反映胰岛素抵抗的最佳血脂指标探讨

目的 探讨反映胰岛素抵抗(IR)的最佳血脂指标。 方法 引用福田人民医院2003-11体检中无糖尿病史且空腹血糖＜5.6mmol/L的人群1002例参加本研究,根据甘油三酯(TG)按百分位数法将研究对象均等地分为3组,以稳态模式法的胰岛素抵抗指数(HOMA-IR)评价IR。 结果 HOMA-IR随TG升高而增加,各组间差异有显著性意义(均P<0.01);以HOMA-IR为因变量的多元逐步回归分析显示血脂指标中仅TG进入回归方程;TG对IR诊断的敏感性和特异性优于高密度脂蛋白胆固醇、总胆固醇、低密度脂蛋白胆固醇。 结论 TG是反映IR的最佳血脂指标。=http://cn.     

女性高甘油三酯血症腰的临床特征

目的探讨女性高甘油三酯血症腰（HTGW）的临床特征。方法根据血清甘油三酯（TG）和腰围（WC）、空腹血糖（FPG）〈5．6mmol／L,将395例女性患者分为HTGW（TG≥1．70mmol／L和腰围≥80cm）组和非HTGW组,FPG≥5．6mmol／L 82例为高FPG组,采用HOMA-IR指数评价胰岛素抵抗。结果①多元逐步回归分析显示腰围、TG和年龄与HOMA-IR指数独立相关;②HTGW组HOMA-IR与高FPG组比较差异无显著性;③与高FPG组比较,HTGW组体重指数、腰围、血压、TG升高,高密度脂蛋白胆固醇（HDL-C）降低,与非HTGW组比较,HTGW组上述指标变化更为明显。结论女性HTGW患者有与高FPG相似的胰岛素抵抗程度,有肥胖、血压高、血脂紊乱（TG升高、HDL-C降低）的临床特征。     

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     

高甘油三脂血症与胰岛素抵抗及糖代谢异常的关系

探讨高甘油三酯及糖代谢异常之间的关系。方法将７１例高ＴＧ血症患者按照空腹血ＴＧ增高的程度分为高ＴＧⅠ组和Ⅱ组，做葡萄糖耐量和胰岛素释放试验，计算岛素敏感性指数，并以３２例正常血ＴＧ者作对照。采用多因素回     

胰岛素抵抗、糖及脂质代谢异常与高血压

虽然经过数十年的广泛研究,高血压(HT)的病因及其治疗仍未完善解决。有充分资料证实HT,糖尿病与肥胖常同时并存,且随年龄增加。三者又常伴高胰岛素血症(Hyperinsulinemia,HIS),胰岛素抵抗(Insulin resistance,ISR),糖及脂质代谢异常(包括糖耐受不良,高甘油三酯血症(HTC),高VLDL及LDL,低HDL),并有更高心血管病危险。近二十余年,大规模降压治疗明显降低了卒中发生率,但对冠心病影响不大,可能的解释是其它因素而非血压本身是更重要的冠心病危险因素,或由于降压药物;使某些危险因素如血糖,脂质障碍等增     

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。     

控制高甘油三酯血症对胰岛素抵抗和糖代谢影响的五年前瞻性研究

目的探讨控制高甘油三酯（TG）血症对胰岛素抵抗（IR）和糖代谢的影响.方法将86例高TG血症患者随机分为治疗组（T组）和非治疗组（N组）,在饮食控制的同时,T组给予非诺贝特0.3 g/日一次顿服,定期复查血脂,N组仅饮食控制.两组高TG血症者均连续追踪观察5年.结果（1）N组血糖、胰岛素及胰岛素抵抗指数（HOMA-IR）随血TG水平上升而上升,胰岛素敏感指数（ISI）随血TG水平上升而下降（P＜0.05～0.01）.（2）T组血糖水平与治疗前无显著变化（P＞0.05）,但胰岛素水平、HOMA-IR和ISI分别低于和高于治疗前（P均＜0.05）.（3）N组5年期间糖代谢异常患病率为9.52%,发生率为7.14%;T组未发现糖代谢异常新增病例.N组糖代谢异常患病率与T组、正常对照组（C组）相比较,相对危险度（RR）分别为4.19和2.86.（4）血TG水平与HOMA-IR正相关（P＜0.01）,与ISI负相关（P＜0.01）,多元逐步回归分析结果表明,TG与HOMA-IR独立相关（P＜0.05）.结论控制高TG血症能够减轻IR,使糖代谢异常和2型糖尿病的发生率降低.     

高胰岛素血症,胰岛素抵抗与高血压病的关系

测定６８例高血压病患者及５０例健康者的血糖、血清胰岛素、血脂、并计算胰岛素释放指数及胰岛素敏感指数。对照分析发现，高血压病组与对照组的血糖无明显差异，而血清胰岛素、胰岛素释放指数对照组显著增高，胰岛素敏感指数则显著降低。     

Hypertriglyceridemic waist phenotype and risk of cardiovascular diseases in China: Results from the Kailuan Study

Background

While some case–control studies have showed the correlation between the hypertriglyceridemic waist (HTGW) phenotype (increased WC and hypertriglyceridemia) and cardiovascular disease (CVD) events, there are few data regarding this correlation in cohort studies, especially in Asian populations that have a higher prevalence of central obesity than other populations.

Objective

The aim of this study was to explore the relationship between HTGW phenotype and risk of incident CVD events among men and women in China.

Methods

We analyzed 95,015 participants (18–98 years old) in the Kailuan Study. CVDs developed in 1958 people during follow-up. The cutoffs for defining HTGW phenotype were a waist circumference (WC) of 90 cm or more and a triglyceride level of 2.0 mmol/L or more for men and a WC of 85 cm or more and a triglyceride level of 1.5 mmol/L or more for women. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated from Cox regression models.

Results

Compared with participants who had a normal WC and a normal triglyceride level (NWNT), those with HTGW phenotype had a higher WC, body mass index, prevalence of hypertension and diabetes mellitus; and a lower level of high-density lipoprotein cholesterol. The HTGW group had an unadjusted HR of 1.76 (95% CI = 1.55–1.99) for future CVDs compared with the NWNT group. After adjustment for confounders, the HR still remained significant (HR = 1.24, 95% CI = 1.07–1.44).

Conclusions

HTGW phenotype was associated with the risk of CVDs independently. HTGW phenotype might be a simple but useful tool to screen the individuals at a high risk for future CVDs, and it might be recommended in most clinical practices.     

甘油三酯代谢异常与胰岛素抵抗关系的研究进展

高甘油三酯血症以及甘油三酯的异位沉积是引起胰岛素抵抗的危险因素,阐明甘油三酯代谢的调控因素是深入研究胰岛素抵抗相关疾病发病机制、寻找有效治疗方法的基础.

Abstract：

Hypertriglyceridemia, and the ectopic deposition of triglycerides, are the risk factors for insulin resistance. To clarify the mechanism of regulations in triglyceride metabolism is an approach to the elucidation of pathogenesis and effective treatment of insulin resistance-related diseases.     

非糖尿病人群肥胖相关指数与胰岛素抵抗的关联

青岛市区30-74岁的居民724名（NGT者447名，IGT者277名）。WC、WHR及BMI同胰岛素抵抗指数的相关性（分别为0．45、0．33、0．47），与WC、WHR及BMI同Fins的相关性（分别为0．44、0．33、0．45）几乎完全一致。     

Waist circumference, body mass index and waist to hip ratio for prediction of the metabolic syndrome in Chinese

Background and aimsTo explore the ability of waist circumference (WC), body mass index (BMI) and waist to hip ratio (WHR) to predict two or more non-adipose components of the metabolic syndrome (MetS) among individuals aged 18–85 in North China.Methods and resultsThis study is a cluster sample survey of 101,510 individuals, complete data are 75,788 subjects, 59,874 males and 15,914 females. Their ages were 51.9 ± 12.7 years (males) and 48.7 ± 11.5 years (females). Receiver operating characteristic (ROC) analysis was used to examine discrimination and find optimal cut off values of WC, BMI and WHR to predict two or more non-adipose components of MetS. The area under the ROC curve (AURC) for WC (0.694) and BMI (0.692) in females showed no difference. In males BMI (0.657) had a better discrimination than WC (0.634). WHR was weaker in both sexes. The optimal cut off value of WC in males (86.5 cm) was higher than in females (82.1 cm); and that of BMI was about 24 kg/m² in both genders. The optimal cut off values of WC, BMI, and WHR, increased with age in both sexes.ConclusionsBMI and WC are more useful than WHR for predicting two or more non-adipose components of MetS. Cut off values for WC in males, and those of BMI and WHR in both sexes are lower than that in present MetS criteria; WC in females is slightly higher. Cut off values of WC, BMI and WHR were increased with age in the Chinese.     

社区非糖尿病人群颈围和胰岛素抵抗的相关性分析

目的 分析和探索中国社区人群健康成人的颈围和胰岛素抵抗的相关性.方法 选择常住江苏徐州地区的社Ⅸ健康人群2 31 8名为研究对象,检测受试者颈围、身高、腰围、臀围、体重和甘油三酯、总胆固醇、高密度脂蛋白胆固醇(H DL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖和餐后2 h血糖等相关生化指标.胰岛素抵抗以稳态模型评估的胰岛素抵抗指数(HOMA-IR)来评价.结果 颈围和年龄、体重指数(BMI)、腰围、臀围、腰臀比、收缩压、舒张压、甘油三酯、总胆固醇、LDL-C、尿酸正相关,与HDL-C负相关.校正年龄和其他心血管代谢危险因素后,无论男性和女性,颈围和HOMA-IR的增加趋势显著相关,进一步校正BMI和腰围后,这种相关性并没有明显变化.颈围和BMI或腰围对HOMA-IR有显著的叠加作用(P＜0.01);在较大BMI和较大腰围的个体,颈围和HOMA-IR的相关性更明显.结论 在中国健康成人中,颈围和胰岛素抵抗、心血管代谢危险因素独立相关,并且和BMI、腰围有交互作用.     

非高血压人群血压与体脂和胰岛素抵抗相关

对 839名非高血压、无糖尿病史且空腹血糖 <5. 6mmol/L者进行分析,结果表明收缩压和舒张压均与McAuley指数呈负相关(r=-0. 25, -0. 27,均P<0. 01),但多元逐步回归分析表明收缩压、舒张压与McAuley指数无独立相关,而与体重指数、腰围呈独立正相关。     

体脂含量与分布对胰岛素抵抗影响的相关研究

目的 研究不同体脂含量与分布对胰岛素抵抗(IR)的影响。方法 874例受试者根据体重指数(BMl)和腰臀比值(WHR)分成4组：1组(腹旗型肥胖)：BMI≥25且WHR≥0．9；2组(外周型肥胖)：BMI≥25且WHR＜0．9；3组(正常体重代谢性肥胖)：BMI＜25且WHR≥0．9；4组(正常对照)：BMI＜25且WHR＜0．9。观察指标包括血压、空腹血糖、餐后2小时血糖、血浆甘油三酯、总胆固醇、空腹胰岛素、餐后2小时胰岛素和尿微量白蛋白排泄率，并计算胰岛素抵抗指数(HOMA-IR)。结果(1）HOMA-IR与以上多变量显著正相关，其中WHR和BMI是互相独立的两个IR危险因素，且WHR对IR的影响程度超过BMI；(2)HOMA-IR在4个组之间差异显著，从高到低依次为排列1组、3组、2组、4组。(3)决定HOMA-IR的主要变量是甘油三酯、BMI。(4)正常体重代谢性肥胖与肥胖组间比较，以上各指标比较差异均无显著性。结论 无论是脂肪组织增加或脂肪组织的中心型分布，都可引起胰岛素抵抗，其中以脂肪中心型分布的作用更加显著。     

A logistic regression model for predicting malignant pheochromocytomas

It is well known that no single histological feature is diagnostic for malignant pheochromocytomas (PCCs). So we developed a logistic model based on a series of clinical and pathological features to predict malignance in PCCs, and evaluated its diagnostic performance. In all 130 cases with malignant or benign PCCs, 15 predictive variables were observed and entered in the logistic regression analysis in a backward stepwise way. The diagnostic performance of this logistic model was evaluated by calculating the area under the receiver operating characteristic (ROC) curve. In logistic analysis, of the 15 variables entered in the logistic regression analysis, 9 were retained in the model. High cellularity had the highest odds ratio (OR), followed by spindle cell (>10% of tumor volume), atypical mitotic figure, periadrenal adipose tissue invasion, mitotic figures [>3/10 high-power field (HPF)], cellular monotony, capsular invasion, vascular invasion, and central or confluent tumor necrosis. High cellularity, spindle cell (>10% of tumor volume) and atypical mitotic figure were selected to built a logistic model. This model had the area under the ROC curve of 0.927 (95% confidence interval 0.883–0.971). The application of the model can benefit the clinical management decision for patients with PCCs. We still emphasize, however, that a clinical prospective evaluation is needed to confirm its actual value.