甘油三酯葡萄糖指数与心血管疾病及代谢综合征相关性的研究进展

甘油三酯葡萄糖指数已被提出可作为胰岛素抵抗的简易灵敏的替代指标,且已有研究表明其与罹患心血管疾病风险呈正相关,对心血管疾病患者的早期筛查、危险分层及预后判断有潜在能力。因此本文就甘油三酯葡萄糖指数对心血管疾病的临床应用价值及最新研究进展做一综述。     

甘油三酯葡萄糖乘积指数与糖尿病血管病变的研究进展

胰岛素抵抗是2型糖尿病发病的重要原因之一,是导致心血管疾病、代谢综合征和其他共病代谢改变的来源.因此,胰岛素抵抗的早期诊断至关重要.血清甘油三酯葡萄糖乘积指数为一种新型胰岛素抵抗替代指标,现就其在2型糖尿病及糖尿病血管病变的研究进展做一综述.     

甘油三酯葡萄糖乘积指数在心力衰竭中的研究进展

甘油三酯葡萄糖乘积指数是一种新型的胰岛素抵抗指标，胰岛素抵抗是心力衰竭(HF)及HF常见危险因素发生发展的共同病理生理学基础，现就甘油三酯葡萄糖乘积指数在HF中的研究进展做综述。     

胰岛素抵抗与老年2型糖尿病患者认知衰弱的研究进展

胰岛素抵抗是老年2型糖尿病患者认知衰弱的重要病理生理机制,及早识别相关危险因素并进行干预,对改善患者生活质量具有重要意义。甘油三酯葡萄糖乘积指数作为一种新型的胰岛素抵抗指数,也可增加老年2型糖尿病患者认知衰弱的风险。现就胰岛素抵抗与老年2型糖尿病患者认知衰弱之间发病机制及危险因素的研究进展,以及甘油三酯葡萄糖乘积指数与认知衰弱之间的研究进展做综述。     

内源性高甘油三酯血症存在胰岛素抵抗

为探讨内源性高甘油三酯血症是否存在胰岛素抵抗，本文对５３例内源性高甘油三酯血症患者及３３例年龄及性别相匹配的正常人的耐糖试验、胰岛素分泌试验、空腹血脂及血浆载脂蛋白进行了分析。结果发现，内源性高甘油三酯血症患者口服１００ｇ葡萄糖后血糖及血浆胰岛素水平明显增加，服糖后２ｈ血糖大于７．２２ｍｍｏｌ／Ｌ，服糖后３ｈ血浆胰岛素仍未恢复至空腹水平；且血浆胰岛素面积和葡萄糖面积、血浆胰岛素面积与葡萄糖面积的百分比及胰岛素抵抗指数均明显高于正常对照组，说明内源性高甘油三酯血症患者存在胰岛素抵抗，出现高胰岛素血症及葡萄糖耐量降低。     

三酰甘油葡萄糖指数对心血管疾病的预测价值

胰岛素抵抗是心血管疾病的主要危险因素,近几年提出的替代预测标志物三酰甘油葡萄糖指数是心血管疾病的独立预测指标.相比既往单一指标,三酰甘油葡萄糖指数能综合反映动脉粥样硬化,预测心血管事件,有望成为心血管疾病的潜在治疗靶点和生物标志物.     

甘油三酯葡萄糖指数对动脉粥样硬化性心血管疾病的预测价值

动脉粥样硬化性心血管疾病(ASCVD)是严重危害人类健康的疾病，随着疾病的发生发展会出现一系列临床综合征，同时给患者带来沉重的经济负担。预防ASCVD的危险因素如高血压、高脂血症和高血糖等非常重要。如何通过无创手段预测ASCVD的严重程度，尽早进行一级预防，避免不良心血管事件的发生和减轻患者的经济负担显得尤为重要。近年来，甘油三酯葡萄糖指数可用于评估人群中是否存在胰岛素抵抗。同时甘油三酯葡萄糖指数是简单、快捷、常规检测易得到的无创数据，可作为心血管疾病的预测因子，对ASCVD的严重程度、累及冠状动脉的数量和严重不良心血管事件等具有重要的预测价值。     

老年高血压病及冠心病的胰岛素抵抗及其与血脂的关系

目的：探讨老年高血压和冠心病患的胰岛素抵抗及其与血脂的关系。方法：以胰岛素曲线下面积／葡萄糖曲线下面积（Ｉ／Ｇ）和胰岛素抵抗指数作为胰岛素抵抗指标，与空腹因脂指标进行直线相关分析。结果：与正常对照组（ｎ＝２０）比较，高血压组（ｎ＝２５）与冠心病组（ｎ＝２０）的血清甘油三酯（ＴＧ）、低密度脂蛋白（ＬＤＬ－Ｃ）、空腹胰岛素、空腹胰岛素／空腹葡萄糖比值、胰岛素曲线下面积、葡萄糖曲线下面积和Ｉ／Ｇ均显     

甘油三酯-葡萄糖指数与胰岛素抵抗相关代谢性疾病的关系

胰岛素抵抗在2型糖尿病、冠状动脉粥样硬化、非酒精性脂肪性肝病、代谢综合征等代谢紊乱性疾病的发生发展中均起着重要作用。诸多研究已表明,甘油三酯-葡萄糖(triglyceride glucose,TyG)指数可作为评估胰岛素抵抗的代谢指标,与胰岛素抵抗及其相关代谢性疾病之间存在着不同程度的联系。因此,本综述重点阐述TyG指...     

文迪雅在2型糖尿病伴代谢综合征患者的应用

文迪雅治疗12周后,血糖、糖化血红蛋白、空腹血浆胰岛素、总胆固醇、甘油三酯、舒张压、尿微量白蛋白及胰岛素抵抗指数较治疗前显著下降,高密度脂蛋白胆固醇、胰岛分泌功能指数增加.结论文迪雅与磺脲类和/或二甲双胍联合使用,能有效地减轻胰岛素抵抗和提高胰岛细胞分泌功能,降低血糖、调节血脂,同时能控制心血管疾病发生的相关危险因素.     

Pioglitazone decreases postprandial accumulation of remnant lipoproteins in insulin-resistant smokers

Background:  Fasting hypertriglyceridaemia has been reported to occur commonly in cigarette smokers and is thought to increase cardiovascular disease (CVD) risk in these individuals. More recently, it has been suggested that an increase in non-fasting triglycerides, rather than fasting hypertriglyceridaemia, is an independent CVD risk factor.
Methods:  In this study, we divided 24 smokers into insulin-resistant (IR) and insulin-sensitive (IS) groups by determining their steady-state plasma glucose concentrations during the insulin suppression test and compared fasting and daylong postprandial accumulation of total triglycerides and remnant lipoprotein (RLP) concentrations, before and after 3 months of pioglitazone (PIO) administration.
Results:  The two groups were similar in age, body mass index, race and gender distribution, but differed dramatically in insulin sensitivity. Baseline fasting and postprandial triglyceride, RLP cholesterol and RLP triglyceride concentrations were significantly higher in the IR smokers (p = 0.01 to <0.01). Insulin sensitivity and both fasting and postprandial triglyceride and RLP triglyceride levels decreased significantly (p = 0.05 to <0.01) in PIO-treated IR smokers, without any significant increase in weight. In contrast, there were no significant changes in either insulin sensitivity or fasting and postprandial triglyceride, RLP cholesterol and RLP triglyceride levels in PIO-treated IS smokers.
Conclusions:  The postprandial accumulation of RLP particles is increased in the IR subset of smokers and is likely to contribute to the increased CVD risk in these individuals. Furthermore, PIO administration provides a possible therapeutic approach to decreasing postprandial lipaemia and CVD risk in IR smokers who are unwilling or unable to stop smoking.     

Endogenous sex hormones and cardiovascular disease in men. A prospective population-based study

Plasma obtained and frozen in 1972-1974 from 1,009 white men (40-79 years old) who have been followed for 12 years was examined for endogenous sex hormone levels according to prevalent or subsequent cardiovascular disease. In these older men, no sex hormone measured (testosterone, androstenedione, estrone, or estradiol) was significantly associated with known cardiovascular disease at baseline or with subsequent cardiovascular mortality or ischemic heart disease morbidity or mortality. Sex hormone-binding globulin levels were also similar by disease status. Analyses of hormone:sex hormone-binding globulin ratios or of estrogen:androgen ratios showed a similar lack of association with cardiovascular disease. Testosterone levels were significantly inversely associated with levels of blood pressure, fasting plasma glucose, and triglyceride and body mass index. In contrast, the only significant estrogen risk factor associations were positive correlations of estrone with total plasma cholesterol, triglyceride, and glucose. These data do not support a causal role for elevated endogenous estrogen levels and heart disease.     

SYNTAX系列评分在复杂冠状动脉病变中的应用进展

摘要：目的：比较沙库巴曲缬沙坦(LCZ696)与血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)或血管紧张素受体阻滞剂(angiotensin receptor blocker,ARB)治疗难治性心力衰竭(refractory heart failure,RHF)患者的疗效和安全性,为临床提供参考依据。方法：通过检索pubmed,embase,web of science,cochrane,CBM,知网等数据库中已发表的中文和英文的随机对照研究(randomized controlled trials,RCTs)。筛选文献,提取数据后,采用cochrane偏倚风险评估工具对纳入的RCTs质量进行评价,采用Stata15.1和Revman 5.4进行meta分析。结果：共纳入13篇文献,总计1338例患者。meta分析结果显示：研究组N端B型利钠肽（N-terminal pro-B-type natriuretic,NT-proBNP）[WMD=-294.79,95%CI(-422.28,-167.31),P=0.000]、高敏感性心肌肌钙蛋白T（high-sensitivity cardiac troponin T,hs-cTnT）[WMD=-0.09,95%CI(-0.11,-0.08),P=0.000]、左室舒张末期内径(left ventricular end-diastolic diameter,LVEDD) [WMD=-4.00,95%CI(-5.34,-2.67),P=0.000]、左室收缩末期内径(left ventricular end-systolic diameter,LVESD) [WMD=-4.94,95%CI(-7.05,-2.82),P=0.000]低于对照组;左室射血分数(left ventricular ejection fraction,LVEF) [WMD=5.88,95%CI(4.38,7.38),P=0.000]、6分钟步行距离(6-min walking distance ,6MWD)、有效率[RR=1.81,95%CI(1.11,1.26),P=0.000]明显高于对照组;两组细胞间黏附分子(intercellular cell adhesion molecule,ICAM-1) [WMD=-3.37,95%CI(-9.08,2.35),P=0.248]、血肌酐(creatinine,CREA) [WMD=0.61,95%CI(-1.18,2.41),P=0.505]、醛固酮(aldosterone,ALD) [WMD=-12.27,95%CI(-30.39,5.85),P=0.184]水平差异无统计学意义。研究组低血压[RR=0.56,95%CI(0.19,1.63),P=0.284]、头晕[RR=1.00,95%CI(0.26,3.92),P=1.000]、恶心/呕吐[RR=1.67,95%CI(0.22,12.35),P=0.617]、粒细胞减少[RR=1.00,95%CI(0.14,6.93),P=1.000]、高钙血症[RR=3.00,95%CI(0.32,28.25),P=0.337]与对照组相比较差异无统计学意义。结论：LCZ696疗效好,能显著提高RHF患者心功能,改善心室重塑,减轻心肌组织损伤,无明显不良反应。     

Elevation of fasting insulin and its association with cardiovascular disease risk in women with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is associated with premature atherosclerosis. We previously showed that SLE patients have a higher risk of insulin resistance (IR) and abnormal insulin secretion. The present study was to further investigate the relationship between fasting insulin levels and both classic and novel cardiovascular risk factors in patients with SLE. Body mass index (BMI), fasting glucose and insulin, lipid profile, oxidation markers, fibrinolytic factors, vascular function factors, and disease-specific variables were determined in a total of 87 female SLE patients. The homeostasis model assessment (HOMA) was used to evaluate the IR and secretion. SLE patients had significantly higher fasting insulin, HOMA IR, HOMA β-cell, titers of autoantibodies against oxidized low density lipoprotein, systolic blood pressure, homocysteine, and brachial-ankle pulse wave velocity (baPWV) than age-matched healthy controls. There were no statistical differences in disease duration, anti-dsDNA, C3, C4, disease activity, and medication dosage between SLE patients stratified by fasting insulin levels. However, mean values for BMI, insulin, HOMA IR, HOMA β-cell, triglyceride (TG), homocysteine, and baPWV were significantly higher in the SLE patients with hyperinsulinemia when compared with those SLE controls. In addition, fasting insulin levels were positively correlated with TG, homocysteine, blood pressure, plasminogen activator inhibitor 1, and baPWV in SLE patients. The elevation of fasting insulin levels in SLE patients is not only associated with IR, but is related to classic and novel cardiovascular risk factors. This study concludes that there is an insulin-related cardiovascular disease risk in SLE. T. K. Tso and W.-N. Huang have equal contributions to this work.     

Development and progression of atherosclerotic disease in relation to insulin resistance and hyperinsulinemia.

It is unclear whether the role of insulin resistance in the development of atherosclerotic cardiovascular disease is similar in populations in which the incidence of atherosclerotic diseases significantly differs from that in Western countries. The aim of this study was to determine the relationship between insulin resistance and the development of cardiovascular disease in the Japanese population. We conducted 75 g-oral glucose tolerance tests (OGTTs) on 1,928 inhabitants of two towns in Hokkaido, Japan. Subjects using antihypertensive agents and known diabetic patients were excluded from the study. Data from the remaining 1,227 subjects (540 males and 687 females; mean age 56.0 +/- 10.8 years) were used for the analysis, and 1,051 subjects were seen in a follow-up care setting for a period of 8 years. The presence of insulin resistance was defined according to the guidelines reported our previous study: insulin levels of 64.0 mU/l or higher 2 h after the 75 g-OGTT. The insulin-resistant (IR) group had several risk factors such as hypertension, diabetes, treated or untreated hypercholesterolemia, hypertriglyceridemia, low high-density-lipoprotein (HDL) cholesterol levels, and obesity. During the follow-up period of 8 years, the incidence of coronary artery disease, which was adjusted for age, body mass index, sex, systolic blood pressure, fasting plasma glucose, total cholesterol, triglyceride, and HDL cholesterol was significantly (3.2 times) higher in the IR group than in the insulin non-resistant group. The results suggested that insulin resistance is an independent risk factor for coronary artery disease in Japanese subjects, as has also been demonstrated in the case of individuals in Europe and USA.     

A combination of high concentrations of serum triglyceride and non-high-density-lipoprotein-cholesterol is a risk factor for cardiovascular disease in subjects with abnormal glucose metabolism—The Hoorn Study

Aims/hypothesis Type 2 diabetes is not only associated with hyperglycaemia, but also with disorders of lipid metabolism. The aim of this study was to investigate the association of triglyceride and non-HDL-cholesterol concentrations with cardiovascular disease in subjects with normal and abnormal glucose metabolism.Methods Subjects were 869 men and 948 women aged 50 to 75 who participated in the Hoorn Study, a population-based cohort study that started in 1989. Glucose metabolism was determined by a 75 g OGTT. High fasting triglyceride and non-HDL-cholesterol concentrations were defined as above the median of the study population.Results After 10 years of follow-up, the age- and sex-adjusted hazard ratios for cardiovascular disease were 1.35 (1.11–1.64) and 1.71 (1.40–2.08) for high triglycerides and high non-HDL-cholesterol, respectively, after mutual adjustment. After stratification for glucose metabolism status, the hazard ratios for cardiovascular disease for non-HDL-cholesterol were 1.70 (1.31–2.21) in normal glucose metabolism and 1.56 (1.12–2.18) in abnormal glucose metabolism. Triglycerides were not a risk factor in subjects with normal glucose metabolism, with a hazard ratio of 0.94 (0.73–1.22), but in subjects with abnormal glucose metabolism, the hazard ratio for cardiovascular disease was 1.54 (1.07–2.22). In subjects with abnormal glucose metabolism, the hazard ratio for the combined presence of high triglycerides and non-HDL-cholesterol was 2.12 (1.35–3.34).Conclusion Our data suggest that in people with abnormal glucose metabolism, but not in those with normal glucose metabolism, high triglyceride concentration could be associated with the risk of cardiovascular disease, particularly in people with high non-HDL-cholesterol.Abbreviations ICD International Classification of Diseases - IDL intermediate-density-lipoprotein - TRL triglyceride-rich lipoproteins     

Predictors of plasma triglyceride elevation in patients participating in a coronary atherosclerosis treatment program

PURPOSE: Low-fat, high-carbohydrate diets have been used successfully to prevent and treat coronary heart disease, although these diets have been shown to cause elevations in fasting plasma triglyceride concentrations. The present study investigated metabolic factors (glucose, insulin, body weight) associated with changes in plasma triglyceride concentrations in patients participating in a comprehensive, multidisciplinary program, which included the use of a very low-fat diet designed to regress atherosclerotic cardiovascular disease. METHODS: Thirty-six patients were entered into the study and placed on a 10% fat diet. Body mass index and fasting plasma insulin, glucose, lipids, and apolipoproteins were assessed at entrance into and after 3 months of participation in the program. Statistical analysis (discriminant function analysis) was used to identify factors that predicted elevations in plasma triglyceride that occurred during therapy. RESULTS: For the entire group, significant reductions in body weight (-2.4%), fasting glucose (-6%), total cholesterol (-8%), and low-density lipoprotein cholesterol (-11%) were observed, while insulin and triglycerides showed no significant changes. Twenty-one of the patients experienced an increase in fasting triglyceride concentration of 10% or greater. CONCLUSIONS: Three variables (baseline body mass index and fasting triglyceride and insulin concentrations) accurately classified 90% of those who would experience a > or = 10% elevation in triglycerides (P = 0.0002) and 67% of those who experienced no change. The present analysis provides a practical algorithm for clinicians to predict which patients will experience significant elevations in plasma triglyceride concentration when undergoing risk factor reduction that includes the consumption of a very low-fat, high-carbohydrate diet.     

Relationship of sex hormone-binding globulin to lipid, lipoprotein, glucose, and insulin concentrations in postmenopausal women.

Sex hormones play a major role in determining the risk of cardiovascular disease. While several studies have shown that reduced sex hormone-binding globulin (SHBG) is associated with increased insulin and triglyceride and decreased high-density lipoprotein cholesterol (HDLC) in premenopausal women, little data are available for postmenopausal women. We hypothesized that in postmenopausal women decreased SHBG would be associated with an atherogenic pattern of cardiovascular risk factors. We measured SHBG, lipids, lipoproteins, glucose, and insulin concentrations, and systolic and diastolic blood pressure in 101 postmenopausal women. SHBG was negatively associated with triglyceride (r = -.21) and insulin (r = -.47) concentrations and positively associated with HDLC concentrations (r = .47). After adjustment for overall adiposity (body mass index) and upper body adiposity (as measured by the ratio of waist to hip circumferences), SHBG was still associated with HDLC and insulin, but not with triglyceride. Sex hormones were not related to systolic and diastolic blood pressure. The results may help to explain an association of increased androgenicity, as measured by a lower SHBG concentration, with diabetes and risk of cardiovascular disease in older women.     

Comparison of simple measures of insulin sensitivity in young girls with premature adrenarche: the fasting glucose to insulin ratio may be a simple and useful measure

Insulin resistance is a strong predictor of the development of type 2 diabetes mellitus and cardiovascular disease. Girls with premature adrenarche (PA) or obesity may be at an increased risk for the development of insulin resistance. Recently, in prepubertal girls with PA, a fasting glucose to insulin ratio (FGIR) of less than 7 was found to be predictive of insulin resistance as determined by the frequently sampled iv glucose tolerance test. We sought to compare the FGIR with 2 insulin sensitivity measures, SiM (an adjusted mean measure of insulin sensitivity based on fasting and 2 h post glucose load insulin sensitivity measures) and the composite whole body insulin sensitivity index, ISI(comp), both derived from the 2-h oral glucose tolerance test in 2 groups of children at risk: girls with PA and obese girls. We studied 25 prepubertal girls with PA and/or obesity and further classified them as insulin resistant (IR) or insulin sensitive (IS) based on the FGIR. Four simple measures of insulin sensitivity [FGIR, quantitative insulin sensitivity check index (QUICKI), fasting insulin resistance index, and fasting insulin] were compared with SiM and ISI(comp). Additionally, we characterized the subjects in terms of risk factors associated with insulin resistance according to their insulin resistance status based on the FGIR. In our subjects the strongest correlations overall appeared to be between FGIR and SiM, FGIR and ISI(comp), QUICKI and SiM, and QUICKI and ISI(comp) [correlations (r) ranged from 0.81--0.84]. Furthermore, the IR group had higher body mass index and body mass index z-scores and triglyceride levels than the IS group and were over 3 times more likely to have triglycerides greater than the 95th percentile compared with national norms. We conclude that the FGIR and QUICKI are highly correlated with oral glucose tolerance test measures of insulin sensitivity. An FGIR less than 7 in young girls with PA or obesity may be helpful in the early identification of children at risk for complications of insulin resistance.