二甲双胍对代谢综合征患者血压的影响

目的 研究二甲双胍长期使用对代谢综合征(MS)患者血压的影响。方法 87例轻度高血压与空腹血糖(FPG)6.1～8.0mmol／L或2h血糖(2 h PG)7.8～12.0mmol／L的MS患者随机分作2组：低脂饮食组43例，予低脂饮食；二甲双胍组44例，予低脂饮食并二甲双胍0.25，3次／d，连用24周；比较2组治疗前与治疗24周的血压与胰岛素抵抗、血脂等影响血压重要指标的变化。结果 与治疗前比较，二甲双胍组治疗24周的收缩压(SBP)、舒张压(DBP)与脉压(PP)显著降低(P＜0.01)。与低脂饮食组比较，治疗24周后二甲双胍组在改善胰岛素抵抗、调脂的同时，收缩压(137±5比142±6)mm Hg、舒张压(88±6比92±4)mm Hg与脉压(40±9比44±8)mm Hg也显著降低(P＜0.01，P＜0.05)。结论 二甲双胍治疗MS具有降低血压作用。     

二甲双胍对代谢综合征患者胰岛素敏感性的影响

代谢综合征（MS）患者胰岛素介导葡萄糖代谢的能力下降,胰岛素敏感性减低。2005年6～12月,我们应用二甲双胍治疗MS患者42例,取得良好效果。现报告如下。     

二甲双胍联合针灸对肥胖患者胰岛素敏感性和代谢的影响

目的探讨二甲双胍联合针灸治疗对肥胖者胰岛素敏感性和代谢的影响。方法将156例单纯肥胖者随机分成A、B、C、D 4组,A组仅给予生活方式干预;其他3组除生活方式干预外,B组给予二甲双胍、C组给予针灸,D组给予二甲双胍与针灸联合治疗;各组受试者均治疗3个月。观察治疗前后空腹血糖（FPG）、空腹胰岛素（FINS）、体质量指数（BMI）、胰岛素敏感性指数（ISI）、TG、TC、HDL-C、LDL-C的变化。结果治疗前后比较,B、C、D组BMI、FPG、FINS、ISI、HDL-C、TG、LDL-C、TC差异有统计学意义（P〈0.05或〈0.01）。治疗后D组与B组比较,BMI降低、ISI升高（P均〈0.05）;治疗后D组与C组比较,BMI、FPG、FINS、TG、LDL-C、TC降低（P均〈0.05）,HDL-C显著升高（P〈0.05）。结论在生活方式干预基础上,二甲双胍联合针灸治疗单纯性肥胖安全、有效。     

二甲双胍对单纯性肥胖患者胰岛素敏感性的影响

将单纯性肥胖患者分成两组,在生活方式干预基础上,治疗组口服二甲双胍,对照组给予安慰剂,观察3个月。观察两组治疗前后体质量（BW）、腰围（WC）、收缩压（SBP）、舒张压（DBP）、空腹血糖（FPG）、空腹胰岛素（FINS）、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）、甘油三酯（TG）、体质量指数（BMI）、胰岛素敏感性指数（ISI）变化。结果显示,与对照组比较,治疗组BMI、WC、BW、FPG、FINS、TG、TC明显下降（P〈0．05）,ISI明显升高（P〈0.01）。认为生活方式干预可减轻单纯性肥胖患者的BW,减小BMI;加用二甲双胍能缩小WC,减轻胰岛素抵抗,改善血脂异常。二甲双胍可用于单纯性肥胖的治疗。     

二甲双胍对尿酸代谢的影响及其机制

<正>目前,多个学会的官方指南都将二甲双胍列为治疗2型糖尿病(T2DM)的一线用药。二甲双胍通过减少肝糖输出和增加骨骼肌对外周葡萄糖的摄取,显著改善胰岛素抵抗(IR),可以有效降低血糖,最适用于超重和肥胖的T2DM患者。越来越多的研究发现,除上述作用外,二甲双胍具有更多降糖之外的作用,如减少晚期糖基化终末产物(AGEs)的形成和细胞氧化应激反应,对代谢综合征具有良好的改善作用,如能调节血脂,降     

二甲双胍对初诊2型糖尿病患者脂餐后代谢的急性影响

目的　观察二甲双胍 1g顿服对 2型糖尿病 (T2DM)患者脂餐后代谢的急性影响 ,探讨其降糖机理及临床新用途。　方法　初诊T2DM、葡萄糖耐量低减 (IGT)患者共 30例 ,按胰岛素抵抗指数 (Homa IR) >2、Homa IR≤ 2分为A、B两组 ,观察服二甲双胍 +脂餐及对照脂餐后 8h内血糖、胰岛素 (INS)、血脂变化。　结果　在糖化血红蛋白 (HbA1c)、空腹、餐后血糖及体重指数 (BMI)相似情况下 ,A组显示高胰岛素血症 ,餐后长时间高甘油三酯 (TG)血症及胰岛素抵抗。二甲双胍 1g顿服显著抑制A组餐后 2h血糖、游离脂肪酸 (FFA) ,长达 8h的TG及 8h低密度脂蛋白 (LDL)水平(P均 <0 .0 5 )而不引起胰岛素变化 ,而B组未见显著改变。　结论　 1g二甲双胍在胰岛素抵抗的T2DM及IGT患者起了明显的胰岛素增敏作用 ,此作用是通过直接或间接促进TG的清除或利用实现的     

二甲双胍治疗代谢综合征肥胖高危人群的临床研究

以30名健康志愿者作为参照,将39名中心性肥胖者作为治疗组干预十二周,观察治疗前后一般情况、胰岛素抵抗、C反应蛋白、相关炎症因子及纤溶系统变化。结果与对照组相比,肥胖人群胰岛素抵抗指数、C反应蛋白、游离脂肪酸、纤溶酶原激活物抑制物1均有升高,组织纤溶酶原激活物下降;治疗后,治疗组体重指数、腰围、腰臀比以及胰岛素抵抗指数、C反应蛋白、游离脂肪酸、纤溶酶原激活物抑制物1、组织纤溶酶原激活物均明显改善,差异有统计学意义。结论二甲双胍干预可明显降低代谢综合征肥胖高危人群肥胖和胰岛素抵抗指数,并在一定程度上改善炎症状态、纤溶系统功能,有助于减轻致动脉粥样硬化的危险性。     

二甲双胍在代谢综合征社区干预中的应用

将84例代谢综合征（MS）患者,随机分为两组,对照组仅行单纯的科学生活方式干预,治疗组在此基础上加服二甲双胍半年。结果治疗组的腰围、甘油三酯、空腹血糖均值显著减低,对照组无显著变化,两组比较有显著统计学意义（P〈0．05）,认为科学生活方式和二甲双胍治疗缺一不可。     

The Effect of Non-dipper and Dipper Blood Pressure Patterns on Aortic Elasticity in Patients with Metabolic Syndrome

The purpose of this study was to evaluate the effect of blood pressure (BP) rhythm on aortic functions in patients with metabolic syndrome. Seventy patients with newly diagnosed hypertension who fulfilled the metabolic syndrome criteria according to the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATP-III) were evaluated with 24-hour BP holter monitoring. According to BP rhythm, 35 patients with dipper BP pattern and 35 patients with non-dipper BP pattern were enrolled as two groups in our study. Systolic and diastolic diameters of the ascending aorta were measured by M-mode echocardiography and aortic functions (aortic strain, distensibility, and stiffness index) were calculated. The nocturnal systolic and diastolic BPs were significantly higher in non-dipper patients than the dipper group. According to clinical parameters including age, gender, height, weight, body mass index, waist circumference, clinical systolic, and diastolic BPs, we did not find significantly difference between the two groups. Aortic strain was significantly higher (6.63 ± 3.37 vs. 1.81 ± 0.92; P < .0001) and aortic distensibility was lower (2.38 ± 1.18 cm^?2/dyn/10^?6 and 6.66 ± 3.67 cm^?2/dyn/10^?6; P < .001) in non-dipper group. These findings suggest that aortic functions were prominently deteriorated in non-dipper hypertensive patients than dippers with metabolic syndrome.     

二甲双胍治疗2型糖尿病人对血压影响的研究

目的观察胰岛素增敏剂二甲双胍治疗2型糖尿病,降低血浆胰岛素水平、改善胰岛素敏感性后对血压的影响.方法 71例2型糖尿病人口服二甲双胍(格华止)850 mg,qd～bid.治疗前后测定BMI、血压、FBG、PBG、FINS、PINS,并按HOMA模型计算胰岛素抵抗指数和胰岛素分泌指数.结果 (1) 二甲双胍治疗8周后,BMI治疗前后比较无显著性差异;血压治疗后明显下降,降压幅度达 13.1±4.9/4.2±9.9 mmHg, 血压治疗前后比较有显著性差异;(2)治疗后FBG、PBG、FINS均明显下降,治疗前后比较有显著性差异;(3)治疗后HOMA-IR下降,IAI升高,治疗前后比较有显著性差异,但HOMA-IS、FINS/FBG无显著性差异.结论二甲双胍治疗2型糖尿病,在降低血浆胰岛素水平、改善IR的同时,伴有血压的明显下降.     

Olmesartan Improves Pulse Wave Velocity and Lowers Central Systolic Blood Pressure and Ambulatory Blood Pressure in Patients With Metabolic Syndrome

Ambulatory blood pressure (BP) and central systolic BP (cSBP) are superior to brachial office BP measurements in predicting cardiovascular end organ damage. The authors aimed to analyze the effect of olmesartan 80 mg (OLM 80) vs 20 mg (OLM 20) vs amlodipine 5 mg (AML 5) on central hemodymamics and ambulatory BP in patients with metabolic syndrome (MetS).In a double‐blind, three‐phase crossover study comprising 69 untreated patients with MetS defined by the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults guidelines, the effects of OLM 80 on central hemodynamics (cSBP), central pulse pressure), pulse wave velocity (PWV), and 24‐hour ambulatory BP were compared with OLM 20 and AML 5, given for 6 weeks each. In 69 patients (47 men, 22 women) (51.5±9.75 years), reduction in cSBP was the highest with OLM 80 and significantly greater than the reduction with AML 5 (−14.1 mm Hg vs −9.7 mm Hg, P=.0117). All three substances significantly reduced 24‐hour ambulatory systolic (OLM 80 and OLM 20 P<.0001; AML 5 P=.0105). BP and 24‐hour diastolic BP (OLM 80 and OLM 20 P<.0001; AML 5 P=.0126). PWV was significantly reduced by OLM 80 (−0.58 m/s, P=.0088) and by OLM 20 (−0.48 m/s, P=.0362) but not by AML 5 (−0.28 m/s, P=.2065). For PWV, no significant differences were detected between the three groups. OLM significantly improves arterial stiffness as demonstrated by the reduction in PWV and in cSBP. In addition, 24‐hour ambulatory BP was reduced to a greater extent with OLM 80 than with AML 5.

The metabolic syndrome (MetS) is a cluster of adverse metabolic parameters with an increasing prevalence in the Western world. Based on data from the National Cholesterol Educational Program (NCEP), an estimated 34% of men and 35% of women are affected by MetS in the United States. In Europe, about 20% to 25% of the population have MetS. Several studies clearly demonstrate that patients with MetS are at increased risk for cardiovascular mortality and morbidity.¹, ² Data from the Hoorn study shows that MetS—independent of the definition applied—is associated with a two‐fold increase of cardiovascular morbidity and mortality.¹ If arterial hypertension coexists with adverse metabolic patterns of the MetS, such as abdominal obesity, hyperlipidemia, and insulin resistance, both conditions exaggerate the detrimental effects on the vasculature by altered hemodynamic and biochemical processes, consecutively resulting in severe cardiovascular end organ damage. Thus, strict control of both blood pressure (BP) and metabolic parameters is essential in preventing or reducing cardiovascular risk in patients with MetS. In the face of the evidence that different antihypertensive classes have been demonstrated to act differently on the vasculature, finding a therapeutic approach that not only reduces high BP but simultaneously exerts beneficial effects on the vasculature might be seminal in patients with MetS.Several experimental and clinical studies have reported beneficial effects of the angiotensin receptor blockers (ARBs) such as olmesartan (OLM) on vascular pathologies.³, ⁴, ⁵ Similarly, in the Conduit Artery Functional Endpoint (CAFE) study, the calcium channel blocker amlodipine (AML) was shown to be superior to the β‐blocker atenolol in reducing central systolic BP (cSBP) despite comparable impact on brachial BP.⁶ In this study we aimed to investigate the effect of OLM 80 mg—a dose above the approved maximum daily dose—compared with OLM 20 mg and the calcium channel blocker AML 5 mg on arterial stiffening determined by pulse wavy velocity (PWV) and on 24‐hour ambulatory BP or brachial and central BP.The OLM dose of 80 mg was chosen since BP‐independent beneficial effects have been observed above the maximum BP dose and because the observation that very high doses of ARBs, such as OLM, are not related to higher incidence of side effects, ie, there is no dose dependency of side effects with ARBs.     

代谢综合征患者血压变异性和心率变异性的临床研究

目的 通过观察代谢综合征(MS)患者血压变异性(BPV)和心率变异性(HRV),探讨MS对心血管系统自主神经功能的影响.方法 入选MS患者(MS组)110例及对照组46例,分别进行24h动态血压和动态心电图监测,对比分析两组的BPV和HRV的指标.结果 (1)MS组的一般资料(性别比、年龄)及HDL-C与对照组比较,差异均无统计学意义(P＞0.05);MS组的体质指数(BMI)、腰围(WC)、腰臀比(WHR)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、体脂含量(FATc)及体脂比例(FATp)与对照组比较,差异均有统计学意义(P＜0.05).(2)MS组BPV中9项指标均较对照组显著性增高(P＜0.05);其余3项(dDBPSD、nSBPSD及nDBPSD)指标升高,但无统计学意义(P＞0.05).(3)MS组HRV各项指标与对照组比较,差异均有统计学意义(P＜0.05).(4)MS与性别、吸烟、心血管病早发家族史、高血压、糖尿病、TG、FBG及MBI具有相关性(P＜0.05);与饮酒、TC、HDL-C及LDL-C无相关性(P＞0.05).结论 MS患者存在心血管系统自主神经功能紊乱,表现为BPV的显著升高和HRV的显著降低,其与性别、吸烟、心血管病早发家族史、高血压病、糖尿病、TG、FBG及MBI相关.     

非诺贝特和吡格列酮对代谢综合征大鼠血压及体重的影响

目的:探讨非诺贝特和吡格列酮对高果糖诱导的代谢综合征(MS)大鼠血压及体重的影响.方法:用高果糖饮食饲养SD大鼠构建Ms大鼠模型,将存活的大鼠随机分为空白对照组(n=8),代谢综合征模型组(n=39).又将代谢综合征模型组分为4个亚组:模型对照亚组(n=10),非诺贝特亚组(n=8),毗格列酮亚组(n=11),非诺贝特+吡格列酮哑组(n=10)分别单用非诺贝特和吡格列酮及二者合用干预.分析比较两种药物单用及合用,对MS大鼠收缩压、体重等的影响.结果:吡格列酮亚组干预后与干预前比收缩压降低(P<0.01),胰岛素敏感指数(ISI)升高(P<0.01).非诺贝特亚组干预后与干预前比收缩压、ISI变化均不明显(P>0.05).非诺贝特+吡格列酮亚组干预后与干预前比收缩压降低,ISI升高(P均<0.01),差异有统计学意义.干预后,各药物干预亚组与模型对照亚组问体重差异无统计学意义(P>0.05).结论:单用吡格列酮或合用非诺贝特干预明显改善MS大鼠胰岛素抵抗、降低收缩压,可更好地控制其心血管病的危险因素.     

Impact of Treatment with Rosiglitazone or Metformin on Biomarkers for Insulin Resistance and Metabolic Syndrome in Patients with Polycystic Ovary Syndrome

Background

There is increasing evidence that insulin resistance (IR) has an important implication in the pathogenesis of polycystic ovary syndrome (PCOS), a common endocrinopathy in women. This study was performed to investigate the impact of different treatments for IR on five currently discussed markers for insulin resistance: intact proinsulin, adiponectin, retinol-binding protein 4 (RBP4), resistin, and visfatin in patients with PCOS.

Methods

Thirty-five women with clinically confirmed PCOS diagnosis were included in the study [age (mean±SD): 24.7±4.8 years; body mass index: 27.4±6.0 kg/m²]. They were randomized to receive either metformin (850 mg twice a day) or rosiglitazone (4 mg once a day). Blood samples for measurement of the HOMA_IR score, visfatin, RBP4, intact proinsulin, resisitin, and adiponectin were taken at baseline and after 6 months of treatment.

Results

Both drugs improved ovulation, and an increase in insulin sensitivity was observed, especially in the rosiglitazone arm. Adiponectin levels increased in both treatment arms (metformin: 8.6±3.3 to 16.7±7.2 mg/liter, p < 0.001; rosiglitazone: 8.2±3.5 to 26.2±9.5 mg/liter, p < 0.001), but the increase was more pronounced with rosiglitazone (p < 0.001). While no changes of visfatin concentrations were observed during rosiglitazone therapy (15.4±6.9 ng/ml vs 17.4±4.8 ng/ml, n.s.), there was an increase in the metformin treatment arm (11.9±4.0 to 21.8±8.3 ng/ml, p < 0.001). Significant increases demonstrated for RBP4 in both treatment arms were more pronounced in the metformin group (metformin: +66%, rosiglitazone: +33%). All patients were in stage I or II of ß-cell dysfunction and none of them showed increased intact proinsulin levels or changes in resisitin at baseline or end point.

Conclusions

Both drugs slightly improved ovulation in our PCOS patient population during 6 months of therapy, which was accompanied by improved insulin sensitivity and an increase in adiponectin levels. Metformin increased visfatin concentrations. Despite improved insulin resistance, an increase in RBP4 concentration was seen for both drugs. Rosiglitazone seems to be the more favorable drug under these circumstances. However, our results regarding visfatin and RBP4 contradict other reports and further research is required to clarify their value as diagnostic markers for the metabolic syndrome. In this study, adiponectin appeared to be the most promising indicator of both metabolic status and therapeutic success.     

Multidisciplinary Treatment of the Metabolic Syndrome Lowers Blood Pressure Variability Independent of Blood Pressure Control

Blood pressure (BP) variability (BPV) contributes to target organ damage independent of BP. The authors examined the effect of a 1‐year multidisciplinary intervention on BPV in patients with the metabolic syndrome (MetS) as defined by criteria from the Third Report of the Adult Treatment Panel. Forty‐four nondiabetic patients underwent clinical and biochemical profiling, 24‐hour ambulatory BP monitoring (ABPM), body composition, carotid intima‐media thickness, and carotid‐femoral pulse wave velocity (PWV). The intervention targeted all MetS components. BPV was assessed by the standard deviation of daytime systolic BP derived from ABPM. Patients with low and high BPV (lower or higher than the median daytime standard deviation of 11.6 mm Hg) did not differ in regards to systolic and diastolic BP, age, fasting glucose, glycated hemoglobin, and body mass index, but the high‐variability group had higher values of low‐density lipoprotein and leg fat. The 1‐year intervention resulted in weight reduction but not BP‐lowering. BPV declined in the high‐variability group in association with lowering of PWV, C‐reactive protein, glycated hemoglobin, alanine aminotransferase, asymmetric dimethylarginine, and increased high‐density lipoprotein cholesterol. A multidisciplinary intervention independent of BP‐lowering normalized BPV, lowered PWV, and enhanced metabolic control.     

动态血压监测评价贝尼地平治疗原发性高血压的疗效观察

目的应用动态血压监测(ABPM)的方法评价贝尼地平治疗原发性高血压的降压疗效、谷/峰比值及不良反应.方法采用开放的方法,20例研究对象经2周洗脱期,服用贝尼地平4mg/d一次,2周末坐位舒张压(SeDBP)≥90 mmHg者加量至贝尼地平8 mg/d一次,继续服用6周.于洗脱期末及治疗8周末各行ABPM和实验室检查一次.结果ABPM显示8周末24 h、日间、夜间收缩压(SBP/DBP)较洗脱期末分别下降(9.4±5.4/6.2±4.1)mmHg、(10.7±6.7/6.8±3.8)mmHg、(6.9±9.0/5.1±7.7)mmHg.降压T/P值SBP为58%,DBP为59%.无严重不良反应.结论贝尼地平4～8 mg/d一次为疗效确切的降压药物.     

动态血压监测评价贝尼地平治疗原发性高血压的疗效观察

目的　应用动态血压监测 (ABPM )的方法评价贝尼地平治疗原发性高血压的降压疗效、谷 /峰比值及不良反应。方法　采用开放的方法 ,2 0例研究对象经 2周洗脱期 ,服用贝尼地平 4mg/d一次 ,2周末坐位舒张压 (SeDBP)≥ 90mmHg者加量至贝尼地平 8mg/d一次 ,继续服用 6周。于洗脱期末及治疗 8周末各行ABPM和实验室检查一次。结果　ABPM显示 8周末 2 4h、日间、夜间收缩压 (SBP/DBP)较洗脱期末分别下降 (9.4± 5 .4 / 6 .2± 4 .1)mmHg、(10 7± 6 .7/ 6 8± 3 8)mmHg、(6 9± 9 0 / 5 1± 7 7)mmHg。降压T/P值SBP为 5 8% ,DBP为 5 9%。无严重不良反应。 结论　贝尼地平 4～ 8mg/d一次为疗效确切的降压药物。