脂肪因子与餐后高血糖的研究进展

近年研究发现,脂肪组织是具有内分泌功能的器官。它分泌瘦素、脂联素、肿瘤坏死因子-α、抵抗素、内脂素等脂肪因子。这些细胞因子可能通过参与炎性反应与物质能量的代谢过程,影响胰岛素的生物学效应,影响餐后血糖水平。本文就近年来一些较多关注的脂肪因子与餐后高血糖关系作一综述,为临床控制餐后高血糖,从而降低心血管事件、预防代谢综合征提供依据。     

餐后高血糖的危害

大多数糖尿病患者都会经常检测空腹和餐后2小时的血糖水平,也经常会产生这样的疑问：到底是空腹血糖重要,还是餐后2小时血糖更重要？我们的回答是：二者都很重要,但是对于2型糖尿病患者来讲,餐后血糖对于预防糖尿病大血管和微血管合并症的发生有着更重要的作用。心血管并发症是2型糖尿病最多见、花费最多的疾病。     

浅谈餐后高血糖对心血管疾病的影响

目的：分析餐后高血糖对心血管疾病产生的影响,探讨相关防治措施。方法：随机抽取笔者所在医院内科2006年3月-2010年9月接诊的心血管疾病患者86例,进行餐前和餐后血糖检测,观察餐后血糖对心血管疾病发生率的影响。结果：餐后高血糖患者心血管疾病发生率明显高于空腹患者（P〈0.01）。结论：餐后高血糖对心血管疾病的产生有着密切影响,要给予足够重视。     

餐后高血糖对心血管危害更大

<正>芬兰一项研究高血糖与心血管危险的流行病学调查纳入29108例患者,平均随访8．8年。结果表明,餐后2 小时血糖水平与心肌梗死、脑卒中和肿瘤的发生率及死亡率呈正相关,其可信性和相关性,远远大于空腹血糖。     

查餐后血糖更重要

糖尿病是园胰岛素分泌绝对或相对不足以及靶组织细胞对胰岛素敏感性降低．引起糖、蛋白、脂肪、水和电解质等一系列代谢紊乱．临床以高血糖为主要特征的一组疾病     

餐后高血糖降之有道

在现实生活中，有的患者以餐前血糖（空腹血糖）增高为主，而另外一些患者则以餐后2小时血糖（餐后血糖）增高为主。那么，餐前血糖和餐后血糖哪个对心血管影响更大呢？随着对空腹血糖和餐后血糖的深入研究，人们逐步认识到：餐后血糖较之空腹血糖与心血管疾病有着更强的相关性。因此，除了要重视降低空腹血糖以外，也要关注餐后血糖水平。     

如何纠正餐后高血糖

<正>(1)提高对餐后高血糖危害的认知度。有些糖尿病患者和健康者体检只重视检测空腹血糖,而忽视了餐后2小时血糖的检测,这是一个误区。(2)少吃多餐,避免暴食暴饮,不仅要注意限制碳水化合物,而且要注意限制总热量,包括脂肪、蛋白质也要严格限制。(3)经过限食、运动、劳逸结合及心理调适,观察1～3个月后,餐后或葡萄糖负荷试验2小时血糖仍≥11．1毫摩/升(200毫克/分升),     

高血糖的危害性与致病机制研究进展

正常人胰岛素分泌有2个时相，糖负荷后5min胰岛素水平迅速升高的分泌相为第一时相，此时曲线呈尖锐高峰，是反映胰腺β细胞贮存颗粒中的胰岛素分泌，历时5—10min后下降。第一时相与空腹高血糖及糖耐量的关系密切。随后是缓慢的输出为第二时相，该时相主要反映新合成的胰岛素及胰岛素原的分泌。2型糖尿病(DM)确诊时已有约75％β细胞衰竭，使得总体胰岛素分泌减少。β细胞代偿功能不全的最早表现是第一时相消失。     

餐后高血糖如何侵害心脑血管

<正>意大利学者研究证实,餐后骤然高血糖,就像“风暴”一样袭击心脑血管,通过过度氧化应激,使心脑血管内皮细胞功能失调,细胞凋亡, 促使血管发生炎症反应,而加速动脉粥样硬化发生和进展；同时它还促     

千万莫拿“餐后高血糖”不当回事

上午八点,我准时出现在糖尿病专家门诊。刚一落座,就进来一位风尘仆仆的外地患者,心急火燎地向我述说了他的病情:两年前,我查出有糖尿病,从那以后我就一直坚持用药,多次化验空腹血糖都基本正常或略微偏高。近几个月以来,老觉着手脚发麻,看东西模糊,并且尿里查出     

代谢综合征与脂肪细胞因子

近年来的研究表明,脂肪组织不仅是机体储存能量的场所,还是功能活跃的内分泌器官分泌多种生物活性分子,而肥胖导致脂肪因子分泌异常,通过自分泌和旁分泌和内分泌的方式产生许多细胞因子和激素,参与胰岛素抵抗和慢性炎症的病理生理过程。该文作者就代谢综合征（MS）与脂肪细胞因子之间的关系和国内外的研究热点做了一篇综述。     

血清脂肪细胞因子与妊娠期糖尿病关系的研究

目的:探讨妊娠期糖尿病(GDM)孕妇血清脂肪因子脂联素、瘦素、肿瘤坏死因子(TNF-α)水平变化及其与胰岛素抵抗的相关性。方法:随机抽取孕周15～20周的孕妇测定空腹血糖(FBG)、空腹胰岛素(FINS)、血脂联素、瘦素、TNF-α水平,孕24～28周行OGTT检查,按结果分为3组,糖耐量正常组(NGT)59例,GDM组41例,GIGT组50例,比较各组胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HBCI)及孕前、孕中期的BMI的差异,分析血脂联素、瘦素、TNF-α与IR的关系。结果:①GDM组及GIGT组HOMA-IR较NGT组明显升高,差异有统计学意义(P<0.05),3组间HBCI比较差异无统计学意义(P>0.05)。②GDM组及GIGT组血清脂联素水平显著低于NGT组(P<0.05),血清瘦素水平及TNF-α水平则显著高于NGT组(P<0.05)。③脂联素与HOMA-IR呈负相关,相关系数为-0.65;而瘦素、TNF-α与HOMA-IR呈正相关,相关系数分别为0.58、0.47。结论:妊娠期糖尿病血清脂联素、瘦素、TNF-α水平的改变与妊娠期胰岛素抵抗有关,可作为GDM的重要预测因子。     

Postprandial triglycerides,endothelial function,and inflammatory cytokines as potential candidates for early risk detection in normal-weight obesity

ProblemNormal-weight obesity (NWO) is associated with increased cardiovascular disease (CVD) risk. However, NWO’s clinical presentation is often unremarkable based on common risk factors. We examined whether CVD risk factors not routinely measured clinically including postprandial triglycerides, flow-mediated dilation (FMD), and inflammatory cytokines would be abnormal in NWO, consistent with their future risk.MethodsIndividuals were recruited into 3 groups (n = 10/ group): controls (Con), NWO, and metabolic syndrome (MetS). Con was defined as a normal body mass index (BMI), < 25% (M) or < 35% (F) body fat, and < 1 International Diabetes Federation (IDF) criteria. NWO were above this body fat cutoff while maintaining a normal BMI and MetS was defined per the IDF. Participants underwent an abbreviated fat tolerance test (i.e., difference in fasting and 4 h triglycerides following a high-fat meal [9 kcal/kg; 73% fat)] and fasting and postprandial lipid and glucose metrics, as well as FMD were measured. A T cell cytokine bioplex was also performed using fasting serum.ResultsNWO and MetS had similar body fat% and both were higher than Con (p < 0.0001). Despite having similar fasting triglycerides to Con, NWO had 4-hour triglycerides 66% greater than Con, but 46% lower than MetS (p < 0.01). FMD decreased in all groups after the high-fat meal (p < 0.0001). MetS displayed lower fasting FMD than Con, and NWO was similar to both groups (p < 0.05). No group differences were observed with postprandial FMD and the majority of fasting cytokines assessed. However, MetS exhibited higher fasting TNF-α than Con (p < 0.05), and NWO was similar to both groups.ConclusionsOverall, NWO was associated with higher postprandial triglycerides than Con, but displayed little evidence of impaired vascular health or inflammation.     

糖尿病餐后高凝血状态及其影响因素

目的研究2型糖尿病标准饮食对凝血、纤溶系统的影响.方法对40例2型糖尿病患者测量体质指数,并于空腹和标准饮食后2 h采血,分别测定空腹血糖(FBG)和餐后血糖(PBG)、空腹胰岛素(FINS)和餐后血胰岛素(PINS)、空腹凝血时间(FTT)和餐后凝血时间(PTT)、空腹凝血酶原时间(FPT)和餐后凝血酶原时间(PPT)、空腹部分激活的凝血活酶时间(FAPTT)和餐后部分激活的凝血活酶时间(PAPTT)、空腹纤维蛋白原(FFIB)和餐后纤维蛋白原(PFIB)及空腹D-二聚体(FD-D)和餐后D-二聚体(PD-D),对可能影响2型糖尿病患者餐后凝血、纤溶的因素进行回归分析.结果PBG[(17.23±6.37)mmol/L]、PINS[(56.71±34.54)mmol/L]较空腹[FBG为(11.75±5.31)mmol/L、,FINS为(15.76±9.06)mmol/L]时增高,P＜0.001;PTT[(13.78±1.70)s、PPT[(11.98±1.14)s]、PAPTT[(31.67±3.49)s]较空腹时[FTT为(15.26±1.26)s、FPT为(13.27±1.21)s、FAPTT为(34.39±3.74)s]缩短;PFIB[(4.18±1.54)g/L]、PD-D[(1.50±1.18)mg/L]与空腹[FFIB(3.75±1.43)g/L、FD-D为(0.86±0.63)mg/L]比较明显升高;多因素回归分析表明,PD-D与PBG、FD-D正相关.结论单纯饮食控制治疗的2型糖尿病患者进食引起凝血、纤溶系统的激活主要表现为血液高凝状态.餐后凝血、纤溶激活主要与餐后血糖、空腹凝血及纤溶指标相关.     

2型糖尿病餐后脂代谢影响因素研究

目的研究 2型糖尿病餐后脂代谢的影响因素。方法 90例 2型糖尿病患者随机分为 3组 :高脂饮食组 (30例 )、正常脂饮食组 (30例 )、低脂饮食组 (30例 )、测量体质指数 (BMI)、腰臀比 (WHR) ,并于空腹及餐后 2 h采血测定血糖、血胰岛素及血脂 :对可能影响 2型糖尿病患者餐后脂代谢的因素进行多因素回归分析。结果高脂饮食组餐后血糖水平及低密度脂蛋白胆固醇低于正常脂饮食及低脂饮食组 (P<0 .0 1) ;而餐后胰岛素水平及甘油三酯 (TG)高于正常脂饮食及低脂饮食组 (P<0 .0 1)。多因素回归分析表明 ,餐后血脂水平与空腹血脂水平呈正相关 ,而与年龄、性别、BMI、WHR、血糖、胰岛素均无明显相关。其中 TG水平还与饮食中脂肪含量密切相关 (P<0 .0 1)。结论 2型糖尿病患者存在明显的餐后脂代谢紊乱 ;餐后血脂水平主要与空腹 TG水平相关 ;饮食中脂肪、碳水化合物比例不同 ,会导致餐后血糖、胰岛素及血脂水平的不同变化。     

Postprandial blood glucose response in relation to gastric emptying and satiety in healthy subjects

Glucostatic appetite regulation has numerous determinants, among others: cephalic phase digestion, gastric emptying and absorption, together influencing postprandial blood glucose responses and satiety. This short communication presents and reviews studies of gastric emptying, antral distension and postprandial glucose response and their relation to reports of satiety in healthy non-obese over night fasting subjects.     

Vitamin D,Vitamin D-Binding Proteins,and VDR Polymorphisms in Individuals with Hyperglycaemia

Vitamin D reportedly plays an important role in the pathogenesis of diabetes mellitus; however, this role is unclear and debated. This study investigated the association between 25(OH) vitamin D, vitamin D-binding proteins, and vitamin D receptor (VDR) polymorphisms in healthy individuals and those with prediabetes and type 2 diabetes mellitus (T2D) from South Africa. A cross-sectional study was conducted involving subjects of mixed ancestry aged ≥20 years. Males presented with higher mean 25(OH) vitamin D levels than females, while females exhibited significantly higher serum vitamin D-binding protein levels. Significant differences in mean 25(OH) vitamin D levels were observed in normo-glycaemic, prediabetes, screen-detected DM, and known DM individuals. Vitamin D receptor SNPs Fok1 and Taq1 were not associated with glycaemic status. Fok1 was not associated with 25(OH) vitamin D deficiency, while Taq1 was associated with vitamin D insufficiency. This study showed a high prevalence of vitamin D deficiency/insufficiency in this South African population, with decreased vitamin D levels observed in hyperglycaemic individuals, which was not linked to either vitamin D-binding protein or polymorphisms in Fok1 of the VDR gene. These results may be used as a platform for further research into diagnosis and treatment of hyperglycaemia.     

Relation of visfatin to cardiovascular risk factors and adipocytokines in patients with impaired fasting glucose

ObjectiveThe discovery of visfatin has great potential to significantly enhance our understanding of impaired fasting glucose and diabetes mellitus. The aim of the present study was to explore the relation of visfatin concentrations to cardiovascular risk factors and serum adipocytokine concentrations in patients with impaired fasting glucose.MethodsA sample of 55 patients with impaired fasting glucose was analyzed in a prospective way. All patients with a 2-wk weight-stabilization period before recruitment were enrolled. Weight, blood pressure, basal glucose, lipoprotein(a), C-reactive protein, insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerols, blood, and adipocytokines (visfatin, leptin, adiponectin, resistin, tumor necrosis factor-α [TNF-α], and interleukin-6) levels were measured. Tetrapolar impedancometry, indirect calorimetry, and prospective serial assessment of nutritional intake with 3-d written food records were performed.ResultsFourteen men (25.5%) and 41 women (74.5%), with a mean age of 57.3 ± 11.7 y and mean body mass index of 35.8 ± 3.6 kg/m², were included. Patients were divided in two groups by median visfatin value (18.2 ng/mL): group I had low values and group II had high values. Patients in group I had greater weight, body mass index, fat mass, fat-free mass, and adiponectin than patients in group II. Patients in group II had higher total cholesterol, low-density lipoprotein cholesterol, resistin, and TNF-α levels than patients in group I. In the multivariate analysis with age- and sex-adjusted basal visfatin concentration as a dependent variable, only TNF-α remained an independent predictor in the model (F = 8.4, P < 0.05), with an inverse correlation. Visfatin concentration decreased 7.33 ng/mL (95% confidence interval 2.10–12.58) for each nanogram per milligram of TNF-α increase.ConclusionOnly TNF-α is related in an independent way to serum visfatin levels.