代谢综合征的临床处理

代谢综合征（metabolic syndrome）有6个主要表现：腹部肥胖、能引致动脉粥样硬化性血脂异常、高血压、胰岛素抵抗和（或）葡萄糖耐量不正常、前炎症状态和前血栓形成状态。代谢综合征涉及多方面的心血管病危险因子,应予较多关注。在临床上,识别代谢综合征一般根据腹部肥胖、高甘油三酯、低高密度脂蛋白、高血压、高血糖等表现。此外,     

Algorithm of diagnosis and treatment of metabolic syndrome

High prevalence and risk of cardiovascular complications dictates necessity of timely diagnosis of the metabolic syndrome. Its criteria does not require detection of insulin resistance and can be widely used. For facilitation of selection of drug therapy the following clinical variants of the syndrome were distinguished: 1) combination of hypertension, abdominal obesity and dyslipidemia; 2) combination of hypertension, abdominal obesity and impaired glucose tolerance; 3) combination of hypertension, abdominal obesity dyslipidemia and impaired glucose tolerance. Management of metabolic syndrome should be complex comprising diet and various combinations of antihypertensive, lipid lowering and hypoglycemic drugs.     

代谢综合征的诊断问题

复习了几种代谢综合征的定义,并对其组分进行了讨论。目前最新的是2005年4月提出的国际糖尿病联盟(IDF)定义。我国于2004年也有一定义。还介绍了最近对代谢综合征诊断的争论。美国糖尿病学会(ADA)及欧洲糖尿病学会(EASD)认为目前此诊断尚不成熟,但IDF定义制定者予以坚决反驳。     

Clinical experience of a carbohydrate-restricted diet for the metabolic syndrome

Background: Our objective was to analyze a restricted carbohydrate dietary approach compared to a standard low-fat diet plus medication plan as treatment for weight loss and the metabolic syndrome. Methods: This was a retrospective analysis of patients attending an outpatient weight and metabolism management program, including periodic individual visits combined with either a carbohydrate-restricted diet (with multivitamin and essential fatty acids supplementation) or low-fat/low-calorie diet + phentermine/fenfluramine. The main outcome measurements were total body weight and fasting serum lipid profiles. Clinical data were maintained on standardized flow sheets. Results: One hundred twenty-two patients had complete baseline and follow-up information. Sixty-six were treated with a carbohydrate-restricted diet without medication, and 56 were treated with a combination of low-fat/low-calorie diet and medication. Weight loss occurred in both groups, but was greater in the medication group: the carbohydrate-restricted group lost a mean of 9.5 kg over 15.0 weeks (0.63 kg/week); the low-fat/low-calorie diet + medication group lost a mean of 14.1 kg over a mean duration of 20.2 weeks (0.70 kg/week), p < 0.01. The carbohydrate-restricted group had a greater reduction in triglycerides (p = 0.02) and triglyceride/HDL ratio (p = 0.01), and a greater increase in HDL (p < 0.001) than the medication group. Conclusions: In this outpatient program, a carbohydrate-restricted diet and a low-fat/low-calorie diet + medication led to weight loss, but the carbohydrate-restricted diet had a more favorable effect on triglycerides and HDL. Because of the effects on weight, triglycerides, and HDL, a carbohydrate-restricted diet may be useful for the treatment of metabolic syndrome.     

中国人代谢综合征的现状及临床特征

代谢综合征（MS）是一组以肥胖、高血糖[糖尿病（DM）或糖调节异常（IGR）]、血脂异常[高甘油三酯（TG）和（或）低高密度脂蛋白胆固醇（HDL-C）]以及高血压等聚集发病，严重影响人类健康的临床征候群。MS者发生心血管事件及中风的患病率及死亡风险是非MS者的2～3倍。有MS的非DM者中发生2型DM的危险是无MS的非DM者的5倍。由MS引发的全球DM以及心脑血管疾病的流行，已引起学者的高度重视。并将早期诊断及干预MS作为预防DM及心脑血管疾病的关键。     

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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。     

The role of insulin resistance in diagnosis of metabolic syndrome

Early diagnosis of metabolic syndrome is based on detection of insulin resistance, hyperinsulinemia, and clinical presentations of this syndrome. Differences in approaches to diagnosis of metabolic syndrome and its multi component nature hamper comparison of results of different studies and elaboration of generalized guidelines for selection of high risk groups and prevention of cardiovascular diseases and type 2 diabetes. Until present there are no common criteria of the syndrome and this makes difficult standardization of methodology of its investigation. Several organizations (WHO, National Cholesterol Education Program, European Group for the Study of Insulin Resistance) issued documents in which diagnostic approaches to detection of metabolic syndrome and its separate components have been formulated. These approaches as well as comparative analysis of direct and calculated methods of assessment of insulin resistance are presented in this review.     

Toll样受体4与代谢综合征

Toll样受体(TLR)4属于模式识别受体,是联系天然免疫和获得性免疫的桥梁.代谢综合征患者体内存在多种代谢紊乱.游离脂肪酸(FFA)、高血糖等可激活人体内的TLR4信号通路,使炎性细胞因子分泌增多,诱发胰岛素抵抗和胰岛β细胞凋亡、血管腔狭窄、血管功能紊乱,促进2型糖尿病、高血压和动脉粥样硬化等代谢综合征相关疾病的发生、发展.对TLR4信号通路进行调控有可能起到防治代谢综合征及其相关疾病的作用.