代谢综合征患者空腹血清游离脂肪酸水平与胰岛素抵抗的关系

目的　探讨代谢综合征 (MS)患者空腹血清游离脂肪酸 (FFAs)水平与胰岛素抵抗的关系。方法　用发色底物法测定 60例MS患者及 2 0名正常人 (对照组 )的空腹血清FFAs浓度 ,比较两组间空腹血清FFAs水平及胰岛素敏感指数 (ISI)的差异 ;并将空腹血清FFAs水平及MS的其他特征性参数分别与ISI作相关性分析。结果　MS患者空腹血清FFAs水平为 ( 60 7.1± 2 17.8)μmol/L ,显著高于对照组 (P <0 .0 1) ;ISI为 -4 .5 8± 0 .49,显著低于对照组 (P <0 .0 1)。MS患者的ISI与FFAs呈显著负相关 (P <0 .0 5 ,r =-0 .3 2 9) ;ISI亦与BMI呈负相关。结论　代谢综合征患者空腹血清FFAs水平升高 ,并可间接反映胰岛素抵抗程度     

Avoiding milk is associated with a reduced risk of insulin resistance and the metabolic syndrome: findings from the British Women's Heart and Health Study.

OBJECTIVE: To examine the association of milk consumption with insulin resistance and the metabolic syndrome. METHODS: The association was examined in 4024 British women aged 60-79 who were randomly selected from primary care centres in 23 towns. RESULTS: Women who never drank milk had lower homeostasis model assessment insulin resistance (HOMA) scores, triglyceride concentrations and body mass indices, and higher high-density lipoprotein (HDL)-cholesterol concentrations, than those who drank milk. The age-adjusted odds ratio for the metabolic syndrome comparing non-milk drinkers with drinkers was 0.55 (0.33, 0.94), which did not attenuate with adjustment for potential confounders. Diabetes was less common in non-milk drinkers. CONCLUSION: Individuals who do not drink milk may be protected against insulin resistance and the metabolic syndrome. However, randomized controlled trials are required to establish whether milk avoidance is causally associated with these outcomes.     

The polygenetically inherited metabolic syndrome of WOKW rats is associated with insulin resistance and altered gene expression in adipose tissue

BACKGROUND: Wistar Ottawa Karlsburg W (RT1u) rats (WOKW) develop a complete metabolic syndrome closely resembling the human disease. The aim of this study was to characterize the phenotype of adipose tissue in WOKW rats with regard to adipocyte metabolism, insulin resistance, and gene expression and thus to define the phenotype more precisely. METHODS: Glucose metabolism, insulin sensitivity, and gene expression of key adipocyte genes, including adiponectin, interleukin 6 (Il6), 11 beta-hydroxysteroid dehydrogenase (11beta Hsd), peroxisome proliferator-activated receptor gamma (Ppar gamma), forkhead box O1 (Foxo1), glucose transporter 4 (Glut4), CCAAT/enhancer binding protein (C/ebp alpha), and fatty acid synthase (Fasn) were characterized in adipocytes from epididymal and subcutaneous fat depots of 28-week-old male WOKW rats and Dark Agouti (DA) controls. RESULTS: WOKW rats display decreased insulin-stimulated glucose uptake and decreased insulin sensitivity during lipogenesis and lipolysis in isolated adipocytes. The severe insulin resistance predominantly in epididymal adipose tissue of WOKW rats is associated with a 10-fold decrease in adipocyte adiponectin gene expression, decreased Ppar gamma, but increased Foxo1 gene expression compared to DA rats. CONCLUSIONS: Insulin resistance in adipose tissue is associated with altered adipocyte gene expression in WOKW rats, additionally completing the picture of the metabolic syndrome in this animal model. This fact not only qualifies the WOKW rat for further detailed analysis of genetic determinants of metabolic syndrome but also highlights its suitability for pharmacological research.     

Japanese IGT subjects with high insulin response are far more frequently associated with the metabolic syndrome than those with low insulin response

Impaired glucose tolerance (IGT) represents a prediabetic state positioned somewhere between normal glucose tolerance and diabetes, which is also assumed to make individuals in this state highly susceptible to atherosclerotic disease. IGT also accounts for a highly heterogeneous population, with the condition varying from individual to individual. In this study, we stratified subjects with IGT by their insulin response and compare the pathology of IGT when it is associated with high or low insulin response to gain insight into the diverse pathology of IGT. Of the male corporate employees who underwent 75 g OGTT at the corporation's healthcare center, 150 individuals diagnosed with IGT (isolated IGT, combined IGT and IFG) comprised our study subjects. The study subjects were stratified into four quartiles by percentile AUC for insulin, and those in the 25th or less percentile were defined as the low insulin response group (n=37) vs those in the 76th or greater percentile defined as the high insulin response group (n=38), and these groups were compared. There was no significant difference observed between the two groups in regard to post-OGTT glucose response and area under the glucose curve. However, the high insulin response group was associated with higher BMI, subcutanesous fat area, uric acid levels, HOMA-β cell values, and Δinsulin/Δglucose (30 min) than the low insulin response group. The number of risk factors for the metabolic syndrome detected (as defined by the ATPIII diagnostic criteria) per subject was 2.84±0.17 and 2.08±0.20, respectively, in the high insulin response group and in the low insulin response group, with the number significantly (p<0.05) higher in the high insulin response group. Furthermore, the incidence of the metabolic syndrome as defined by the ATPIII diagnostic criteria was 63.2% (24/38) in the high insulin response group vs 32.4% (12/27) in the low insulin response group, with the incidence significantly (p<0.01) higher in the high insulin response group. Likewise, the incidence of the metabolic syndrome as defined by the Japanese diagnostic criteria was found to be significantly (p<0.05) higher in the high insulin response group at 50% (19/38) compared to 27.0% (10/37) in the low insulin response group. Our study findings suggest that IGT subjects with high insulin response and those with low insulin response vary greatly in regard to the number of atherosclerotic risk factors complicated and the frequency with which they are associated with the metabolic syndrome. It is also shown in middle-aged Japanese males that of the two forms of IGT, IGT with high insulin response is more closely linked to the pathogenesis of atherosclerotic cardiovascular disease.     

The metabolic syndrome and changing relationship between blood pressure and insulin with age, as observed in Aboriginal and Torres Strait Islander peoples.

AIMS: To determine the prevalence of the metabolic syndrome (MS) among Aboriginal and Torres Strait Islander peoples. A further objective was to investigate the relationships between fasting insulin and blood pressure (BP) within these groups with increasing age. METHODS: A cross-sectional population-based study included 369 Torres Strait Islanders (residing in Torres Strait and Far North Queensland), and 675 Aborigines from central Australia. Data necessary for classification of MS was collected, including fasting and 2-h glucose and insulin, urinary albumin and creatinine, anthropometric measurements, BP, serum lipids. RESULTS: The ATPIII criteria classified 43% of Torres Strait Islanders and 44% of Aborigines with MS, whereas 32 and 28%, respectively, had the MS according to WHO criteria. Agreement between the two criteria was only modest (kappa coefficient from 0.28 to 0.57). Factor analyses indicated no cluster including both insulin and BP in either population. Significant correlations (P < 0.05) [adjusted for gender, body mass index (BMI) and waist circumference] were observed between BP and fasting insulin: a positive correlation for Torres Strait Islanders aged 15-29 years, and an inverse correlation for Aborigines aged 40 years and older. CONCLUSION: Torres Strait Islanders and Aborigines had very high prevalences of the MS. Specific population characteristics (high prevalences of central obesity, dyslipidaemia, renal disease) may make the WHO definition preferable to the ATPIII definition in these population groups. The poor agreement between criteria suggests a more precise definition of the metabolic syndrome that is applicable across populations is required. This study showed an inverse relationship with age for the correlation of BP and fasting insulin.     

Obstructive sleep apnoea is associated with risk factors comprising the metabolic syndrome

Background and objective: Several features of OSA syndrome suggest that it is a manifestation of the metabolic syndrome (MS). In this study, we investigated the prevalence of the MS among male Japanese patients with OSA, as well as the relationship between OSA in non‐obese patients and components of the MS other than obesity (hypertension, dyslipidaemia and glucose intolerance). Methods: The study included 416 Japanese men who were diagnosed as having OSA by polysomnography. Among these, 101 non‐obese patients were selected and the severity of OSA, as well as the prevalence of hypertension, dyslipidaemia and glucose intolerance, was assessed. Results: The MS was associated with OSA in 218/416 patients (52.4%). A significant increase in the prevalence of the MS was associated with increased severity of OSA, as categorized according to AHI. In the non‐obese patients with OSA (mean age 57.6 years, BMI 22.7 kg/m², AHI 34.3 events/h), hypertension, dyslipidaemia and glucose intolerance were identified in 70 (69.3%), 43 (42.6%) and 20 patients (19.8%), respectively. At least two of these factors were identified in 40 patients (39.6%). Non‐obese patients with severe OSA had a significantly higher prevalence of two or more of these factors (33/59 patients, 55.9%). Conclusions: Although Asians are generally less obese than Caucasians, the prevalence of the MS was high among Japanese patients with OSA, and even among non‐obese patients, OSA was associated with risk factors for the MS.     

冠心病合并代谢综合征患者胰岛素抵抗与单核细胞趋化蛋白-1的关系

目的研究冠心病合并代谢综合征患者胰岛素抵抗与单核细胞趋化蛋白-1(MCP-1)表达的关系。方法选择单纯代谢综合征患者37例(A组),单纯冠心病患者31例(B组),冠心病合并代谢综合征患者39例(C组)和正常对照组28例(D组)。对所有受试者测量其身高、体重、腰围、臀围;测血脂、空腹血糖、胰岛素、MCP-1;计算体重指数、腰臀比、胰岛素抵抗指数并进行比较。结果A、B、C 3组患者的胰岛素、胰岛素抵抗指数、MCP-1均高于D组,C组的胰岛素抵抗指数、MCP-1分别高于A、B两组。直线相关分析显示,胰岛素抵抗指数与体重指数、腰围、甘油三酯、空腹血糖、胰岛素和MCP-1呈正相关,与高密度脂蛋白呈负相关,差异有显著性意义;逐步回归分析显示,胰岛素抵抗指数与空腹血糖、胰岛素、甘油三酯、高密度脂蛋白、MCP-1、体重指数相关。结论冠心病合并代谢综合征患者的胰岛素抵抗度和炎性因子MCP-1的表达异常升高,同时,胰岛素抵抗与MCP-1的异常表达相关。     

A confirmatory factor analysis evaluation of the coronary heart disease risk factors of metabolic syndrome with emphasis on the insulin resistance factor

Aim:  The goals of this study were: (1) to analyse the underlying associations between coronary risk factors and the metabolic syndrome and (2) to evaluate the construct validity of the variables used to measure each factor.
Methods:  The subjects were from a previously studied cohort of 284 middle-aged Caucasian males from Goteborg, Sweden, who were selected from the National Population Register. A confirmatory factor analysis was performed using EQS Multivariate Software Version 5.7b with maximum likelihood estimation. Hypertension, obesity, insulin resistance and hyperlipidaemia were the latent factors hypothesized.
Results:  The final, four-factor model showed good fit, with significant intercorrelations noted between all factors. The highest correlations were noted between the insulin resistance factor and the obesity factor (r = 0.887) and the insulin resistance factor and the lipid factor (r = 0.835). All factors exhibited good values for construct reliability and variance extracted except for the insulin resistance factor, which was measured with the variables of fasting insulin and fasting glucose levels.
Conclusions:  A four-factor model of metabolic syndrome including the coronary heart disease risk factors of hypertension, obesity, insulin resistance and hyperlipidaemia was developed using this sample of European, middle-aged Caucasian males. Insulin resistance was not well defined using the variables of fasting insulin and fasting glucose levels. Other possible variables to include in the measurement of this factor are discussed.     

Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance

The aim of this study was to investigate cross-sectionally the prevalence and covariates of obstructive sleep apnea syndrome (OSAS) and its relationship to metabolic syndrome (MS), insulin resistance (IR), and coronary heart disease (CHD) in a population sample of 1,946 men and women representative of Turkish adults. OSAS was identified when habitual snoring and episodes of apnea were combined with another relevant symptom. MS was diagnosed based on modified criteria of the Adult Treatment Panel III and IR by homeostatic model assessment (HOMA). OSAS was identified in 61 men (6.4%) and 58 women (5.8%), at a similar prevalence, after adjusting for covariates. Among individuals with OSAS, significantly higher odds ratios (ORs), adjusted for age, body mass index (BMI), and waist girth, were observed for MS, hypertension, and prevalent CHD, but not for HOMA or menopause. Significantly higher C-reactive protein existed only in women with OSAS who were also more frequent smokers. In logistic regression models, waist circumference, but not BMI nor hypertension, was significantly associated with OSAS among men. In women, by contrast, current cigarette smoking and hypertension were the significant independent covariates. Regression models controlling for sex, age, and smoking revealed that MS (and not IR per se) was associated significantly with OSAS (OR 1.94) in nondiabetic individuals. To conclude, abdominal rather than overall obesity in men and smoking among women are significant independent determinants of OSAS in Turkish adults. OSAS is associated with MS rather than IR per se. Relatively high prevalence of OSAS is observed in Turkish women in whom it is significantly associated with CHD.     

Diabetes, insulin resistance, and metabolic syndrome in horses

Analogous to the situation in human medicine, contemporary practices in horse management, which incorporate lengthy periods of physical inactivity coupled with provision of nutritional rations characterized by inappropriately high sugar and starch, have led to obesity being more commonly recognized by practitioners of equine veterinary practice. In many of these cases, obesity is associated with insulin resistance (IR) and glucose intolerance. An equine metabolic syndrome (MS) has been described that is similar to the human MS in that both IR and aspects of obesity represent cornerstones of its definition. Unlike its human counterpart, identification of the equine metabolic syndrome (EMS) portends greater risk for development of laminitis, a chronic, crippling affliction of the equine hoof. When severe, laminitis sometimes necessitates euthanasia. Unlike the human condition, the risk of developing type 2 diabetes mellitus and many other chronic conditions, for which the risk is recognized as increased in the face of MS, is less likely in horses. The equine veterinary literature has been replete with reports of scientific investigations regarding the epidemiology, pathophysiology, and treatment of EMS.     

Congenital and environmental factors associated with adipocyte dysregulation as defects of insulin resistance

The metabolic syndrome refers to insulin resistance and its associated cluster of related cardiovascular metabolic risk factors including type 2 diabetes, hypertension, dyslipidemia and central obesity. Although many hypotheses and facts have been proposed to explain the interaction between genetic and environmental causes of this syndrome, the primary etiology of the metabolic syndrome is adipose tissue dysregulation. Firstly, the thrifty genotype and phenotype hypothesis may explain the endemic increase in type 2 diabetes and cardiovascular disease in developing countries and elucidates the congenital susceptibility and environmental triggering of the metabolic syndrome. Secondly, over-nutrition leads to fatty acid (FA) accumulation in adipocytes and to an overflow to ectopic fat storage organs. This causes functional changes in adipocytes shifting the intra-cellular metabolic pathway toward insulin resistance. Thirdly, obese subjects exhibit increased fat cell size and over-secretion of biologic adipocytokines. Fourthly, failure to adequately develop adipose tissue mass, as seen in lipodystrophy cases, causes severe insulin resistance and diabetes. Lastly, similar to human type 2 diabetes, Psammonys obesus, a desert rat which feeds mainly on low-calorie vegetation, develops the metabolic syndrome when given a diet of calorie rich food. The above evidence indicates adipocyte dysregulation and secretion of FA as well as certain molecules from overloaded adipocytes/adipokines contribute to the pathogenesis of impaired insulin secretion and insulin resistance, endothelial dysfunction, a pro-inflammatory state and promote progression of atherosclerosis. The metabolic syndrome is a modern disease resulting adipocyte dysmetabolism resulting from the paradox of the slow human evolution combined with rapid environmental changes.     

Low serum total bilirubin concentrations are associated with increased prevalence of metabolic syndrome in Chinese

Background: To investigate the association between serum concentrations of total bilirubin (TBil) in the physiological range and metabolic syndrome (MS) in middle‐aged and elderly Chinese, as well as any associations between serum TBil concentrations and insulin resistance, hyperinsulinemia, and systemic inflammation. Methods: A cross‐sectional study was conducted on 1423 individuals recruited from an urban community of Shanghai (average age 62.3 years) to investigate the relationship between bilirubin and cardiovascular diseases. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans. Results: Total bilirubin concentrations were significantly lower in individuals with MS compared with those without (0.65 ± 0.21 vs 0.69 ± 0.22 mg/dL, respectively; P = 0.002). The adjusted mean concentration of TBil decreased gradually with an increase in the number of components of MS (P_trend < 0.0001). After adjustment for a range of potential confounders (e.g. age, sex, body mass index, smoking, alcohol intake, homeostasis model assessment of insulin resistance etc.), each 1 SD increase in TBil was found to be associated with a 17% reduction in the risk of MS (odds ratio 0.83; 95% confidence interval 0.73–0.95; P = 0.006). Furthermore, after adjustment for all covariables, each 1 SD increase in TBil was found to be associated with lower odds of central obesity, hypertriglyceridemia, low high‐density lipoprotein–cholesterol, and hyperglycemia. Serum TBil concentrations were inversely associated with hyperinsulinemia, insulin resistance, and systemic inflammation. Conclusions: Serum TBil concentrations within the physiological range were inversely associated with MS and insulin resistance, hyperinsulinemia, and systemic inflammation in middle‐aged and elderly Chinese.     

Elevated fasting insulin is associated with cardiovascular and metabolic risk in women with polycystic ovary syndrome

AimsPCOS is associated with various immediate and long term health complications. The aim of this study was to investigate the association of serum fasting insulin concentration with cardiovascular and metabolic risk factors in women with polycystic ovary syndrome.MethodsA total of 349 women, 249 women with polycystic ovary syndrome and 100 age-matched healthy controls, were recruited in this case-control study. Fasting insulin and various other biochemical, hormonal and clinical parameters were measured in all participants. The correlation of insulin with cardiometabolic risk factors was evaluated in PCOS women with normal and high serum insulin concentration.ResultsFasting Insulin, BMI, WHR, FAI, LH: FSH, HOMA, QUICKI were significantly higher in PCOS women compared with healthy controls (p < 0.01). Fasting insulin showed a positive correlation with more cardiovascular and metabolic risk factors in PCOS compared to controls. The BMI, BAI, LAP, HOMA IR, QUICKI and FAI were significantly higher (all p < 0.05) in PCOS patients with higher insulin levels than with PCOS women with normal levels.ConclusionFasting insulin is an important determinant in the pathogenesis of obesity and hyperandrogenism in PCOS. It is associated with an increased risk of cardiovascular and metabolic disorders in women with PCOS.     

Tissue specificity of insulin resistance in humans: fat in the liver rather than muscle is associated with features of the metabolic syndrome

Aims/hypothesis The aim of this study was to investigate whether intrahepatic and intramyocellular fat are related to insulin resistance in these respective tissues or to the metabolic syndrome. Methods Hepatic (insulin 1.8 pmol kg⁻¹ min⁻¹ combined with [3-³H]glucose) and muscle (insulin 6.0 pmol kg⁻¹ min⁻¹) insulin sensitivity were measured on separate occasions in 45 non-diabetic men (age 42 ± 1 years, BMI 26.2 ± 0.6 kg/m²) using the euglycaemic–hyperinsulinaemic clamp. Liver fat and intramyocellular lipid (IMCL) were measured by proton magnetic resonance spectroscopy and body composition by magnetic resonance imaging. We also determined fasting serum insulin and adiponectin concentrations, components of the metabolic syndrome and maximal oxygen consumption. Results In participants with high [median 12.0% (interquartile range 5.7–18.5%)] vs low [2.0% (1.0–2.0%)] liver fat, fasting serum triacylglycerols (1.6 ± 0.2 vs 1.0 ± 0.1 mmol/l, p = 0.002) and fasting serum insulin (55 ± 4 vs 32 ± 2 pmol/l, p < 0.0001) were increased and serum HDL-cholesterol (1.26 ± 0.1 vs 1.48 ± 0.1 mmol/l, p = 0.02) and fasting serum adiponectin (9.5 ± 1.2 vs 12.2 ± 1.2 μg/ml, p = 0.05) decreased. In participants with high [19.5% (16.0–26.0%)] vs low [5.0% (2.3–7.5%)] IMCL, these parameters were comparable. Liver fat was higher in participants with [10.5% (3.0–18.0%)] than in those without [2.0% (1.5–6.0%), p = 0.010] the metabolic syndrome, even independently of obesity, while IMCL was comparable. Insulin suppression of glucose rate of appearance and serum NEFA was significantly impaired in the high liver fat group. Conclusions/interpretation Fat accumulation in the liver rather than in skeletal muscle is associated with features of the metabolic syndrome, i.e. increased fasting serum triacylglycerols and decreased fasting serum HDL-cholesterol, as well as with hyperinsulinaemia and low adiponectin.     

Elevated glucose concentrations during an oral glucose tolerance test are associated with the presence of metabolic syndrome in childhood obesity

Aims To investigate whether changes in glucose concentrations during an OGTT in obese children reflect the presence of peripheral insulin resistance and/or cardiovascular risk factors more closely than single measurements of fasting plasma glucose (FPG). Methods One hundred and twenty‐two obese children attending our Paediatric Obesity Service underwent formal OGTTs, following the measurement of blood pressure and fasting levels of insulin, glucose and lipid profiles in the majority. Fasting insulin was used as a surrogate measure of insulin sensitivity. Three different child‐specific definitions for metabolic syndrome were used to identify clustering of cardiovascular risk factors in 65 of these children. Results In the whole group, 10.7% had IGT but changes in glucose during the OGTT were not influenced by age, sex, pubertal status or raw (or age‐ and sex‐adjusted) body mass index (BMI). During the OGTT, FPG, glucose at 60 min and area under the glucose curve correlated highly with fasting insulin. Children with metabolic syndrome (defined using any of three definitions) had comparable FPG levels to those without metabolic syndrome, but they demonstrated significantly elevated glucose levels at 60 min. On sub‐group analysis, obese children with normal carbohydrate metabolism were significantly more likely to have a 1 h glucose level ≥ 7.8 mmol/l if they had metabolic syndrome (P = 0.026). Conclusions These data suggest that an elevated 1 h post‐load glucose measurement is seen in obese children who have a coexistent clustering of cardiovascular risk factors.     

Clinical significance of fatty liver associated with metabolic syndrome

Aim: Metabolic syndrome (MS) has been recognized as a high-risk disorder that leads to life-threatening diseases, such as coronary vascular disease. The aim of the present study was to investigate the association of fatty liver (FL) with MS in order to establish an effective treatment for FL. Methods: One thousand two hundred and fifty-four individuals (694 males, 560 females) who visited the Department of General Medicine, International Medical Center of Japan for a human dry dock annual check-up from 2000 to 2004 were analyzed. Results: FL was diagnosed in 41.5% of the males and 10.7% of the females, with the prevalence rate increasing in postmenopausal females over 55 years old. High body mass index and waist circumference were observed in those with FL, whereas body mass index reduction was strongly correlated with a decrease in alanine aminotransferase level (R = 0.6,P < 0.01). MS complications were more common in subjects with FL and the most common initial events of MS were shown to be obesity, hyperlipidemia and FL, followed by glucose intolerance and hypertension. Subjects with FL showed a higher level of high-sensitivity C-reactive protein (hs-CRP) (normal: FL = 0.38: 0.73 mg/L, P < 0.05), which was strongly correlated with serum markers that indicated lipid and glucose metabolism in females with FL (R = 0.61-0.77, P < 0.05). Conclusions: FL could be a part of or, at least, a predictor of MS. Further, bodyweight reduction is an effective treatment for FL.     

Melatonin–insulin interactions in patients with metabolic syndrome

Abstract:  Metabolic syndrome (MS) as a group of risk factors is strongly associated with diabetes type 2 and cardiovascular disease. Insulin resistance plays a key role in the pathogenesis of MS. Recent studies have shown that melatonin may influence insulin secretion and glucose homeostasis. Therefore, the present study analyzed the relationships between the melatonin and the insulin in patients with MS and controls. The melatonin rhythm, insulin and lipid levels were studied in 40 subjects (21 patients and 19 controls) in reproductive age. The night melatonin–insulin ratio was correlated negatively with low-density lipoprotein cholesterol ( r  = −0.370, p  = 0.024) and total cholesterol ( r  = −0.348, p  = 0.030), and positively with high-density lipoprotein cholesterol levels ( r  = +0.414, p  = 0.010). Night-time melatonin levels were related to night-time insulin concentrations ( r  = +0.313, p  = 0.049). The correlation was pronounced in patients with MS ( r  = +0.640, p  = 0.002), but did not reach statistical significance in controls ( P  > 0.05). In the patients with MS unlike the controls the night–day melatonin difference (%) correlated negatively with the fasting glucose ( r  = −0.494, p  = 0.023) and positively to daily insulin ( r  = +0.536, p  = 0.012). Our results show that melatonin–insulin interactions may exist in patients with MS, as well as relationships between melatonin–insulin ratio and the lipid profile. Pineal disturbances could influence the pathogenesis and the phenotype variations of the MS. Larger studies are needed to confirm or reject this hypothesis and to clarify the role of the melatonin in the metabolic disturbances.     

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雄激素不敏感性综合征是一类与雄激素受体基因突变密切相关的X染色体隐性遗传病。最新研究表明,该疾病除可引起性发育异常外,还与肥胖、胰岛素抵抗、血脂异常等代谢综合征的危险因素相关。因此,关于雄激素不敏感性综合征与代谢综合征之间的关系已日益成为人们关注的焦点。     

B型胰岛素抵抗综合征

B型胰岛素抵抗综合征是一种严重胰岛素抵抗状态,是由于循环中存在针对胰岛素受体的抗体所引起的自身免疫综合征,常表现为严重胰岛素抵抗如高血糖、高胰岛素血症、黑棘皮病或顽固性低血糖,大部分患者合并有系统性红斑狼疮等自身免疫性疾病。目前认为胰岛素受体自身抗体的产生是机体免疫调节紊乱所致,而抗体作用的机制未明。B型胰岛素抵抗综合征的确诊有赖于体内胰岛素受体自身抗体的检测。国外文献报道应用免疫抑制剂可以使部分患者病情缓解,但其预后表现为多样化。