM组43例、血尿酸正常糖尿病(NUADM)组42例,分析2组空腹血糖(FPG)、空腹胰岛素(FINS)、脂联素、CRP、糖化血红蛋白(HbA1c)及餐后2h血糖、餐后2h胰岛素,IMT,计算胰岛素抵抗指数(HOMA-IR),并且进行多元逐步回归分析。结果与NUADM组比较,HUADM组患者FPG、餐后2h血糖、FINS、餐后2h胰岛素、HbA1c、IMT、尿酸和lgHOMA-IR均明显升高,脂联素明显降低(P0.05,P0.01)。HUADM组患者IMT与HOMA-IR、TG、LDL-C和CRP呈正相关,与脂联素呈负相关。结论 HUADM患者存在更明显的代谢紊乱和胰岛素抵抗,且血清脂联素水平降低,CRP水平升高,提示更容易发生动脉粥样硬化。     

Insulin resistance, beta-cell function, and glucose tolerance in Brazilian adolescents with obesity or risk factors for type 2 diabetes mellitus

OBJECTIVE: To evaluate insulin resistance (IR), beta-cell function, and glucose tolerance in 119 Brazilian adolescents with obesity or risk factors (RF) for type 2 diabetes mellitus (T2DM). STUDY DESIGN: We analyzed weight (kg), height (m), body mass index (BMI; kg/m(2)), waist (W; cm), acanthosis nigricans (AN), systolic and diastolic blood pressure (SBP and DBP; mm Hg), fasting plasma glucose (FPG), and 2-h plasma glucose (2hPG) on oral glucose tolerance test (OGTT; 1.75 g of glucose/weight), lipid profile [total cholesterol (TC), fractions, and triglycerides (TGs)], fasting insulin (FI) and 2-h insulin on OGTT (2hI-RIA), HOMA-B (%; beta-cell function--HOMA program), HOMA-S (%; insulin sensitivity--HOMA program) and HOMA-IR [fasting plasma insulin (mU/ml)xfasting plasma glucose (mmol/L)/22.5]. Division according to number of RF-family history of T2DM (FHT2DM), obesity, hypertension, dyslipidemia, polycystic ovary syndrome (PCOS), and AN. G1: subjects with no or one RF; G2: subjects with two or more RFs. Statistical data were nonparametrical. RESULTS: Fasting plasma glucose (G2: 81.6+/-10.2 vs. G1: 79.8+/-9.9 mg/dl) and 2hPG (88.1+/-18.0 vs. 87.0+/-19.9 mg/dl) were not different between G2 (n=67) and G1 (n=52), and all adolescents had normal glucose tolerance (NGT). Fasting insulin (13.0+/-7.9 vs. 7.6+/-3.9 microIU/ml; P<.001) and 2hI (60.2+/-39.1 vs. 38.3+/-40.0 microIU/ml; P<.001), HOMA-B (169.1+/-131.6% vs. 106.1+/-39.9%; P<.001), and HOMA-IR (2.62+/-1.7 vs. 1.52+/-0.8; P<.001) were higher in G2. HOMA-S (92.5+/-59.5% vs. 152.2+/-100.5%; P<.001) was also lower in this latter group. CONCLUSION: Brazilian adolescents with two or more RFs for the development of T2DM have higher IR and beta-cell function and lower insulin sensitivity. However, adolescents with impaired glucose tolerance (IGT) or DM have not been found, differently from similar studies. Differences in ethnic background, environment, and lifestyle factors may account for this disparity.     

2型糖尿病患者血清内脏脂肪素水平及其影响因素

目的探讨2型糖尿病（T2DM）患者血清内脏脂肪素水平的变化及其影响因素。方法选择T2DM患者47例,健康对照（NGT）35名,测定受试者一般临床及生化指标,酶联免疫吸附法（ELISA）测定空腹血清内脏脂肪素水平,并分析各指标的关系。结果与NGT组相比,T2DM组内脏脂肪素水平明显升高（70．43±20．710g／Lw98．48±22．37μg／L,P〈0．01）;相关性研究显示,内脏脂肪素水平与腰围、臀围、腰臀比、空腹血糖、HbA1c均呈正相关;多元线性逐步回归分析表明,腰围和空腹血糖是影响内脏脂肪素水平的独立相关因素。结论T2DM患者空腹血清内脏脂肪素水平升高,血清内脏脂肪素可能在T2DM发生发展中起一定的作用。     

2型糖尿病患者应用甘精胰岛素治疗前后内脏脂肪素水平的变化

目的探讨应用甘精胰岛素治疗的2型糖尿病患者血浆内脏脂肪素（Visfatin）水平的变化与胰岛素抵抗及血糖的关系。方法共32例2型糖尿病患者,比较其治疗前后空腹（FPG）及餐后血糖（2hPG）、甘油三酯（TG）、糖化血红蛋白（HbA1c）、空腹胰岛素（Fins）、胰岛素抵抗指数（HOMA-IR）、胰岛素分泌指数（HOMA-β）、Visfatin等相关指标。同时选择性别、年龄等相匹配的26名健康体检者作为对照组进行比较。结果32例糖尿病患者治疗前后的TG、FPG、2hPG、HbA]C、HOMA-IR、HOMA-13差异有统计学意义（P〈0．05）,治疗后Visfatin水平降低（P〈0．05）,与健康人相比,糖尿病患者Visfatin水平降低（Pd0．01）;Pearson相关分析显示Visfatin与HbA1C、Fins、HOMA-IR呈正相关（r=0．259,Pd0．05;r=0．586,P〈0．01;r=0．385,P〈0．01）。多元线性逐步回归分析表明HOMA-IR是血浆Vis—fatin的独立相关因素。结论2型糖尿病患者血浆Visfatin水平的变化与胰岛素抵抗及平均血糖有关,可能在糖尿病及胰岛素抵抗的发病机制中具有一定的作用。     

2型糖尿病合并冠心病患者血清内脂素和视黄醇结合蛋白4的临床意义

目的探讨血清内脂素(visfatin)和视黄醇结合蛋白4(RBP4)水平与2型糖尿病(T2DM)合并冠心病(CHD)的临床意义。方法选取单纯T2DM(T2DM组)患者61例、T2DM合并CHD(T2DM+CHD组)患者58例、单纯CHD(CHD组)患者60例、门诊健康体检者(对照组)60例,检测各组血清内脂素、RBP4水平、空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,HbA1c和空腹血清胰岛素(FINS),计算胰岛素抵抗指数(HOMA-IR)、体重指数(BMI)及腰臀比(WHR),并作相关性分析。结果 T2DM+CHD组血清内脂素和RBP4水平均明显高于T2DM组、CHD组和对照组,差异均有统计学意义(q=2.56~3.13,均P<0.05)。T2DM+CHD组内脂素水平与WHR、RBP4、TG和HOMA-IR呈正相关(r=0.27~0.52,均P<0.05);T2DM与RBP4和HbA1c密切相关(OR=2.09~3.67,P=0.05),T2DM合并CHD与内脂素、RBP4和TG密切相关(OR=2.13~3.81,P=0.05)。结论血清内脂素和RBP4与T2DM合并CHD的发病有一定联系。     

Low plasma apelin levels in newly diagnosed type 2 diabetes mellitus.

OBJECTIVE: To investigate blood apelin concentrations in patients with newly diagnosed and untreated type 2 diabetes mellitus (T2DM) who had no additional disorder and to investigate the association of apelin with adiponectin, body mass indexes (BMI) and insulin sensitivity. METHODS: Forty patients with T2DM and 40 healthy controls were enrolled. Apelin levels were measured along with BMI, lipids, glucose, insulin and adiponectin levels, and HOMA-IR indexes. Age, sex and BMI were similar in the two groups. RESULTS: Plasma apelin and adiponectin levels were significantly lower in the diabetic group compared to controls (p<0.001, for both). Insulin levels and HOMA indexes were significantly higher in patients with T2DM (p<0.001 and p=0.001, respectively). Apelin levels were negatively correlated with age (r=-0.315, p=0.006), fasting blood glucose (r=-0.556, p<0.001) and HOMA indexes (r=-0.411, p=0.001), and positively correlated with plasma adiponectin levels (r=0.593, p<0.001). Plasma adiponectin was negatively correlated to plasma insulin (r=-0.379, p=0.001), fasting glucose (r=-0.604, p<0.001), HOMA-IR (r=-0.559, p<0.001) and BMI (=-0.229, p=0.04). CONCLUSIONS: Plasma apelin is reduced in newly diagnosed and untreated patients with T2DM having no confounders. Regulation of circulating apelin and adiponectin seems to be in the same manner in patients with T2DM. Dysregulation of apelin might be involved in the mechanism of establishment of overt diabetes mellitus as well as associated atherosclerotic complications.     

Plasma resistin, adiponectin and leptin levels in lean and obese subjects: correlations with insulin resistance

OBJECTIVE: Adipose tIssue regulates insulin sensitivity via the circulating adipocytokines, leptin, resistin and adiponectin. The objective of this study was to compare the levels of resistin, adiponectin and leptin in lean and obese subjects and determine the relationship between circulating adipocytokines and insulin resistance. METHODS: We examined plasma levels of resistin, adiponectin and leptin in 17 lean subjects with a mean body mass index (BMI) of approximately 23 and 34 non-diabetic obese individuals with a mean BMI approximately 33. Insulin resistance was assessed using the homeostasis model assessment ratio (HOMA-R) formula derived from fasting insulin and glucose levels. RESULTS: Resistin levels were not significantly different between the two groups but were significantly higher in women compared with men, 35.4+/-6.5 (s.e.) vs 15.4+/-2.9 microg/L, P<0.01. Resistin did not correlate with BMI but did significantly correlate with HOMA-R, P<0.01, and this correlation remained significant after adjustment for gender and BMI. Adiponectin levels were significantly lower in obese compared with lean subjects, P<0.005, and higher in women, P<0.001, but showed no significant correlation with HOMA-R. Leptin levels were significantly higher in obese subjects and women and correlated with HOMA-R and resistin. DISCUSSION: In this small group of patients we demonstrated that insulin resistance correlated most strongly with leptin levels. A significant correlation between resistin levels and insulin resistance was also observed. Although a similar trend was apparent for adiponectin, the correlation with insulin resistance did not achieve statistical significance.     

Undiagnosed diabetes and impaired glucose regulation in adult Ghanaians using the ADA and WHO diagnostic criteria

Fasting glucose and oral glucose tolerance test (OGTT) criteria for glucose homeostasis were compared in a cross-sectional cluster, community study in Accra, Ghana. A total of 4636 subjects without prior diagnosis of diabetes had fasting plasma glucose, 2-hour OGTT and measurement of cardiovascular risk factors. Mean age of subjects was 44.2 years; 39.1% of subjects were males. The overall prevalence of undiagnosed diabetes ascertained with both criteria was 4.5% (n=209). The prevalence of undiagnosed diabetes by fasting (3,2%) and OGTT (3.1%) criteria were similar (p>0.05). The prevalence of impaired glucose tolerance (IGT) (15.8%) was higher than that of impaired fasting glucose (IFG) (10.7%). Only 56.5% (n=83) of subjects with diabetes by fasting criteria also had diabetes by OGTT criteria. Sixty-two subjects (42.8%) with diabetes by OGTT had normal or impaired fasting glucose. There was poor agreement between the two diagnostic criteria (kappa=0.31). The concordant normoglycaemic group was the youngest and had the lowest body-mass indey (BMI), waist girth, waist-hip ratio (WHR), total cholesterol, and systolic and diastolic blood pressures. The concordant diabetic group, in contrast, had the highest BMI, waist girth, WHR, total cholesterol and triglyceride levels. Both systems gave similar undiagnosed diabetes rates bur dissimilar IFG and IGT rates. There was poor agreement between the two diagnostic criteria. Diagnostic criteria influenced cardiovascular risk factors. A case may be made for using both criteria in order to ascertain all “diabetes” and all “at-risk” subjects. Received: 4 January 2001 / Accepted in revised form: 18 January 2002     

Plasma homocysteine concentrations and insulin sensitivity in hypertensive subjects

Hyperhomocysteinemia is associated with several cardiovascular disease risk factors including endothelial dysfunction and abnormalities of clotting functions, which are also common features of insulin resistance syndrome observed in hypertensive patients. Recent study has shown that acute hyperinsulinemia can lower plasma homocysteine concentrations in nondiabetic but not in type 2 diabetic individuals, indicating that insulin may regulate homocysteine metabolism. To investigate the relationships between plasma homocysteine concentration and insulin sensitivity, we studied 90 Chinese hypertensive patients and a group of control subjects (n = 86) matched for age, gender, and body mass index. Fasting plasma homocysteine levels, plasma lipoprotein concentrations, plasma glucose, and insulin responses to oral glucose tolerance tests (OGTT) were determined. The results showed that fasting plasma homocysteine concentrations were significantly higher in subjects with hypertension than in those with normotension (mean ± SEM, 8.1 ± 0.6 v 6.8 ± 0.2 μmol/L; P < .05). Fasting plasma homocysteine levels correlated significantly with insulin secretion in response to OGTT even after adjustment for body mass index (P < .05) in hypertensive patients but not in normotensive individuals. However, fasting plasma homocysteine concentrations showed no correlations with steady-state plasma glucose concentration, a measurement of insulin sensitivity, during an insulin suppression test in groups of hypertensive (n = 42) and normotensive (n = 37) subjects. When the steady-state plasma glucose concentrations were divided into three tertiles, fasting plasma homocysteine concentrations showed no difference across these three groups in either hypertensive patients (8.6 ± 0.5 v 7.2 ± 0.5 v 8.4 ± 0.6 μmol/L; P = .148) or normotensive subjects (6.3 ± 0.4 v 8.0 ± 0.8 v 7.0 ± 0.8 μmol/L; P = .199). In conclusion, hypertensive Chinese subjects had higher fasting plasma homocysteine concentrations and a higher degree of insulin resistance when compared to a group of age-, gender-, and body mass index-matched normotensive individuals. Fasting plasma homocysteine levels were associated with insulin response to OGTT in hypertensives but not in normotensives. No correlation was observed between the degree of insulin resistance and plasma homocysteine levels in either the hypertensive or the normotensive group. The role of insulin in homocysteine metabolism deserves further investigation.     

Changes of serum omentin-1 levels in normal subjects,type 2 diabetes and type 2 diabetes with overweight and obesity in Chinese adults

Purpose

Omentin-1 has been identified as interesting novel adipokines that may modulate insulin action. Its exact biological function is unclear. The aim of this study is to assay the levels of serum omentin-1 in normal subjects and type 2 diabetes mellitus (T2DM) with normal weight, overweight and obesity and to analyze the relationship between serum omentin-1 levels with body mass index (BMI), waist to hip ratio (WHR), glycosylated hemoglobin (HbA1c), plasma glucose, insulin resistance index (HOMA-IR) and serum lipid levels.

Methods

There are eighty newly diagnosed type 2 diabetes patients, thirty-five type 2 diabetes patients with normal weight, twenty-nine type 2 diabetes patients with overweight, sixteen type 2 diabetes patients with obesity, and forty healthy control subjects were enrolled in this study. The levels of plasma glucose at fasting and 2-hour postprandial blood glucose and fasting serum levels of insulin, omentin-1and HbA1c were measured. HOMA-IR was calculated.

Results

Serum omentin-1 levels were found to be significantly decreased in type 2 diabetes patients with normal weight (821.16 ± 312.50 ng/L), in type 2 diabetes patients with overweight (748.00 ± 322.51 ng/L), and in type 2 diabetes patients with obesity (530.44 ± 357.35 ng/L) compared with healthy control subjects (994.71 ± 435.90 ng/L) at P < 0.05. The level of serum omentin-1 was negatively correlated to BMI, HOMA-IR, WHR, fasting insulin (FINS), fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2HPG), triglycerides (TG), and positively correlated to high-density lipoprotein (HDL). BMI was independent related factor that influenced the levels of serum omentin-1.

Conclusion

Decreased omentin-1 levels may contribute to the development of insulin resistance, T2DM and particularly to obesity in Chinese adults, however, its role in these diseases needs to be fully elucidated.     

冠心病并代谢综合征患者血清糖基化终末产物的水平及其临床意义

目的:研究冠心病并代谢综合征(MS)患者血清糖基化终末产物(AGE)含量的变化及其临床意义。方法:选择单纯MS患者(A组)32例,单纯冠心病患者(B组)36例,冠心病并MS患者(C组)39例和正常对照(D组)28例。对所有受试者测量其身高、体重、腰围(WC)、臀围(HC);测血脂、空腹血糖(FBG)、胰岛素(FIN)、AGE;计算体质指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR)并进行比较。结果:A、B、C组患者的FIN、HOMA-IR、AGE均高于D组,C组的HOMA-IR、AGE分别高于A、B组。直线相关分析显示,HOMA-IR与BMI、WC、TG、FBG、FIN和AGE呈正相关,与HDL呈负相关。结论:冠心病并MS患者AGE的表达异常升高。     

尿微量白蛋白排泄率与血清促甲状腺激素相关性研究

目的探讨尿微量白蛋白排泄率(ACR)与血清促甲状腺激素(TSH)的关系。方法 2007年10月对沈阳市大东区居民进行分层抽样调查共收集1523人,详细填写流行病学调查表,测量血压、身高、体重及腰围(WHR),采集血样测定TSH、甲状腺氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)、空腹血糖(FPG)、糖负荷后30 min血糖(OGGT 30minPG)、2 h血糖(OGTT 2hPG)、空腹胰岛素浓度(FINS)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),采集空腹尿液检测尿微量白蛋白(MAU)及尿肌酐,计算尿微量白蛋白与尿肌酐比值。结果 MAU的发生率为11.8%,MAU的发生率随年龄的增长而增加(P<0.01)。MAU组较非MAU组的腰围、体重指数、收缩压、舒张压、心率、空腹血糖、糖负荷后30min血糖、糖负荷后2h血糖、TG、胰岛素抵抗指数均有明显升高(P<0.05);WHR、FINS、TC、HDL-C、LDL-C差异无统计学意义(P>0.05);TSH、亚临床甲减及亚临床甲亢的患病率差异亦无统计学意义(P>0.05);Logistic分析提示,高血压、高血糖是ACR的独立危险因素(OR值分别为1.868和1.469,P均<0.05)。结论 ACR与血清TSH未见相关性,高血糖、高血压是发生ACR的独立危险因素。     

多囊卵巢综合征患者血清apelin蛋白水平及意义

目的 检测多囊卵巢综合征(PCOS)患者血清apelin蛋白水平并探讨其变化意义.方法 50名PCOS患者及20名健康对照者的空腹血糖、胰岛素、胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白水平应用化学发光法检测,卵泡刺激素、黄体生成素、雌二醇,孕酮、催乳素、睾酮的血清浓度采取磁酶免疫法测定,血清apelin水平采用酶联免疫法测定.结果 PCOS组apelin血清浓度明显高于对照组(P＜0.05);其中PCOS体重指数(BMI)≥25 kg/m2患者血清apelin水平高于PCOS BMI ＜25 kg/m2患者(P＜0.05);PCOS患者血清apelin水平与胰岛素抵抗(IR)、BMI、腰臀比(WHR)呈正相关(r=0.43,P ＜0.007;r =0.38,P ＜0.02;r =0.456,P ＜0.003),与高密度脂蛋白(HDL,r=-0.456,P＜0.005)呈负相关;二项Logistic回归分析显示apelin与PCOS发病有关(P＜0.05).结论 PCOS患者血清apelin水平升高,可能参与胰岛素代谢及血管舒缩.     

Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans.

AIMS: This study was conducted to compare the prevalence and cardiovascular risk factors of different categories of glucose tolerance in the elderly Korean population using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. METHODS: This study included 1456 non-diabetic subjects over the age of 60 years, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. Fasting and post-challenge 2-h plasma glucose, insulin levels, body mass index (BMI), waist-hip ratio (WHR), blood pressure, and lipid profiles were examined. Prevalence of glucose tolerance categories and the level of agreement (kappa statistics) were obtained using WHO 2-h criteria and ADA fasting criteria. Comparison of cardiovascular risk factors among several concordant and discordant glucose intolerance groups was done. RESULTS: The prevalence rates of newly diagnosed diabetes of elderly men defined by WHO 2-h criteria and ADA fasting criteria were 11.8% and 4.8%, respectively. That of elderly women was 8.1% by WHO 2-h criteria and 3.1% by ADA fasting criteria. The prevalence of impaired glucose tolerance (IGT) by WHO criteria was also higher than that of impaired fasting glucose (IFG) by ADA criteria (23.5% vs. 10.0% men, 23.7% vs. 7.5% women). The level of agreement between ADA fasting criteria and WHO 2-h criteria was low (weighted kappa = 0.228 men, weighted kappa = 0.301 women). The concordant diabetic women by both ADA fasting criteria and WHO 2-h criteria showed higher BMI, WHR, diastolic blood pressure, total cholesterol and triglyceride levels than concordant normal subjects. However, the isolated post-challenge hyperglycaemia (IPH) women group was not different significantly from the concordant normal women group except in BMI. CONCLUSIONS: Our results clearly show that the 1997 ADA fasting criteria are less sensitive for diagnosing diabetes than oral glucose tolerance test (OGTT)-based WHO criteria in elderly Koreans. Also, there is a poor agreement of different categories of glucose tolerance between ADA and WHO criteria; therefore, the OGTT remains a valuable test in diagnosing diabetes and classifying various categories of glucose intolerance, especially in elderly Koreans.     

Insulin and C-peptide responses to 75 g oral glucose load in the healthy man

Plasma insulin and C-peptide levels in the fasting state and after a 2-h 75 g oral glucose tolerance test (OGTT) in a large number of healthy subjects are reported. 247 volunteers (134 males, 113 females), aged 13-69 years, who had a negative history of diabetes, no history of significant disease, normal physical examination, normal body weight, normal glucose tolerance, normal blood tests, and who were taking no drugs were studied. Results, mean +/- SEM (range): fasting glucose concentration = 4.64 +/- 0.03 mmol/l (3.10 - 6.10), 1-h glucose concentration = 5.23 +/- 0.10 mmol/l (2.20 - 9.90), 2-h glucose concentration = 4.11 +/- 0.06 mmol/l (2.00 - 6.80); fasting insulin level = 0.088 +/- 0.002 nmol/l (0.03 - 0.28), 1-h insulin level = 0.45 +/- 0.01 nmol/l (0.06 - 1.63), 2-h insulin level = 0.24 +/- 0.01 nmol/l (0.05 - 1.12); fasting C-peptide concentration = 0.60 +/- 0.01 nmol/l (0.14 - 1.34), 1-h C-peptide concentration = 2.17 +/- 0.05 (0.63 - 8.56), 2-h C-peptide concentration = 1.77 +/- 0.04 nmol/(0.35 - 5.74). Fasting insulin and fasting C-peptide concentrations correlated to post-glucose insulin and C-peptide concentrations, respectively. At each sampling-point insulin concentration correlated to C-peptide concentration. After glucose ingestion, both insulin and C-peptide plasma levels correlated significantly with the corresponding glucose levels. During fasting, C-peptide but no insulin level correlated to glucose level.(ABSTRACT TRUNCATED AT 250 WORDS)     

国产吡格列酮治疗2型糖尿病患者的临床研究

目的观察国产吡格列酮对2型糖尿病(T2DM)病人血糖、血脂代谢和胰岛素抵抗(IR)的作用,并检测治疗前后血清脂联素水平的变化。方法用随机双盲法、与安慰剂平行对照,比较48例T2DM病人用吡格列酮30mg和安慰剂(1:1)干预治疗12w后的血糖、血脂、IR、血清脂联素水平改变。结果吡格列酮治疗12w后,空腹血糖和餐后2h(2hPG)血糖、糖化血红蛋白(HbA1c)与治疗前比较明显下降(P<0·05或P<0·01);空腹胰岛素(FINS)及HOMA模型IR指数(HOMA-IR)较治疗前也减低(P<0·05或P<0·01);血清脂联素水平、高密度脂蛋白(HDL-C)在12w治疗后显著升高,低密度脂蛋白(LDL-C)与治疗前比较明显降低(P<0·05或P<0·01),上述指标与安慰剂组比较差异均有显著意义(P<0·05或P<0·01)。但是总胆固醇(TC)、甘油三酯(TG)治疗前后无明显差异。结论国产吡格列酮可改善T2DM病人血糖及血脂代谢,降低IR并升高血清脂联素水平,有助于防治T2DM血管并发症。     

Circulating E-selectin,vascular cell adhesion molecule-1, and intercellular adhesion molecule-1 in men with coronary artery disease assessed by angiography and disturbances of carbohydrate metabolism

It is hypothesized that adhesion molecules could be an early predictor of coronary artery disease. Therefore we investigated the relationship between the concentrations of soluble forms of adhesion molecules and disturbances of glucose metabolism in 78 men referred for coronary angiography but with no previous history of diabetes. The group consisted of 78 men (mean age, 47.6 +/- 7.0 years; mean body mass index [BMI], 28.4 +/- 3.24 with the symptoms of angina pectoris and positive exercise test. All subjects were given a standard oral glucose tolerance test (OGTT) with glucose and insulin estimations. Fasting plasma concentrations of the soluble (s) forms of E-selectin, intercellular adhesion cell molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and HbA(1c) were also measured. According to the OGTT, 10.2% of the patients (n = 8) fulfilled the criteria for type 2 diabetes mellitus and 44.9% (n = 35) for impaired glucose tolerance (IGT). The highest concentrations of sE-selectin were observed in patients with type 2 diabetes mellitus and were significantly higher in comparison to the group with normal glucose tolerance and IGT. The concentration of sVCAM-1 increased with the progression of disturbances of glucose metabolism and remained the highest in type 2 diabetic patients. sICAM-1 concentration was not significantly different. sE-selectin concentration correlated significantly with fasting glucose (r = 0.23, P =.041), postload glucose (r = 0.39, P =.001), and postload insulin (r = 0.28, P =.023). sVCAM-1 was significantly related to the postload glucose concentration (r = 0.30, P =.009). A significant correlation between sICAM-1 concentration and postload insulin was also observed (r = 0.27, P =.025). This would suggest that hyperglycemia increases sE-selectin and sVCAM-1 in plasma, which reflects excessive formation of atherosclerotic plaques in patients with disturbances of glucose metabolism.     

Ghrelin基因Leu72Met多态性与胰岛素分泌、胰岛素抵抗和糖调节受损的相关性

目的探讨ghrelin基因Leu72Met（C408A）多态性与胰岛素分泌、胰岛素抵抗和糖调节受损（IGR）之间的关系。方法用PCR-RFLP法对126例IGR和423例NGT者进行ghrelin基因Leu72Met多态性分析。同时检测生化指标和临床参数。结果NGT组分为BMI〈24．0kg／m^2和BMI≥24．0kg／m^2两组,比较OGTT各点血糖、胰岛素和HOMA-IR、HOMA-β,结果提示组内CC基因型者和CA＋AA基因型者间,上述指标均无统计学差异。NGT和IGR组ghrelin基因C408A分布和等位基因频率无统计学差异。IGR组CC基因型者DBP明显低于CA＋AA基因型者;血尿酸水平均明显高于CA＋AA基因型者。结论ghrelin基因Leu72Met与血压和血尿酸水平相关。