妊娠糖尿病患者脂联素与胰岛素抵抗相关性的初步探讨

目的探讨妊娠糖尿病（GDM）患者脂联素与胰岛素抵抗（IR）的关系。方法检测40例GDM患者（GDM）、34例糖耐量正常（NGT）的孕妇作对照（NC）组的血清脂联素水平，同时以稳态模型HOMA-IR计算胰岛素抵抗指数。结果（1）GDM组脂联素水平、HOMA-IR分别为7．83±1．57μg／L，3．57±1．27，对照组分别为9．36±1．41μg／L、2．98±1．03，两组比较差异有统计学意义。（2）GDM组多元线性逐步回归分析结果显示孕前BMI、脂联素是影响GDM患者IR的独立危险因素。结论GDM患者血清脂联素减少与IR密切相关。     

胰岛素抵抗相关因子与妊娠糖尿病

研究发现,肿瘤坏死因子α、瘦素、脂联素、抵抗素、游离脂肪酸、性激素结合球蛋白、甲胎球蛋白等因子紊乱可引起胰岛素抵抗,进而导致了妊娠糖尿病的发生。本文着重讨论这些相关因子与妊娠糖尿病的关系。     

瘦素与妊娠糖尿病患者胰岛素抵抗及胎儿发育的相关性

目的 探讨瘦素及可溶性瘦素受体(sLR)在妊娠糖尿病发病及胎儿发育中的作用.方法 选取2014年1月至12月在厦门大学附属成功医院连续产检并分娩的673名孕妇为研究对象,跟踪随访至孕晚期.根据糖耐量试验结果,采用随机抽样法选取50例血糖控制良好的妊娠糖尿病患者纳入妊娠糖尿病组,根据一般资料进行匹配选取50名糖耐量试验结果阴性者纳入正常妊娠组.根据妊娠周数分为孕早期和孕晚期亚组,比较两组不同孕期血清及脐血瘦素、sLR、脂联素、抵抗素及生化指标水平,计算稳态模型评估-胰岛素抵抗指数(HOMA-IR),精确测量新生儿生长发育指标,使用多元Logistic回归分析孕早期胰岛素抵抗的危险因素,同时采用Spearman相关性分析血清瘦素与sLR、脂联素、抵抗素及生化指标水平的相关性.结果 与正常妊娠组相比,妊娠糖尿病组孕早期血清瘦素、甘油三酯、总胆固醇、低密度脂蛋白-胆固醇(LDL-C)、空腹胰岛素(FINS)、HOMA-IR明显升高(t=0.938～6.864,P均＜0.05),sLR、脂联素显著降低(t=9.237、2.216,P均＜0.05),抵抗素、高密度脂蛋白-胆固醇(HDL-C)、空腹血糖差异无统计学意义(P均＞0.05).与正常妊娠组相比,妊娠糖尿病组孕晚期血清瘦素、抵抗素、空腹血糖、FINS、甘油三酯、总胆固醇、LDL-C、HOMA-IR明显升高(t=0.429 ～ 13.787,P均＜0.05),sLR、脂联素显著降低(t=2.216、5.623,P均＜0.05),HDL-C差异无统计学意义(P＞0.05).与正常妊娠组相比,妊娠糖尿病组脐血瘦素、抵抗素明显升高(t=1.007、11.857,P均＜0.05),sLR、脂联素显著降低(t=0.201、4.558,P均＜0.05).多元Logistic回归分析显示,瘦素(OR =1.288,95％ CI:1.137 ～4.370)、抵抗素(OR=1.223,95％CI:1.035～ 1.570)、总胆固醇(OR=1.216,95％CI:1.026 ～1.823)、甘油三酯(OR=1.357,95％CI:1.008～ 3.572)、LDL-C (OR=1.634,95％ CI:1.251～3.764)是妊娠糖尿病组孕早期发生胰岛素抵抗的独立危险因素,sLR (OR =0.714,95％ CI:0.161～0.893)、脂联素(OR =0.352,95％CI:0.112 ～0.510)是妊娠糖尿病组孕早期发生胰岛素抵抗的保护性因素.妊娠糖尿病组孕晚期母体血瘦素含量与sLR、脂联素均呈负相关(r=-0.16、-1.13,P均=0.000),与抵抗素呈正相关(r=0.269,P=0.019).妊娠糖尿病组脐血瘦素含量与sLR、脂联素均呈负相关(r=-0.147、-1.250,P均=0.000),与抵抗素、体重、Ponderal 指数均呈正相关(r =0.410、0.673、0.301,P均＜0.05),与头围、身长无关(P均＞0.05).结论 瘦素及sLR与妊娠糖尿病患者胰岛素抵抗存在相关性,但与胎儿宫内生长和发育无关.     

2型糖尿病患者血清乳酸脱氢酶与胰岛素抵抗的相关性

目的探讨2型糖尿病(T2DM)患者血清乳酸脱氢酶(LDH)与胰岛素抵抗的相关性。方法选取2016年10月至2017年12月安徽省马鞍山市人民医院内分泌科住院的T2DM患者138例。患者入院后行口服葡萄糖耐量试验(OGTT),即清晨空腹状态下口服75 g葡萄糖,分别抽取口服葡萄糖前,口服葡萄糖后30、60、120 min静脉血,检测血糖及胰岛素水平。根据稳态模型胰岛素抵抗(HOMA-IR)指数标准将患者分为HOMA-IR<2.5组(50例)和HOMA-IR≥2.5组(88例)。收集并比较2组患者一般资料、相关生化指标、LDH及Matsuda胰岛素敏感指数(Matsuda ISI)等数据。根据LDH三分位数水平将患者分为<172 IU/L、172~197 IU/L和>197 IU/L 3个亚组,比较3个亚组胰岛β细胞功能相关指标HOMA-IR和Matsuda ISI及其他相关指标。采用SPSS 24.0统计软件进行分析。根据数据类型,组间比较采用独立样本t检验、Mann-Whitney U检验、χ2检验、单因素方差分析或Kruskal-Wallis H检验。指标相关性采用Spearman非参数相关分析。多因素logistic回归用于评估发生胰岛素抵抗的危险因素。结果与HOMA-IR<2.5组比较,HOMA-IR≥2.5组患者LDH、空腹血糖、各时间点胰岛素等显著升高,Matsuda ISI显著降低,差异有统计学意义(P<0.05)。<172 IU/L、172~197 IU/L和>197 IU/L 3个亚组中HOMA-IR≥2.5人数分别占50.00%(23/46)、52.17%(24/46)和89.13%(41/46)。随着LDH水平升高,HOMA-IR显著升高,Matsuda ISI显著降低,同时3亚组OGTT各时间点胰岛素不同,差异有统计学意义(P<0.05)。相关分析显示,LDH与HOMA-IR呈正相关(r=0.289,P<0.05),与Matsuda ISI呈负相关(r=-0.314,P<0.001)。校正年龄等相关因素后,多因素logistic回归分析显示,LDH为发生胰岛素抵抗的独立预测因素之一(OR=2.99,95%CI 1.83~4.67;P<0.001)。结论LDH与胰岛β细胞功能指标HOMA-IR及Matsuda ISI存在显著相关性,可以作为简单易行的指标来初步评估T2DM患者胰岛素抵抗的严重程度,协助调整治疗方案。     

胰岛素抵抗和胰岛β细胞分泌功能对妊娠糖尿病的影响

目的探讨胰岛素抵抗(IR)和β细胞分泌功能对妊娠糖尿病(GDM)的影响。方法观察妊娠中晚期孕妇糖耐量正常(NGT)者35例、糖耐量减低(IGT)者33例和GDM者38例在不同糖耐量状态下的IR和β细胞分泌功能,采用HOMA-IR和HOMA-β分别评价IR和β细胞分泌功能。结果IGT组的HOMA-IR明显高于NGT组(P<0·05),两组的HOMA-β的差异无统计学意义;GDM组的HOMA-IR明显高于NGT和IGT组(P<0·05),HOMA-β明显低于NGT和IGT组,差异均有统计学意义。结论妊娠中晚期孕妇IGT阶段胰岛素早期分泌功能受损,到GDM阶段兼有严重的IR和β细胞缺陷。从NGT、IGT到GDM,随着糖代谢紊乱的不断进展,IR逐渐加重,胰岛β细胞功能进行性减退。     

妊娠糖尿病患者血游离脂肪酸与β细胞功能及胰岛素抵抗的关系

检测36例孕24～36周妊娠糖尿病患者和同期30例健康孕妇凌晨3:00、5:00及75 g葡萄糖负荷后血游离脂肪酸和胰岛素水平,比较两组胰岛素敏感性和胰岛素分泌功能.结果提示凌晨及糖负荷后高游离脂肪酸均与妊娠糖尿病患者胰岛素抵抗相关[胰岛素:(7.18±3.19)对(5.05±1.80)mIU/L(3:00)、(8.19±4.42)对(5.31±1.82)mIU/L(5:00)、(59.18±30.85)对(40.52±15.07)mIU/L(糖负荷后);游离脂肪酸:(0.39±0.20)对(0.23±0.11)mmol/L(3:00)、(0.46±0.17)对(0.29±0.12)mmol/L(5:00)、(0.19±0.13)对(0.09±0.06)mmol/L(糖负荷后);均P<0.01],糖负荷后30 min(早期相)的高水平的游离脂肪酸可能与妊娠糖尿病患者早期胰岛素分泌功能缺陷有关.     

Oxidative stress and antioxidant status in patients with late-onset gestational diabetes mellitus

The relationship between late-onset gestational diabetes mellitus [GDM] and oxidative stress is not well known, and the importance of the oxidant/antioxidant equilibrium in the clinical evolution and its complications require elucidation. The aim of the study was to evaluate the relationships between maternal levels of markers of oxidative stress in women with late-onset GDM that, potentially, may have considerable clinical implications in the pathogenesis and/or the evolution of GDM. Pregnant women (n = 78; 53 with GDM, 25 controls), between the 24th and 29th week of gestation, were enrolled. Both groups were analysed for demographic data, perinatal and obstetrics outcomes together with the levels of the marker’s oxidative stress and antioxidant status. Control versus patient results in the univariate analysis were the following: pre-gestational body mass index [BMI] 23.31 ± 4.2 vs. 27.13 ± 4.6 kg/m² (P = 0.001); weeks at delivery 39.2 ± 3.05 vs. 38.9 ± 1.8 (P = 0.09); Caesarean delivery 12.5 vs. 43% (P = 0.004); macrosomia 4 vs. 9.4% (P = 0.6); lipoperoxides [LPO] 2.06 ± 1.00 vs. 3.14 ± 1.55 μmol/mg (P = 0.001); catalase 3.23 ± 1.41 vs. 2.52 ± 1.3 nmol/min/ml (P = 0.03); superoxide dismutase [SOD] 0.11 ± 0.04 vs. 0.08 ± 0.01 U/ml (P = 0.0003); glutathione peroxidase [GPX] 0.03 ± 0.006 vs. 0.025 ± 0.006 nmol/min/ml (P = 0.01); glutathione reductase [GSH] 0.004 ± 0.002 vs. 0.004 ± 0.004 nmol/min/ml (P = 0.9)]; and glutathione transferase [GST] 0.0025 ± 0.0012 vs. 0.0027 ± 0.00017 nmol/min/ml (P = 0.7). Multivariate analysis showed catalase might have a protective effect against GDM development and LPO seems to be a risk factor for the disease. These data suggest an increase in oxidative stress and a decrease in antioxidative defence in women with late-onset GDM and, as such, may have considerable clinical implications in the pathogenesis and/or the course of the pregnancy in these patients.     

妊娠糖尿病患者IR与脂肪细胞因子的关系

目的探讨妊娠糖尿病（GDM）患者胰岛素抵抗（IR）与脂联素（ADI）、瘦素（Leptin）的关系。方法测定40例GDM患者（GDM组）及34例正常人（对照组）空腹血糖（FPG）、胰岛素（FINS）、ADI、Leptin、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蚕白（HDL）,以及餐后2h血糖（2hPG）、胰岛素（0hINS）,计算胰岛素抵抗指数（IRI）.结果两组ADI、Leptin,IRI比较有统计学差异（P〈0.05）。Pearson相关分析显示,GDM组IRI与年龄、孕周、体质量指数（BMI）、TG、TC、LDL、FPG、FINS、2h INS、Leptin呈正相关（P〈0．05,〈0.01）,与ADI呈负相关（P〈0.01）。多元线性逐步回归分析结果显示,BMI、ADI、Leptin是影响GDM患者IR的独立危险因素。结论GDM患者存在明显IR,ADI、Leptin与GDM患者IR有关。     

妊娠期糖尿病患者肥胖抑制素水平及其与胰岛素抵抗的关系

肥胖抑制素是与编码胃促生长素的同一基因共同编码的含23个氨基酸的多肽,可通过与G蛋白耦联的孤儿受体39作用减少摄食,减轻体质量,减慢胃排空,抑制肠能动性.在胰腺组织中,胰岛素和肥胖抑制素浓度存在明显的相关性.     

妊娠糖尿病患者血清瘦素水平与胰岛素抵抗的关系

28例妊娠糖尿病(GDM)患者和30例正常对照组(NGT)的研究显示，GDM组瘦素、空腹胰岛素、甘油三酯和胰岛素抵抗指数水平均比NGT组显著升高；瘦素和孕前BMI是影响GDM患者胰岛素抵抗的独立危险因子。     

Correlation of serum testosterone with insulin resistance in elderly male type 2 diabetes mellitus patients with osteoporosis

Aims/Introduction

The present study was designed to investigate the correlations between the serum testosterone level and insulin sensitivity in elderly male type 2 diabetes patients with osteoporosis.

Materials and Methods

A total of 35 elderly male patients with type 2 diabetes (type 2 diabetes group), 30 elderly male type 2 diabetes patients combined with osteoporosis (DO group) and 30 healthy elderly men (normal control group) participated in the present study. The fasting plasma glucose, fasting insulin, testosterone (T) and estradiol (E₂) were measured. The insulin sensitivity index (ISI), homeostasis model assessment of insulin resistance (HOMA-IR) and E₂/T were calculated. Then, the correlations of serum testosterone level with ISI and HOMA-IR were analyzed by statistical methods.

Results

The HOMA-IR, E₂ and E₂/T of the type 2 diabetes group and DO group were significantly increased, whereas the bone mineral density, ISI, T and sex hormone binding globulin were decreased compared with those of the normal control group. Serum testosterone levels of the type 2 diabetes group and DO group were negatively correlated to the HOMA-IR (r = −0.496, −0.506; P < 0.05), whereas they were positively correlated to the fasting insulin (r = 0.281, 0.292; P < 0.05) and ISI (r = 0.364, 0.403; P < 0.05).

Conclusions

The reduced level of serum testosterone in elderly male type 2 diabetes patients with osteoporosis might promote insulin resistance.     

Magnesium deficiency and insulin resistance in patients with type 2 diabetes mellitus

Magnesium is a predominantly intracellular ion, and it is a cofactor in more than 300 enzymatic reactions, like tyrosinokinase activity. Its deficiency may increase insulin resistance, especially in patients with metabolic syndrome or type 2 diabetes. This study evaluated in 27 patients with poorly controlled type 2 diabetes if there was correlation between intracellular magnesium levels, laboratorial indexes of insulin resistance and glycemic control. Decreased serum and intracellular magnesium depletion were found in 75% and 30.8% of patients, respectively. A negative correlation between intracellular magnesium levels (ICMg) and BMI and HbA1 was found. The homeostasis model assessment for insulin resistance (HOMA-IR) was higher than 3.0 in 59.2% of patients and there was a tendency to negative correlation with ICMg levels, although without statistical significance. Despite the small number of patients, this study shows that magnesium deficiency is frequent in patients with diabetes and its correlation with insulin resistance should be more studied.     

2型糖尿病患者Roux-en-Y胃旁路术后血糖、胃肠激素、调节性B细胞和应激激素的相关性

目的研究2型糖尿病患者Roux-en-Y胃旁路术(RYGB)术后血糖水平、调节性B细胞(Breg)、胃肠激素、应激激素的相关性。方法选择2015年6月至2018年6月住院行RYGB的T2DM患者103例,术后根据疗效分为完全缓解组(n=88)和改善组(n=15),检测患者手术前后血糖水平、Breg、胃肠激素、应激激素,分析术后各指标间的相关性。结果完全缓解组术后12个月空腹血糖(FPG)、皮质醇(Cor)、去甲肾上腺素(NE)、胃饥饿素(Ghrelin)、瘦素(Leptin)明显低于改善组,Breg明显高于改善组(P0.05)。两组治疗前、治疗后12个月胰高血糖素样肽(GLP)-1水平比较差异无统计学意义(P0.05)。Breg与FPG、体重指数(BMI)呈正相关(r=0.842,0.703,均P0.05),Ghrelin与FPG、BMI呈负相关(r=-0.659,-0.582,均P0.05),Leptin与FPG、BMI呈负相关(r=-0.720,-0.697,均P0.05),Cor、NE与FPG呈负相关(r=-0.347,-0.334,均P0.05)。结论 2型糖尿病患者RYGB术后Breg、胃肠激素、应激激素与血糖水平、BMI相关。     

Roles of insulin resistance and beta cell dysfunction in macrosomia among Chinese women with gestational diabetes mellitus

Aims

The aim was to examine associations of insulin resistance and beta cell dysfunction with macrosomia in Chinese women with gestational diabetes mellitus (GDM).

合并糖尿病或胰岛素抵抗的缺血性卒中患者的抗血小板治疗

糖尿病是缺血性卒中患者抗血小板治疗后发生血小板高反应性的独立预测因素,而后者与卒中复发风险增高密切相关.糖尿病或胰岛素抵抗患者血小板反应性增高的机制与多种因素有关,一些血液循环分子可作为预测血小板反应性增高的标记物.监测新型抗血小板药治疗后的血小板反应性,可为合并糖尿病或胰岛素抵抗的缺血性卒中患者的个体化抗栓治疗提供依据.