肥胖儿童食欲素、瘦素和神经肽Y水平及其相互关系

目的分析肥胖儿童血中食欲素(O rex ins)、瘦素(L eptin、LEP)和神经肽Y(neuropeptide Y,NPY)水平及其相互关系,探讨O rex ins,LEP和NPY在儿童肥胖发生中的作用及三者存在的相互作用关系。方法以放射免疫法测定98名肥胖〔BM I男(29.24±1.87)kg/m2,女(28.12±2.30)kg/m2〕和104名正常对照〔BM I男(20.49±1.95)kg/m2,女(19.59±1.51)kg/m2〕儿童血中的LEP、O rex ins和NPY浓度。结果肥胖儿童血中LEP浓度〔男(26.00±14.66)ng/mL;女(33.59±14.63)ng/mL〕高于对照组儿童〔男(6.65±4.49)ng/mL;女(10.48±5.52)ng/mL,P<0.01〕;肥胖儿童血中O rex inA浓度〔男(3.23±1.86)pg/mL;女(3.38±1.80)pg/mL〕低于对照组〔男(4.52±1.52)pg/mL;女(4.71±1.53)pg/mL,P<0.05〕;两组间LEP与NPY皆呈负相关关系(对照组r=-0.310;肥胖组r=-0.302,P均<0.01),但斜率不同(对照组-2.969;肥胖组-0.809);NPY与O rex inA为正相关关系r=0.207 P<0.05,肥胖组儿童相对于对照组O rex inA的波动范围明显变小。结论肥胖儿童与对照组相比血中LEP与O rex inA浓度水平相反,儿童肥胖的发生与LEP、O rex inA、NPY和它们之间的相互作用有关。     

肥胖患者血清瘦素、TNF-α、游离脂肪酸水平与胰岛素敏感性的相关性研究

目的了解瘦素、TNF-α、游离脂肪酸在肥胖患者血清中的水平及与胰岛素敏感性的相互关系。方法选取19例肥胖症(BMI≥25 kg/m2)和29例非肥胖症(BMI<25 kg/m2)患者为研究对象,检测空腹血浆葡萄糖(FPG)、空腹血浆胰岛素(FINS)、血脂和血清瘦素(Leptin)、肿瘤坏死因子α(TNF-α)、游离脂肪酸(FFA)等指标,使用SPSS11. 0统计软件包统计分析瘦素、TNF-α、FFA在两组人群间的水平差异以及与反映胰岛素敏感性的指标间的相互关系。结果(1)肥胖患者的血浆TG、VLDL-C、FINS、瘦素、TNF-α、FFA均显著高于正常对照组(P<0.05-P<0.01)。(2)肥胖组中FFA与血浆TG、Tch、LDL、FINS、胰岛抵抗指数(HOMA-IR)呈正相关(γ分别为0.492、0.610、0.632、0.612、0. 607,均P<0.05),与胰岛素敏感指数(ISI)呈负相关(γ为-0.47,P<0.05);瘦素与BMI、FINS、HOMA-IR呈正相关(γ分别为0.673、0.831、0.823、P<0.01-P<0.001),与ISI呈负相关(γ为-0.578,P<0.05);TNF-α与ISI呈负相关(γ为-0.676,P<0.05)。结论肥胖患者的血清瘦素、TNF-α、FFA水平显著高于正常人群,且其水平与反映胰岛素敏感性的指标显著相关,血清瘦素、TNF-α、FFA是一组很好的评估胰岛素敏感性的指标。     

Serum leptin levels and adiposity in adult Chinese: a preliminary observation

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Serum leptin levels and body weight in postmenopausal women under transdermal hormone replacement therapy

Leptin, the adipocyte-specific product of the ob gene, is implicated in body weight regulation and energy balance. We investigated the influence of hormone replacement therapy (HRT) on the body mass index (BMI) and serum leptin levels in 20 postmenopausal, nonobese women treated with transdermal HRT (delivery rate 50 microg 17beta-estradiol/24 h, 1 patch per week) for 6 months. Serum leptin levels were measured by ELISA and results were compared by means of the Student's paired t-test or Pearson's correlation. The mean patient age was 55+/-6.04 years. The mean body weight prior to the start of the study was 69.39+/-9.37 kg, and the BMI before HRT was 26.92+/-4.47 kg/m2. Both parameters remained unchanged under therapy. No significant change in absolute serum leptin values (18.8+/-8.4 ng/ml; 20.47+/-9.7 ng/ml; 17.92+/-8.7 ng/ml at 0, 4 and 6 months respectively) or in adiposity-corrected values (serum leptin/BMI) (0.68+/-0.24; 0.75+/-0.29; 0.67+/-0.26 at 0, 4 and 6 months respectively) were found. Serum leptin levels correlated well with BMI (r = 0.7193, p<0.0001). There was no significant correlation of estradiol with serum leptin levels before or during therapy. In summary, low dose, transdermal HRT exhibited no influence on serum leptin levels or BMI in postmenopausal women. These data suggest that low dose HRT does not influence body weight regulation in postmenopausal women.     

Sympathetic activity and response to ACE inhibitor (enalapril) in normotensive obese and non-obese subjects

BACKGROUND: Angiotensinogen has been proposed as a possible link between obesity and hypertension because the adipocyte produces angiotensinogen and contains the enzymes required for its conversion. Moreover, sympathetic overactivity has been reported in obese subjects. The aim of this study was to compare heart sympathetic activation and serum angiotensinogen levels in obese and non-obese normotensive subjects, their relationship, and the effect of a drug that modifies the renin-angiotensin system. METHODS: Serum angiotensinogen, leptin, lipids, glucose, and insulin levels were measured and 24-h electrocardiograph monitoring was carried out in 41 (20 non-obese and 21 obese) volunteers before and after administration of 5 mg enalapril twice/day for 7 days. RESULTS: Obese subjects had higher values than non-obese subjects for % body fat (35.1+/-4.6 vs. 30.5+/-5.2; p=0.005), triglycerides (1.93+/-0.9 vs. 1.25+/-0.7 g/L, p=0.002), insulin (114.8+/-82.5 vs. 45.9+/-22.2 pmol/L), leptin (31.4+/-20.4 vs. 14.1+/-11.2 ng/mL, p=0.002), and LF/HFn index (4.3+/-2.9 vs. 2.2+/-1.3, p<0.005). Enalapril increased angiotensinogen levels only in the non-obese group (4.2+/-3.9 vs. 9.7+/-5.4 ng/mL, p=0.001) and diminished the LF/HFn index (4.3+/-2.9 vs. 3.0+/-1.4, p=0.007) in the group of obese subjects. There was no association between angiotensinogen levels and sympathetic activity. CONCLUSIONS: Higher level of sympathetic activity was found in normotensive obese as compared with non-obese subjects. Enalapril treatment reduced heart sympathetic activity in obese subjects but did not change angiotensinogen levels.     

Relationships between serum osteoprotegerin, matrix metalloproteinase-2 levels and bone metabolism in postmenopausal women

Background Serum osteoprotegerin (OPG) and matrix metalloproteinase-2 (MMP-2) have been shown to play a role in bone metabolism by degrading the bone matrix. The present study was undertaken to compare OPG and MMP-2 with bone mineral density and three markers (alkaline phosphatase (AKP), calcium and phosphorus) in postmenopausal women in Wuhan.Methods Serum OPG, MMP-2, and AKP of 78 Chinese postmenopausal women aged 48 to 65 were measured using enzyme-linked immunosorbent assay (ELISA). Bone mineral density was measured with dual energy X-ray absorptiometry (DEXA), and serum calcium and phosphorus were measured by auto biochemical analysis .Results Serum OPG and MMP-2 concentrations were significantly higher in postmenopausal women with osteoporosis ((127.6±6.3) ng/L; (1388±121) μg/L)) than those in age-matched normal controls ((72.3±2.4) ng/L; (1126±141) μg/L, P&lt;0.01). Negative relationships were found between serum OPG, MMP-2 levels and bone mineral density in osteoporotic women. Adjusted by age and body mass index (BMI), the correlation of MMP-2 with bone mineral density of the neck of the femur disappeared. In osteoporotic women, negative correlations between OPG, MMP-2 levels and serum calcium were found (r=–0.216; r=–0.269, P&lt;0.05), but positive correlations between OPG and serum AKP, serum phosphorus (r=0.235; r=0.124, P&lt;0.05).Conclusions Significant correlations exist between serum OPG, MMP-2 levels and bone metabolism in high bone turnover of postmenopausal osteoporotic women. The concentrations of serum OPG and MMP-2 increase possibly as a concomitant event in the high bone turnover state, such as postmenopausal osteoporosis. Therefore serum OPG and MMP-2 could be used as indicators for the bone metabolism in postmenopausal osteoporotic women.     

人血浆瘦素水平与肥胖及血浆胰岛素水平的关系

目的: 探讨人血浆瘦素水平与肥胖、血糖、胰岛素浓度的关系.方法: 免疫放射法测定171例疑有糖尿病者(男性90例,女性81例)的空腹血浆瘦素水平,并行口服葡萄糖耐量试验 ,测定血浆葡萄糖和胰岛素浓度,同时测量身高、体重,计算体重指数(body mass index, BMI).结果: 空腹血浆瘦素水平与体重指数呈正相关(男性r=0.6772, P<0.01;女性r=0.7191, P<0 .01),但女性血浆瘦素水平是男性的2～3倍,性别差异有显著性.采用多元逐步回归法分析, 去除体重指数等因素的影响后,瘦素与胰岛素曲线下面积呈正相关,与血糖浓度无相关性. 结论: 肥胖者空腹血浆瘦素升高,血浆高瘦素水平与高胰岛素血症的相关性提示瘦素可能在2型糖尿病的发病中起一定作用.     

Hypomagnesemia, insulin resistance, and non-alcoholic steatohepatitis in obese subjects

BACKGROUND: Epidemiological evidence shows a strong relationship between decreased serum magnesium levels (DSML) and insulin resistance. As nonalcoholic steatohepatitis (NASH) seems to be related to insulin resistance, the aim of this study was to determine the potential relationship between DSML and NASH in obese subjects. METHODS: We compared obese individuals with the diagnosis of diabetes, insulin-resistance, and non-insulin resistance to a control group of non-obese, non-insulin-resistant subjects. Participants were required to have negative viral markers and negligible alcohol intake. Other liver diseases and well-known causes for decreasing of magnesium were exclusion criteria. A liver biopsy was performed in subjects with aspartate aminotransferase (AST) and alanine aminotransferease (ALT) levels > or =40 IU/mL. RESULTS: Of the 60 obese subjects, 20 were non-insulin resistant, 20 were insulin resistant, and 20 were type 2 diabetics. Twenty subjects were in the control group. Eleven (33.3%) diabetics, 14 (42.4%) insulin-resistant subjects, and 8 (24.2%) non-insulin-resistant subjects underwent liver biopsies. Diagnosis of NASH was established in 29 (36.2%) individuals. Subjects with the diagnosis of NASH exhibited lower serum magnesium levels of 1.7 +/- 0.2 mg/dL (0.70 +/- 0.08 mmol/L), and those with fibrosis showed the lowest serum magnesium concentration at 1.5 +/- 0.3 mg/dL (0.62 +/- 0.12 mmol/L). Multiple regression analysis adjusted by age showed that low serum magnesium concentration was independently related to a high HOMA-IR index (OR 7.6, CI 95% 2.1-11.2; p <0.0001) and that a high HOMA-IR index was related to NASH (OR 6.5, CI 95% 1.5-8.8; p <0.01). After adjusting for age and a high HOMA-IR index, hypomagnesemia remained independently related to NASH (OR 1.4, CI 95% 1.1-5.4; p <0.05). CONCLUSIONS: The results of this study demonstrate an independent relationship between DSML and NASH.     

女性2型糖尿病病人血清瘦素水平及其与代谢因素的关系

①目的　观察初诊女姓 2型糖尿病 (DM )病人血清瘦素 (LPT)水平 ,探讨其与年龄、体质量指数、糖代谢、脂代谢、尿酸代谢及其他激素的关系。②方法　采用放射免疫分析法 (RIA)和酶联免疫吸附法 (ELISA)测定初诊未经治疗 1 1 1例 2型糖尿病病人 (男 5 6例 ,女 5 5例 )及 96例正常人 (男 4 8例 ,女 4 8例 )空腹血清LPT、睾酮(TT)、雌二醇 (E2 )、真胰岛素、血糖、血清胆固醇、三酰甘油和尿酸水平。③结果　女性DM组血清瘦素水平明显低于女性对照组 (F =1 7.985 ,P <0 .0 1 ) ;DM组及对照组中 ,女性血清瘦素水平明显高于男性 (F =34.6 0 8、5 3.72 1 ,P <0 .0 1 ) ;绝经后女性DM组与绝经前女性DM组瘦素水平比较 ,差异无显著性 (P >0 .0 5 ) ;女性DM组血清瘦素水平与体质量指数、胰岛素浓度、腰臀围比值及尿酸水平呈正相关 (t =4 .0 75～ 1 1 .72 5 ,P <0 .0 1、0 .0 5 ) ,与空腹血糖及血清睾酮水平呈负相关 (t=- 3.94 6、- 2 .30 5 ,P <0 .0 5 )。④结论　女性 2型糖尿病病人血清瘦素水平较正常女性明显降低 ;女性 2型糖尿病病人血清瘦素水平与体质量指数、脂肪分布、胰岛素浓度、睾酮、血糖及血尿酸相关 ;雌激素不是影响瘦素的主要因素 ;瘦素参与了女性 2型糖尿病病人的糖代谢及尿酸代谢     

肥胖及2型糖尿病患者血清网膜素水平及其相关因素分析

目的 测定肥胖及新诊断2型糖尿病患者血清网膜素水平,探讨网膜素与体脂参数、糖脂代谢、胰岛素抵抗的相关性.方法 69例2型糖尿病(T2DM)和74例正常糖调节(NGR)者按BMI≥25 ks/m2分为正常体重与超重/肥胖亚组,采用ELISA法检测空腹血清网膜素水平,同时检测空腹血糖(FPG),口服葡萄糖耐量试验2 h血糖(OGTY-2 hPG),糖化血红蛋白(HbA1c)、血脂各项指标及空腹胰岛素(FINS)水平,计算体重指数(BMI)和腰臀比值(WHR),并以稳态模型(HOMA-model)计算胰岛素抵抗指数(HOMA-IR).结果 校正年龄及性别后,血清网膜素水平在T2DM组低于NGR组[(17.5±5.8)μg/L vs(20.0±7.6) μg/L,P＜0.05];T2DM组和NGT组中的超重/肥胖者均低于非肥胖者[分别为(15.2±5.6)μg/L vs(19.0±5.8)μg/L和(17.4±6.4)μg/L vs(22.8±7.9)μg/L,均P＜0.05)];且T2DM超重/肥胖组明显低于NGR超重/肥胖组.相关分析显示,血清网膜素水平与腰围、WHR、In(HOMA-IR)、甘油三酯、BMI、FINS、2 hPG均呈负相关(r=-0.166～-0.313,P＜0.01或P＜0.05);与HDL-C呈正相关(r=0.400,P＜0.01).多元逐步回归分析发现,HDL-C、腰围和In(HOMA-IR)是血清网膜素独立相关因素(分别为r2=0.155,r2=0.181,r2=0.201,均P＜0.01).结论 血清网膜素水平与腹型肥胖、胰岛素抵抗及脂代谢相关,可能参与构成胰岛素抵抗的病理生理基础.     

肥胖型多囊卵巢综合征患者临床及内分泌代谢特征的研究

目的分析总结肥胖型多囊卵巢综合征(PCOS)患者的临床及内分泌代谢特征。方法对象为肥胖型PCOS(A组)70例、非肥胖型(B组)122例以及同期就诊的输卵管因素不孕症患者104例(其中单纯肥胖25例,C组;正常体重79例,D组)作为对照。对上述对象进行临床体征评分,内分泌、代谢指标测定。采用雄激素指数(FAI)评估雄激素增多症,用稳态模型指数(HOMA IR)、胰岛素曲线下面积(IAUC)评估胰岛素敏感性,HOMA-IS、ΔI30/ΔG30评估胰岛β细胞功能。结果(1)A组患者的FAI(3.40±1.84)高于B组(1.75±1.20)和C组(1.65±0.90),P均<0.01。B组黄体生成素(LH)/卵泡刺激素(FSH)比值(2.41±1.13)高于A、C、D组,P均<0.01。(2)192例患者总的胰岛素抵抗发生率为43.23%,A、B组分别为82.86%及20.49%。A组黑棘皮症发生率、空腹胰岛素、IAUC、HOMA IR及甘油三酯水平均高于B组(P均<0.01)。A、B、D组间HOMA IS、ΔI30/ΔG30差异无统计学意义(P>0.05)。(3)人体质量指数、腰臀比与FAI、HOMA-IR均呈正相关(P均<0.01);与LH/FSH比值呈负相关(r=-0.345、-0.260,P<0.01)。结论肥胖型PCOS患者较非肥胖型存在更严重的内分泌及代谢紊乱,胰岛β细胞功能处于代偿期,其远期并发症的防治应受到高度重视。     

单核细胞趋化蛋白-1与多囊卵巢综合征临床特征的相关性研究

目的探讨多囊卵巢综合征（PCOS）患者血清中单核细胞趋化蛋白（MCP）-1浓度的变化及其与PCOS患者临床特征的关系。方法将PCOS患者和对照者根据体重指数分为PCOS肥胖组（27例）、PCOS非肥胖组（38例）及肥胖对照组和非肥胖对照组（后两组各20例）。应用ELISA方法检测PCOS组及对照组血清中MCP-1水平,应用化学发光法检测血清泌乳素、黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇和睾酮,应用放射免疫方法检测血清雄烯二酮水平;同时检测空腹血糖和空腹胰岛素。结果（1）非肥胖PCOS组血清中MCP-1水平明显高于非肥胖对照组[（984-67）ng／ml vs（584-41）ng/ml,P＜0．05]。（2）Pearson相关分析显示,MCP-1与体重指数（r=0．339,P=0．000）、LH（r=0．224,P=0．024）及稳态模型的胰岛素抵抗指数（HOMA-IR,r=0．239,P=0．016）呈正相关,与胰岛素敏感指数（ISI）呈负相关（r=-0．250,P=0．011）;排除体重指数影响后的偏相关分析显示,MCP-1与LH（r=0．2873,P=0．0006）呈正相关,与其他临床指标之间无明显相关（P＞0．05）。（3）多元回归分析结果显示,体重指数（t=3．607,P=0．000）和LH（t=2．298,P=0．024）是影响血清中MCP-1的主要因素,其中体重指数的影响因素更明显。结论PCOS患者血清中MCP-1水平的升高与LH有关;PCOS可能是一种慢性炎症性疾病;MCP-1可能参与了PCOS患者的肥胖、高胰岛素血症和胰岛素抵抗的发生。     

肥胖患者血清瘦素和胰岛素抵抗的关系及西布曲明对其的影响

OBJECTIVE: To assess the relationship between serum leptin and insulin resistance (IR) in obesity, and to investigate the effects of sibutramine on obesity, serum leptin and IR. METHODS: Seventy obese subjects [body mass index (BMI) > or =25 kg/m2] were randomly divided into 2 groups: group B (sibutramine 10 mg/day) and group C (a placebo tablet/day). Both had been treated for 12 weeks. Another 30 healthy adults served as the normal control (group A: BMI < 23 kg/m2). Their height, body weight, waist and hip circumference, fasting plasms glucose (FPG), fasting plasma insulin (FINS), and serum leptin were examined at the baseline and 12 weeks after the therapy. Insulin senstivity index (ISI) was calculated [ISI = 1/(FPG x FINS)]. Multiple linear regression analysis and partial correlation were performed on serum leptin. RESULTS: The body weight, BMI, waist and hip circumference decreased significantly after the 12 week-treatment with sibutramine in group B (P < 0.01), but those indexes did not change after the treatment with placebo in group C (P > 0.05). The levels of leptin and FINS were higher (P < 0.01), but ISI was lower (P < 0.01) both in group B and C compared with those in group A at the baseline. The levels of serum leptin and FINS decreased (P < 0.01), and ISI increased significantly (P < 0.05) after the treatment with sibutramine in group B, while those indexes did not change after the treatment with placebo in group C. The most important factors to influence serum leptin level were listed as follows: sex > BMI > FINS > ISI (R2 = 0.661, F = 12.662, P < 0.01). The lep- tin was positively correlated with FINS (r = 0.597, P < 0.01) , but negatively correlated with ISI (r = -0.468, P < 0.01 ) after eliminating the effects of sex and BMI. Conclusion Leptin resistance and insulin resistance exist in obesity, and serum leptin is associated with IR. Treatment with sibutramine significantly reduces the body weight and leptin, increases insulin senstivity, and improves IR.     

多囊卵巢综合征患者血清miR-143-3p、miR-222-3p及抗苗勒管激素水平检测及其临床价值

  目的  探讨血清miR-143-3p、miR-222-3p水平联合抗苗勒管激素(AMH)在多囊卵巢综合征(PCOS)中的表达及临床价值。  方法  选取2018年1月—2022年3月三亚市妇女儿童医院收治的128例PCOS患者(PCOS组)和50例健康女性(对照组)。PCOS患者根据胰岛素抵抗指数(HOMA-IR)分为胰岛素抵抗组(83例,HOMA-IR≥2.69)和非胰岛素抵抗组(45例,HOMA-IR＜2.69);根据BMI分为肥胖组(40例,BMI≥28)和非肥胖组(88例,BMI＜28);根据睾酮水平分为高雄激素组(71例,睾酮≥0.7 ng/mL)及非高雄激素组(57例,睾酮＜0.7 ng/mL)。采用实时定量PCR法检测血清miR-143-3p及miR-222-3p水平和电化学发光法检测AMH水平。ROC曲线分析miR-143-3p、miR-222-3p联合AMH对PCOS的诊断价值。相关性分析采用Pearson相关分析。  结果  PCOS组血清miR-143-3p、miR-222-3p及AMH水平均明显高于对照组,肥胖组明显高于非肥胖组,高雄激素组明显高于非高雄激素组,胰岛素抵抗组明显高于非胰岛素抵抗组,差异均有统计学意义(均P＜0.001)。ROC曲线显示,miR-143-3p、miR-222-3p及AMH三项联合诊断PCOS的曲线下面积最大(AUC=0.910,95% CI:0.852~0.974)。PCOS患者血清miR-143-3p、miR-222-3p水平与AMH均呈正相关关系(r=0.842、0.795,均P＜0.001)。  结论  PCOS患者血清miR-143-3p、miR-222-3p及AMH水平明显升高,三项联合检测对PCOS诊断具有较高的价值。      

Body trunk fat and insulin resistance in post-pubertal obese adolescents.

CONTEXT AND OBJECTIVE: Insulin resistance is a metabolic disorder commonly associated with excess body fat accumulation that may increase chronic disease risk. The present study was undertaken to evaluate the relationship between body composition and insulin resistance among obese adolescents. DESIGN AND SETTING: Cross-sectional study, at the Adolescence Center, Pediatric Department, Universidade Federal de S?o Paulo. METHODS: Body composition was assessed using dual-energy X-ray absorptiometry. Dietary intake was evaluated using a three-day dietary record. The biochemical evaluation comprised glucose, insulin, serum lipid, leptin and ghrelin measurements. Insulin resistance was calculated by means of the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Forty-nine post-pubertal obese adolescents participated in the study: 12 boys and 37 girls of mean age 16.6 (1.4) years and mean body mass index (BMI) of 35.0 (3.9) kg/m(2). The mean glucose, insulin and HOMA values were 90.3 (6.4) mg/dl, 16.6 (8.1) microIU/ml and 3.7 (1.9), respectively. Hyperinsulinemia and insulin resistance were observed in 40.2% and 57.1% of the subjects, respectively. Adolescents with insulin resistance had higher BMI and body trunk fat. There was a trend towards higher leptin concentration in obese individuals with insulin resistance. Insulin resistance was positively correlated with body trunk fat, BMI, body fat mass (kg), leptin and body fat percentage. Furthermore, there was a negative correlation between HOMA-IR and lean body mass. The body composition predicted 30% of the HOMA-IR levels, according to linear regression models. CONCLUSION: Body trunk fat was significantly associated with insulin resistance, demonstrating the clinical importance of abdominal obesity during adolescence.     

多囊卵巢综合征患者血清脂肪细胞因子与胰岛素抵抗的相关性研究

目的 探讨PCOS患者血清脂肪细胞因子与胰岛素敏感性的相关性.方法 将PCOS患者60例分为肥胖组PCOS36例、非肥胖组PCOS24例,将同期就诊的男方因素不孕症患者(正常体重)26例作对照组.进行内分泌代谢指标测定,采用空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)评估胰岛素敏感性;并应用酶联免疫吸附法测定血清游离脂肪酸(FFA)、瘦素及C反应蛋白(CRP),放射免疫法测定血清脂联素(APN)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6.结果 (1)肥胖组PCOS的血清APN为(10±7)mg/L,低于非肥胖组PCOSE(17±9)mg/L]和对照组,均P＜0.01;FFA为(548±105)μmol/L,高于非肥胖组PCOS[(427±67)μmoL/L]和对照组,P＜0.01;血清瘦素水平为(42±21)μg/L,高于非肥胖组PCOS[(24±13)μg/L]和对照组,均P＜0.01.非肥胖组PCOS与对照组间APN、FFA和瘦素差异无统计学意义.血清IL-6肥胖组PCOS[(173 4-184)ng/L]和非肥胖组PCOS[(184±44)ng/L]均高于对照组(P＜0.05、P＜0.01);血清TNF-α非肥胖组PCOS[(0.97±0.33)μg/L]和肥胖组PCOS[(0.82 4-0.21)μg/L]均高于对照组(P＜0.01,P＜0.05);非肥胖组PCOS TNF-α高于肥胖组(P＜0.05).非肥胖组和肥胖组的PCOS患者血清中CRP高于对照组,但差异无统计学意义(P＞0.05).(2)瘦素与人体质量指数(BMI)、腰臀比及HOMA-IR呈正相关(P＜0.01),APN与BMI、腰臀比及HOMA-IR呈负相关(P＜0.01).(3)BMI和TNF-α是FINS的独立影响因素,APN是除FINS、空腹血葡萄糖、BMI外,对HOMA-IR的独立影响因素.结论 炎性因子可能参与了非肥胖型PCOS患者IR的发生;而肥胖型PCOS IR的进一步加重可能与其脂肪组织分泌瘦素、FFA增多及分泌APN减少相关.     

经鼻持续气道内正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征瘦素水平及代谢紊乱的影响

目的评价经鼻持续气道内正压通气(nasal continuous positive airway pressure,nCPAP)治疗对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea/hypopnea syndrome,OSAHS)瘦素水平和代谢紊乱的影响,探讨瘦素水平在OSAHS发病中的作用.方法测定OSAHS患者在nCPAP一夜治疗(18例)和长期治疗(8例,治疗时间7.5个月)前后的血清瘦素浓度,对比治疗前后部分代谢参数的变化.结果nCPAP一夜治疗后,血清瘦素水平下降[(8.47±0.62)μg/L vs(7.32±0.64)μg/L,P=0.022],其余参数未见明显变化(P＞0.05);血清瘦素水平在nCPAP长期治疗后明显下降并独立于体重指数(body mass index,BMI)[(8.35±0.83)μg/L vs(6.05±0.78)μg/L,P=0.036];血清空腹血糖(FBG)和空腹真胰岛素(TI)均在nCPAP长期治疗后明显下降(P值均为0.036),但甘油三酯(TG)和胆固醇(Chol)未见明显变化.结论nCPAP一夜和长期治疗能降低OSAHS的瘦素水平并独立于BMI,OSAHS可能对血清瘦紊水平具有独立的作用;nCPAP长期治疗可改善OSAHS的糖代谢及胰岛素抵抗.     

肥胖患者血清瘦素和胰岛素抵抗的关系及西布曲明对其的影响

目的 :观察肥胖患者血清瘦素和胰岛素抵抗的关系及西布曲明治疗单纯性肥胖的疗效及对瘦素和胰岛素抵抗的影响。方法 :单纯性肥胖患者 [体重指数 (BMI)≥ 2 5kg/m2 ]70例 ,随机分为B组 (口服盐酸西布曲明片10mg/d)和C组 (口服安慰剂 1片 /d) ,共治疗 12周 ;另选 30例年龄匹配的健康正常人作为对照组 (A组 ) :BMI<2 3kg/m2 ,均检测身高、体重、腰围、臀围 ,观察空腹血糖 (FPG)、血清空腹胰岛素 (FINS)、血清瘦素 (leptin)的变化 ,计算胰岛素敏感指数 [ISI=1/ (FPG×FINS) ],对瘦素与上述指标和ISI的相关性用多元逐步回归分析和偏相关分析。结果 :治疗 12周后 ,B组体重、BMI ,腰围、臀围显著下降 (P <0 .0 0 1) ,但C组上述指标无明显变化。两组肥胖受试者在治疗前血清瘦素、胰岛素水平明显高于A组 (P <0 .0 1) ,ISI明显低于A组 (P <0 .0 1) ;但B组用西部曲明治疗后血清瘦素、胰岛素水平明显下降 (P <0 .0 1) ,ISI水平显著升高 (P <0 .0 5 ) ;而C组用安慰剂治疗后上述指标无变化。在肥胖受试者中 ,影响瘦素最主要的因素依次为性别、BMI,胰岛素、ISI(R2 =0 .6 6 1,F =12 .6 6 2 ,P <0 .0 1) ,去除性别、BMI的影响后 ,瘦素与胰岛素呈著显正相关 (r=0 .5 97,P <0 .0 1) ,与ISI明显负相关 (r= 0 .4 6 8,P <0 .0     

Relationship between left ventricular mass and heart sympathetic activity in male obese subjects

BACKGROUND: Pathogenesis of left ventricular hypertrophy (LVH) is multifactorial, but evidence that the sympathetic system is involved in progression of cardiovascular structural alterations in hypertension is substantial. However, the relationship between heart sympathetic activity and left ventricular mass in normotensive obese subjects has not been studied. METHODS: We studied 103 male normotensive subjects (53 obese and 50 non-obese). Left ventricular mass (LVM), heart sympathetic activity by 60 min electrocardiograph (EKG) monitoring, leptin, insulin, lipid profile, and blood pressure were measured. RESULTS: Obese subjects showed higher LVM (p=0.0002), low frequency/high frequency ratio (LF/HF) (p=0.004), systolic and diastolic blood pressure (p <0.00001 for both), insulin (p=0.00001), and leptin levels (p <0.00001) than non-obese subjects. In contrast, standard deviation (SD) of all rate-rhythm (R-R) intervals (SDNN) (p=0.0002) and total power (TP) (p=0.03) were lower in obese than in non-obese subjects. In multiple regression analysis for factors associated with LVM, body mass index (BMI) (R=0.24), systolic blood pressure (R=0.22), and LF/HF (R=0.21) were the only factors included in the model (R2=0.32, p <0.0001). CONCLUSIONS: LVM is increased in normotensive obese subjects and correlates with systolic blood pressure and heart sympathetic activity.     

Leptin receptor Lys656Asn polymorphism is associated with decreased leptin response and weight loss secondary to a lifestyle modification in obese patients

BACKGROUND: Human obesity is characterized by high levels of leptin, and it has been suggested that obese patients may be leptin resistant. The aim of our study was to investigate the influence of Lys656Asn polymorphism in the leptin receptor gene on leptin response and weight loss secondary to a lifestyle modification (Mediterranean hypocaloric diet and exercise) in obese patients. METHODS: A population of 67 obese (body mass index >30) nondiabetic outpatients was analyzed in a prospective way. Before and after 3 months of lifestyle modification program, bipolar electrical bioimpedance, blood pressure, and a serial assessment of nutritional intake with 3 days written food records and biochemical analysis were performed. The lifestyle modification program consisted of a hypocaloric diet (1520 kcal, 52% carbohydrates, 25% lipids and 23% proteins). The exercise program consisted of aerobic exercise for at least three times per week (60 min each). Statistical analysis was performed for the combined Lys656/Asn656 and Asn656/Asn656 as mutant group and type Lys656/Lys 656 as wild-type second group. RESULTS: Sixty seven patients gave informed consent and were enrolled in the study. The mean age was 45.7 +/- 16.6 years and the mean BMI 34.1 +/- 5.1, with 18 males (26.9%) and 49 females (73.1%). Thirty six patients (10 males/26 females) (46.8%) had the genotype Lys656/Lys 656 (wild-type group) and 31 patients (8 males/23 females) (46.3%) Lys656/Asn656 (n = 28, 41.8%) or Asn656/Asn656 (n = 3, 4.5%) (mutant group). The percentage of responders (weight loss) was similar in both groups (91.7 vs. 87.1%). In wild-type group (responders and nonresponders), BMI, weight, fat mass, systolic blood pressure and waist circumference decreased. In mutant group, BMI, weight and waist circumference decreased. No differences were detected between basal values in both groups. Only leptin levels decreased significantly in wild-type group (11.5%; p <0.05) (57.3 +/- 31.5 ng/mL vs. 45.8 +/- 29.3 ng/mL; p <0.05). In mutant group, leptin increased without statistical differences (0.44%; ns). CONCLUSIONS: Patients with Asn656 allele of LEPR gene have a different response than wild-type patients, and Lys656Lys patients have a significant decrease in weight, BMI, fat mass, waist circumference, systolic blood pressure and leptin levels.