代谢综合征与肾脏损害

代谢综合征(metabolic syndrome,MS)目前国内、外尚无统一的诊断标准.它是以胰岛素抵抗(IR)为共同土壤,主要包括糖耐量异常(糖尿病,糖耐量减低),中心性肥胖、高血压、极低密度脂蛋白(VLDL-TG)升高和高密度脂蛋白胆固醇(HDLCH)降低等一组症群,相互之间各自独立又有内在联系.     

高尿酸血症在代谢综合征与非代谢综合征的比较

目的：观察高尿酸血症在代谢综合征与非代谢综合征临床上有何不同。方法：对来我院和我市其它医院就诊和查体的高尿酸血症患者370人中，按其伴有代谢综合征（HS＋）和非代谢综合征（HS一）分两组均进行强化干预；并对其1年的追踪。结果：在高尿酸血症中MS＋的患病率占65．95％，MS-的患病率占34．05％；性别比：男：女MS＋为3．44：1，MS-为4．48：1；年龄分布为40-79岁的患病率MS＋：84．02％，MS-：83．33％，二者平均83．78％；MS＋与MS-比较：血压、空腹血糖、高密度脂蛋白和甘油三脂有显著性差异，尿酸无显著性差异；脂肪肝、冠心病、脑猝中和周围血管病有显著性差异，肾结石和痛风无显著性差异。结论：高尿酸血症中MS＋的患病率与MS-的相比明显增高；二者的的性别无差别，男女比为3～4：1；二者发病年龄都集中在40岁以上；干预后二组均能有效的降低尿酸水平，MS＋的相关疾病也较明显改善。     

代谢综合征老年患者高血压靶器官损害的分析

目的探讨老年高血压合并代谢综合征(MS)患者与靶器官损害的关系。方法依据MS及高血压诊断标准选择对照组(无任何MS组分)70例,单纯高血压组(EH)120例,老年高血压并MS患者150例,进行颈动脉、心脏超声检查,测量颈动脉内膜-中层厚度(IMT)、左室射血分数(LVEF)、计算LVMI、E/A,计算体质量指数(BMI)、测定其血压、血脂、血糖、肌酐、晨尿微量白蛋白浓度等。结果HMS组靶器官损害参数:IMT(0.98±0.47)mm、斑块发生率70%、LVMI(107.4±15.1)g/m2、LVH41%、E/A0.79±0.29、LVEF(63.4±5.4)%、CR(115.02±17.94)μmol/L、MUAC(35.65±17.84)mg/L与对照组EH组比较,差异有统计学意义(P<0.05)。结论在老年人中MS明显加重了高血压靶器官的损害。     

便携式简易人体测量装置评估军队干部心血管代谢危险的临床研究

目的 探讨军队在职干部中发生心血管代谢的危险率以及血清瘦素与心血管代谢危险分层之间的关系.方法 对2007年8月～2008年5月入广州疗养院体检的军队男性干部共416人运用便携式简易人体测量装置测量和检测身高、体重、腰围、血压、心率、生化等指标,根据心血管代谢危险评估量表纳入数据分层评估,并进行统计学分析.结果 中年组的心血管代谢低危异常率为28.72%,比同等危险度的老年组异常率21.22%高,差异有显著性意义(P<0.05):中年组、老年组各危险度检出率均比青年组高,差异有显著性意义(P<0.05);其余各年龄组间检出率比较差异无显著性意义.血清瘦素水平随年龄的上升而上升,随着危险水平的上升而逐渐上升(P<0.05).结论 便携式简易人体测量装置及技术所筛选的心血管代谢危险分组准确可信,能准确地筛选出心血管代谢危险的低、高危人群,可作为科学完善的心血管病评估工具.     

36例心血管X综合征临床分析

目的提高对心血管X综合征的认识并探讨其可能的发病机制。方法回顾性分析36例经冠状动脉造影确诊的心血管X综合征患者的临床特征和检查结果。结果除冠状动脉造影正常外,心血管X综合征的临床表现、心电图、运动试验、负荷核素心肌灌注断层显像、胸痛缓解方式均与冠心病极为相似。结论冠状动脉造影是唯一鉴别心血管X综合征和冠心病的方法。心血管X综合征可能发病机制为冠状动脉微小血管病变、内皮功能异常、胰岛素抵抗等。     

中青年急性冠脉综合征合并代谢综合征的临床特点

目的观察中青年急性冠脉综合征(ACS)合并代谢综合征(MS)患者临床特点。方法中青年ACS患者137例,根据是否合并MS分为MS组和非MS组,比较2组临床特点。结果 MS组代谢异常主要表现为肥胖、高血压、高血糖脂血症、低HDL-C血症等,冠脉造影以多支血管病变和弥漫性血管病变多见。结论对冠状动脉病变严重、左室功能受损明显的中青年ACS合并MS患者及早进行个体化治疗,消除肥胖,控制血糖、血脂等,是降低心血管事件发生率及病死率,提高患者生活质量的关键。     

马凡氏综合征并严重心血管损害(六例报告并文献复习)

1987年8月到1989年4月我院共收治合并有严重心血管损害的马凡氏综合征六例,其中四例合并有升主动脉瘤,重度主动脉瓣关闭不全。另外二例则各以二尖瓣脱垂,重度二尖瓣关闭不全和复杂青紫型先心为其临床特点。六例中有二例均外科手术纠治,心功能明显好转,其中一例行带瓣人造血管置换升主动脉瘤和主动脉瓣,同时行冠脉移植术,另一例则行二尖瓣置换术。手术疗效显著。余下的四例均因严重心衰,失去手术时期,虽经积极内科治疗,均在入院后一个月内死亡。本文结合文献,就马凡氏综合征合并严重心血管损害的诊断及治疗问题进行了讨论。     

肾病综合征患者氨基酸代谢临床观察

目的 探讨肾病综合征(NS)严重低白蛋白血症患者，氨基醛代谢异常情况。方法 应用反相高压液相色谱法，测定30例肾病综合征急者血、尿氨基醛含量，并与15例健康对照组比较。结果 肾病综合征患者血清中缬氨酸、亮氨酸、苏氨酸、组氨酸、赂氨酸含量显著低于正常对照组(P＜0．05—0．001)，苯丙氨酸、色氨酸、谷氨酸、胱氨酸、3—甲基组氨酸显著高于正常对照组(P＜0．001)。这些异常与以往报道的慢性肾功能不全时氨基酸代谢异常极为相似，仅程度略轻；尿液中氨基酸的排出量与肾性尿糖一致。结论 在NS时确实存在氨基酸代谢异常，其异常程度略低于侵性肾功能不全；同时根据尿氨基酸排出量也提示NS时可伴肾小管病变。     

儿童单纯性肥胖与心血管代谢及骨代谢的关系研究

目的 探讨儿童单纯性肥胖与心血管代谢及骨代谢的关系,以期为防治儿童肥胖及相关疾病提供理论支持。方法选择2019年10月至2020年12月诊断为单纯性肥胖的75例儿童作为肥胖组,选择同时期进行健康体检的75例儿童作为对照组。比较两组的基础资料、心血管代谢指标及骨代谢指标,分析肥胖组心血管代谢指标、骨代谢指标与身体质量指数（BMI）的关系。结果 肥胖组的体重、BMI、收缩压（SBP）和舒张压（DBP）高于对照组,差异具有统计学意义（P<0.05）。肥胖组的血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）水平均高于对照组,高密度脂蛋白（HDL）水平低于对照组,舒张末期室间隔厚度（IVST）、舒张末期左室后壁厚度（LVPWT）、左室相对室壁厚度（RWT）、左室质量（LVM）明显大于对照组,差异具有统计学意义（P<0.05）;两组的左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）及左室射血分数（LVEF）比较,差异无统计学意义（P>0.05）。肥胖组的25羟维生素D[25(OH)D]水平...     

原发性醛固酮增多症心血管事件相关代谢指标研究

目的:探讨原发性醛固酮增多症(PA)患者心血管事件相关代谢指标的特征。方法:收集2008-2012年在我院初诊经手术病理确诊的PA 63例及原发性高血压(EH)58例患者的临床资料,比较两组代谢指标及主要心血管事件发生的差异。结果:(1)除性别构成比(男/女),两组的年龄、体质指数(BMI)、收缩压、舒张压、病程差异无统计学意义(P>0.05)。(2)PA组胰岛素释放试验(IRT)的0、2 h胰岛素低于EH组(P<0.01),两组的糖代谢异常、合并代谢综合征(MS)、糖化血红蛋白和IRT 1、3 h的胰岛素水平差异无统计学意义(P>0.05)。PA组血总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及血清尿酸(SUA)低于EH组(P<0.01)。(3)PA组主要心血管事件发生率17.5%,EH组为15.5%,差异无统计学意义(P>0.05)。结论:与EH患者相比,PA患者的代谢紊乱、心血管事件发生情况无明显差异,可能与PA的早期筛查、诊断有关。     

Managing cardiovascular risk in patients with metabolic syndrome

Metabolic syndrome consists of a cluster of cardiovascular (CV) and metabolic risk factors (e.g., abdominal obesity, hypertension, elevated levels of fasting plasma glucose and triglycerides, and low levels of high-density lipoprotein cholesterol [HDL-C]) and is associated with an increased risk for type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). Because the risks for CVD and type 2 DM are highly variable among patients with metabolic syndrome, it is essential to assess a patient's risks before identifying specific treatment or lifestyle interventions. The major risk factors for CVD are smoking, hypertension, elevated levels of total and low-density lipoprotein cholesterol, low levels of HDL-C, and older age. In patients at low risk for CV events, lifestyle interventions (i.e., weight loss and increased physical activity) may be sufficient to control the components of metabolic syndrome and to reduce the risk for type 2 DM and CVD. Patients who are at high risk, however, must receive aggressive drug therapy in addition to lifestyle interventions. The following factors need to be targeted: obesity (particularly abdominal obesity), dyslipidemia, hypertension, and prothrombotic/proinflammatory states. Drugs with various and complementary mechanisms of action, including drugs targeting lipid metabolism, may be effective in controlling these factors and thereby delaying or preventing CV events and type 2 DM.     

Predictive value of insulin-glucose homeostasis markers in patients with metabolic syndrome X

AIM: To clarify informative value of secretory ability of pancreatic beta-cells and correspondence of insulin values to glycemia in the course of standard glucose tolerance test (GTT) in detection of insulin-resistance in patients with arterial hypertension (AH) to verify metabolic syndrome (MS). MATERIAL AND METHODS: Correlation and factor analyses were performed of correlations between glycemia, immunoreactive insulin (IRI), C-peptide, glucose/IRI in the course of GTT in 111 AH patients divided into groups by the sum of metabolic disturbances. RESULTS: The greatest number of correlations were seen for glucose/IRI fasting index. According to the factor analysis, changed sensitivity to insulin and hyperinsulinemia are the first stage of metabolic disturbances in AH irrespective of body mass. In obesity the number of the above correlations is maximal. Multivariance analysis has shown significant differences between AH patients and healthy subjects irrespective of body mass and glucose tolerance. CONCLUSION: Basal index glucose/IRI < 6 relative units is informative in all the studied variants of metabolic syndrome as regards insulin resistance.     

Treatment of hypertension and other cardiovascular risk factors in patients with metabolic syndrome

Metabolic syndrome (MetS), a concurrence of hypertension, abdominal obesity, impaired fasting glucose, and dyslipidemia, has been shown to be a risk factor for cardiovascular disease. Insulin resistance has been thought to be one of the pathophysiologies of the syndrome. Reduction of the underlying causes of MetS, such as obesity, physical inactivity, and atherogenic diet, is first-line therapy. Treatment of hypertension and other cardiometabolic risk factors of MetS is also required. This article reviews the treatment of the metabolic syndrome with a focus on the importance of lifestyle changes and treatment of hypertension.     

Managing cardiovascular risk inpatients with metabolic syndrome

The metabolic syndrome is a constellation of risk factors that contribute to the onset of type 2 diabetes mellitus and cardiovascular disease (CVD). CVD has been identified by the National Cholesterol Education Program (NCEP) as the primary clinical outcome of the metabolic syndrome. Although no algorithm is currently available for estimating the absolute risk of CVD for patients with the metabolic syndrome, screening for cardiovascular (CV) risk in these patients involves testing for lipoprotein abnormalities (namely, an analysis of specific low-density lipoprotein particle numbers) and an assessment of various surrogate markers for subclinical coronary artery disease. Such screening can be used to help predict the development of CVD and thereby allow for effective interventions to help prevent coronary events. Strategies for reducing CV risk in patients with the metabolic syndrome are multifactorial. In addition to placing an emphasis on therapeutic lifestyle changes that increase levels of physical activity, dietary modification, and weight reduction, several pharmacologic therapies are available. One novel approach for managing CV risk in patients with the metabolic syndrome involves the inhibition of the endocannabinoid system, including the use of rimonabant. A review of CV risk factors in patients with the metabolic syndrome is beneficial for clinicians to apply in the care of their patients, along with a discussion about strategies for identifying at-risk patients and managing CVD risk for these patients.     

Effect of rosiglitazone on endothelial function and inflammatory markers in patients with the metabolic syndrome

OBJECTIVE: The aim of this study was to assess the effect of rosiglitazone on endothelial function and inflammatory markers in patients with the metabolic syndrome. RESEARCH DESIGN AND METHODS: This was a randomized, double-blind, controlled clinical trial. One hundred subjects (54 men and 46 women) with the metabolic syndrome, as defined by the Adult Treatment Panel III, were followed for 12 months after random assignment to rosiglitazone (4 mg/day) or placebo. Primary end points were flow-mediated dilation and high-sensitivity C-reactive protein (hs-CRP) levels; secondary end points were lipid and glucose parameters, homeostasis model assessment (HOMA) of insulin sensitivity, endothelial function score, and circulating levels of interleukin (IL)-6, IL-18, and adiponectin. RESULTS: Compared with 60 control subjects matched for age and sex, patients with the metabolic syndrome had decreased endothelial function, raised concentrations of inflammatory markers, and reduced insulin sensitivity. After 12 months, subjects with the metabolic syndrome receiving rosiglitazone showed improved flow-mediated vasodilation (4.2%, P < 0.001) and reduced hs-CRP levels (-0.7 mg/dl, P = 0.04), compared with the placebo group. Moreover, HOMA (-0.8, P = 0.01) and serum concentrations of IL-6 (-0.5 pg/ml, P = 0.045) and IL-18 (-31 pg/ml, P = 0.036) were significantly reduced in subjects receiving rosiglitazone, whereas adiponectin levels showed a significant increment (2.3 microg/ml, P = 0.02). High-density lipoprotein-cholesterol levels increased more and triglyceride levels decreased more in the rosiglitazone group compared with the placebo group. At 1 year of follow-up, 30 subjects receiving rosiglitazone still had features of the metabolic syndrome, compared with 45 subjects receiving placebo (P < 0.001). CONCLUSIONS: Rosiglitazone might be effective in reducing the prevalence of the metabolic syndrome.     

The metabolic syndrome and cardiovascular disease

The metabolic syndrome, which is very common in the general population, is defined by the clustering of several classic cardiovascular risk factors, such as type 2 diabetes, hypertension, high triglycerides and low high-density lipoprotein cholesterol (HDL). Central obesity and insulin resistance, which are the two underlying disorders of the syndrome, are further risk factors for cardiovascular disease. Moreover, a panel of novel (non-traditional) risk factors are ancillary features of the metabolic syndrome. They include biomarkers of chronic mild inflammation (e.g. C-reactive protein, CRP), increased oxidant stress (e.g. oxidized low density lipoprotein, LDL), thrombophilia (e.g. plasminogen activator inhibitor-1, PAI-1) and endothelial dysfunction (e.g. E-selectin). Therefore, subjects with the metabolic syndrome are potentially at high risk of developing atherosclerosis and clinical cardiovascular events.In recent years several longitudinal studies have confirmed that subjects with the metabolic syndrome present with atherosclerosis and suffer from myocardial infarction and stroke at rates higher than subjects without the syndrome. The risk of cardiovascular disease (CVD) is particularly high in women with the syndrome and in subjects with pre-existing diabetes, CVD and/or high CRP. However, an increased risk is already present in subjects with a cluster of multiple mild abnormalities. The risk related to the metabolic syndrome is definitely higher when subjects affected are compared to subjects free of any metabolic abnormality.     

代谢综合征与糖尿病和心血管疾病

1999年世界卫生组织(WHO)公布了代谢综合征(metabolic syndrome,MS)的工作定义(简称WHO定义)。此后6～7年间,世界各国及多个学术组织对其相继提出了不同定义。众多不同定义在一定程度上造成了对MS的认识及临床应用上的混乱;也造成了MS的国际间交流和比较上的     

Clinical outcomes in metabolic syndrome

Metabolic syndrome is a clustering of cardiovascular risk factors. Its definition is the presence of any 3 of the following: obesity, hypertriglyceridemia, low high-density lipoprotein, hypertension, and impaired fasting glucose. The development of coronary artery disease is the most dreaded complication of this disease. In the United States, Mexican Americans and African American women are the most affected. Management of this syndrome includes physical exercise, weight loss, and effective drug treatment of dyslipidemia, high blood pressure, and impaired fasting blood glucose. Because of the increasing prevalence of obesity and diabetes, there is a rise in fatal and nonfatal cardiovascular events. With the development of effective antiplatelet medication and newer drug-eluting stents, percutaneous coronary intervention has become an effective revascularization strategy for those with coronary artery disease. Rates of stent restenosis and target-lesion revascularization have been reduced. Oral hypoglycemic drugs like thiazolidinediones improve insulin resistance and may have a favorable effect in those with metabolic syndrome. Diagnosis and appropriate management of metabolic syndrome are challenges as the presence of risk factors predates the coronary event.