糖耐量低减患者进行动态血压及尿白蛋白检测的临床意义

应用动态血压监测（ＡＢＰＭ）技术进行了５４例血压正常的糖耐量低减（ＩＧＴ）患者动态血压与尿白蛋白检测，并与３０例正常人进行对照，结果显示：ＩＧＴ患者在未出现高血压之前，已有动态血压改变，部分ＩＧＴ存在阵发性高血压，尤其是收缩压（ＳＢＰ）升高显著，舒张压有增高趋势。ＩＧＴ患者尿白蛋白排出率（ＵＡＥＲ）较正常人升高（Ｐ〈０．０１），血压升高者尿白蛋白（ＵＡＥ）增高多见。因此，预防糖尿病并发症，干预应从     

新诊断的NIDDM和IGT患者的早期肾功能改变

本文研究了６３例新诊断的非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者和１６例糖耐量减低（ＩＧＴ）患者的早期肾功能改变，显示ＮＩＤＤＭ患者早期存在肾小球滤过率（ＧＦＲ）升高，肾脏体积增大和尿白蛋白排泄率（ＵＡＥ）轻度增高；１６例ＩＧＴ患者的ＧＦＲ也高于正常对照组。３４例ＮＩＤＤＭ患者经饮食控制和／或口服降糖药治疗４个月后进行了复查，结果显示：１２例代谢改善者的ＧＦＲ、肾脏体积和ＵＡＥ有不同程度的恢复；２２例代谢无改善者的ＧＦＲ有所升高，肾脏体积和ＵＡＥ则无明显变化。     

急性心肌梗塞患者及其血管再通后血浆中内皮素和降钙素基 …

采用同位素放射免疫法检测４１例发病６ｈ内的急性心肌梗塞组（ＡＭＩ）及该组溶栓再通后２ｈ，２４ｈ血浆中的内皮素（ＥＴ），降钙素基因相关肽（ＣＧＲＰ）的浓度，另检测３８例发病２４ｈ的ＡＭＩ患者及４１例正常健康人血浆中ＥＴ、ＣＧＲＰ浓度。结果：ＡＭＩ患者血浆中ＥＴ与ＣＧＲＰ的正常平衡被破坏，发病６ｈ内较２４ｈ这种平衡的破坏较明显，且随着血管的再通，ＥＴ与ＣＧＲＰ逐渐趋向于正常平衡。     

培哚普利对高血压病患者血胰岛素水平的影响

对４０例高血压病（ＥＨ）患者和２０例健康对照者行口服葡萄糖耐量试验，测定其血糖（ＧＳ）和血胰岛素（ＩＳ）水平，计算其释放曲线下面积（ＡＵＣＧ、ＡＵＣＩ），发现两组空腹血糖无显著差别，ＥＨ组空腹ＩＳ和服糖后ＧＳ、ＩＳ及其ＡＵＣＧ、ＡＵＣＩ均显著高于对照组。提示高血压患者存在糖耐量降低、高胰岛素血症和胰岛素抵抗。３１例ＥＨ患者接受培哚普利降压治疗４周后，糖耐量试验显示糖负荷后１ｈ、２ｈ的ＧＳ和ＡＵＣＧ及空腹与糖负荷后各点的ＩＳ和ＡＵＣＩ均较治疗前显著降低。提示培哚普利能够降低ＥＨ患者血ＩＳ水平，具有改善其胰岛素抵抗的作用。     

NIDDM患者24小时血压,尿白蛋白排泄率的早期改变

观察１７例血压和尿白蛋白排泄经（ＵＡＥＲ）皆正常的ＮＩＤＤＭ患者及１０例年龄、性别匹配的对照组的２４小时动态血压和ＵＡＥＲ变化。发现ＮＩＤＤＭ者夜间血压、２４小时血压和最小心率明显增加。６５％的患者血压昼夜节律消失，而对照组仅为３０％。８２％的ＮＩＤＤＭ伴有自主神经功能异常而对照组无一例。同时发现ＮＩＣＤＤＭ的ＵＡＥＲ高于对照组，但ＵＡＥＲ与动态血压间无明显相关。本研究认为血压和ＵＡＥＲ皆正常的Ｎ     

血压偏高儿童糖耐量试验胰岛素测定

研究血压偏高儿童的血糖及胰岛素改变情况。对血压偏高儿童和对照者各５０例进行葡萄糖耐量试验，测定ＳＧ，ＩＳ浓度。血压偏高组空腹ＳＧ，ＩＳ和ＯＧＴＴ反应曲线下面积及反应曲线下面积ＩＳ与ＧＳ比值显著增高；血压偏高级肥胖儿ＯＧＴＴ及ＳＧ ＡＵＣ，空腹ＩＳ及ＯＧＴＴ、ＩＳ ＡＵＣ及ＡＵＣ ＩＳ／ＳＧ显著高于高血压非肥胖者。     

NIDDM患者244、时血压、尿白蛋白排泄率的早期改变

观察１７例血压和尿白蛋白排泄率（ＵＡＥＲ）皆正常的ＮＩＤＤＭ患者及１０例年龄、性别匹配的对照组的２４小时动态血压和ＵＡＥＲ变化。发现ＮＩＤＤＭ者夜间血压、２４小时血压和最小心率明显增加，６５％的患者血压昼夜节律消失，而对照组仅为３０％。８２％的ＮＩＤＤＭ伴有自主神经功能异常而对照组无一例。同时发现ＮＩＤＤＭ的ＵＡＥＲ高于对照组，但ＵＡＥＲ与动态血压间无明显相关。本研究认为血压和ＵＡＥＲ皆正常的ＮＩＤＤＭ者已有夜间血压、心率的增加，这可能与自主神经功能异常有关。     

正常血压Ⅱ型糖尿病患者尿微量白蛋白多因素分析

应用多因素逐步回归的分析方法对７０例正常血压Ⅱ型糖尿病患者有关微量尿白蛋白排泄率（ＵＡＥＲ）的危险因素，包括年龄、体重指数（ＢＭＩ）、病程、收缩压、舒张压、空腹血糖（ＦＢＧ）、糖化血红蛋白（ＨｂＡ１ｃ）、红细胞山梨醇（ＲＢＣＳ）、血脂、血浆纤维蛋白原（Ｆｇ）、血浆镁、心血管交感神经活性（ＳＡ）和副交感神经活性（ＰＡ）等作了探讨。结果显示：糖尿病患者尿ＵＡＥＲ水平明显增高；多因素分析表明，在上述１７     

血压正常的Ⅱ型糖尿病患者尿白蛋白排泄率与胰岛素抵抗的关系

目的 了解血压正常的Ⅱ型糖尿病患者尿白蛋白排泄率（ＵＡＥＲ）与胰岛素抵抗的关系。方法 对血压正常的３１例Ⅱ型糖尿闰中并微量白蛋白尿（ＭＡＵ）患者与３２例未合并ＭＡＵ患者的血糖，胰岛素、胰岛素敏感性指数（ＩＳＩ）进行比较分析，并对所有患者的ＵＡＥＲ与有关因素进行多因素逐步回归分析。结果 Ⅱ型糖尿病合并ＭＡＵ时ＩＳＩ显著降低，而且ＩＳＩ与ＵＡＥＲ呈独立的相关性「偏回归系数（β）＝－０．３９，Ｐ〈０．０     

血压对NIDDM患者尿白蛋白排泄的影响

本文对１６４例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者２４ｈ尿白蛋白排泄（２４ｈＵＡＥ）进行检测，结果显示：（１）在病程＜１０年的患者中，伴或不伴高血压者，２４ｈＵＡＥ无显著差异，但伴高血压者，微量白蛋白尿的发生率明显高于不伴高血压者，分别为３６．９％（１／１９）和７．９％（６／７６）；（２）在病程１０－２０年的患者中，伴高血压者，２４ｈＵＡＥ、微量及大量白蛋白尿的发生率均明显高于不伴高血压者；（３     

Metabolic risk factors and markers of cardiovascular and renal damage in overweight subjects

BACKGROUND: The prevalence of overweight and obesity in the United States has dramatically increased. Obesity clusters with a variety of hemodynamic and metabolic disturbances that increase the risk of cardiovascular disease. In this study we evaluated whether overweight subjects with hypertension also manifest hemodynamic and metabolic abnormalities compared with individuals of normal weight. METHODS: In a cohort of 129 patients with essential hypertension we measured the relationship between body mass index (BMI), blood pressure (BP), insulin sensitivity, lipid profile, and markers of organ damage including thickness of the carotid artery (IMT) and urine albumin excretion (UAE). A total of 41 normotensive, age-matched, healthy individuals served as control subjects. RESULTS: Hypertensive individuals showed higher levels of serum triglycerides, insulin area-under-the-curve (AUC), UAE, and greater IMT than normotensive subjects. Overweight hypertensive subjects showed higher levels of serum triglycerides, LDL cholesterol, glucose AUC, insulin AUC, UAE, and IMT than hypertensive subjects with normal body weight (BMI <25). Night-time systolic BP was higher and night-time fall in BP was lower among overweight than among normal-weight hypertensive patients. Simple regression analysis showed that BMI was correlated with age, UAE, BP, insulin and glucose AUC, serum triglycerides, cholesterol, and IMT in hypertensive subjects. However multiple regression analyses showed that BMI significantly correlated only with UAE. CONCLUSIONS: The study results show that increased body weight clusters with a variety of hemodynamic and metabolic abnormalities in hypertensive subjects. However multiple regression analyses showed a significant correlation only between BMI and UAE, a marker and predictor of cardiovascular and renal disease.     

中心性肥胖的糖耐量低减患者的临床特点分析

目的探讨中心性肥胖的糖耐量低减（IGT）患者的临床特点及防治策略。方法将IGT患者69例分为中心性肥胖组（试验组）31例，非中心性肥胖组（对照组）38例，比较其体重指数、收缩压和脉压、血脂异常和心血管病发病率、饮食和运动习惯等的差异。结果合并中心性肥胖的IGT患者超重和肥胖率、非HDL-C性高脂血症的发生率、饮食和运动习惯的良好率与对照组相比差异有显著性。收缩压和脉压、心血管病的发生率与对照组相比差异无显著性。结论合并中心性肥胖的IGT患者肥胖、高脂血症的发病率更高，胰岛素抵抗更严重，应从饮食和运动习惯人手积极干预，预防糖尿病及其血管病变的发生。     

高血糖是高血压的独立危险因素？

作者分析糖耐量低减者（ＩＧＴ）２５０例及正常糖耐量者（ＮＧＴ）１７５例的资料。ＩＧＴ者中高血压所占比例明显高于ＮＧＴ者（分别为３０．１４％、１３．１７％，Ｐ＜０．００１）；Ｐｅｒｓｏｎ相关分析中，收缩压、舒张压、平均血压均与体重指数，空腹及服糖后２小时血糖和胰岛素呈显著正相关；应用多因素回归分析，在调整年龄、性别、体重指数、血浆总胆固醇、空腹胰岛素等因素后，收缩压、舒张压、平均血压仍与服糖后２小时血糖呈独立正相关。提示高血糖可能为高血压的独立危险因素。     

Significance of beta2-adrenergic receptor gene polymorphism in obesity and type 2 diabetes mellitus in Korean subjects

Catecholamines play a central role in the regulation of energy expenditure, in part stimulating lipid mobilization through lipolysis in fat cells. The beta(2)-adrenergic receptor (ADRB2) is a major lipolytic receptor in human fat cells, and a recent study has shown that common polymorphisms occurring in codons 16 and 27 of the ADRB2 gene are significantly associated with obesity and lipolytic ADRB2 function in adipose tissue. We investigated whether previously described human ADRB2 gene polymorphisms are associated with obesity and diabetes in Korean subjects. According to the World Health Organization (WHO) criteria for oral glucose tolerance testing, 57 subjects had normal glucose tolerance (NGT), 32 had impaired glucose tolerance (IGT), and 106 had diabetes mellitus. The nondiabetic group (including NGT and IGT) consisted of 46 obese (defined as those with body mass index [BMI] of >or= 27 kg/m(2)) and 43 nonobese subjects (BMI < 27 kg/m(2)). The subjects with diabetes consisted of 62 obese and 44 nonobese subjects. There was no significant difference between nonobese and obese subjects in the allele frequency of ADRB2 gene polymorphisms at codons 16 and 27. There were no significant differences in BMI, percentage body fat, waist-to-hip ratio (WHR), systolic blood pressure, diastolic blood pressure and concentrations of fasting plasma glucose, fasting serum insulin, serum low-density lipoprotein (LDL)-cholesterol, serum high-density lipoprotein (HDL)-cholesterol, serum triglyceride, and serum free fatty acids, according to ADRB2 gene polymorphisms at codons 16 and 27. The frequency of the Glu27 homozygote was 1.1%. These findings suggest that genetic variability in the ADRB2 gene may not be a major determinant for the development of obesity and diabetes in Koreans.     

糖尿病前期尿白蛋白排泄率和微量白蛋白尿患病率的比较

目的　比较糖耐量正常 (NGT)、单纯空腹血糖受损 (I IFG)、单纯糖耐量低减 (I IGT)、糖耐量低减合并空腹血糖受损 (IGT/IFG)、新诊断的 2型糖尿病 (2型DM ) 5种不同糖代谢状态的尿白蛋白排泄率 (UAE)和微量白蛋白尿 (MAU )患病率。方法　根据 75g口服葡萄糖耐量试验 (75gOGTT)结果 ,将 2 93 4例受试者分为 :NGT组 13 3 2例、I IFG组 186例、I IGT组 470例、IGT/IFG组 2 3 6例、新诊断的 2型DM组 710例。用放射免疫法测定过夜 12h尿白蛋白。UAE在 2 0～ 2 0 0μg/min之间定义为MAU。 结果　 (1)UAE水平 [中位数 (四分位数 ) ] ,在新诊断的 2型DM组为8 50 (4 89～ 15 95) μg/min、IGT/IFG组为 6 93 (4 85～ 10 89) μg/min、I IGT组为 6 51(4 0 9～10 74) μg/min ,均高于I IFG组的 5 56(3 70～ 9 2 3 ) μg/min(P值均 <0 0 1) ;I IFG组与NGT组的 5 2 6(3 50～ 8 12 ) μg/min比较差异无显著性 (P >0 0 5) ;MAU的患病率在新诊断的 2型DM组为 2 0 7%、IGT/IFG组为 13 1%、I IGT组为 11 7%、I IFG组为 5 8%、NGT组为 5 6% ,同样呈现上述变化规律。(2 )多元逐步回归分析显示 :UAE与OGTT 2h血糖、舒张压、体重指数呈现独立正相关。logistic回归分析显示 ,导致MAU危险性增加的因素有OGTT 2h血糖、舒张     

2型糖尿病相关因素与sICAM-1关系的探讨

为探讨2型糖尿病(DM)患者可溶性细胞间粘附分子(sICAM—1)水平变化及其与血糖代谢控制、胰岛素抵抗(IR)、血压(BP)、体重指数(BMI)的关系，采用酶联免疫吸附法测定51例2型DM患者及20例查体健康者的血清sICAM—1水平，同时检测其空腹胰岛素(FIN)、糖化血红蛋白(GHbAlc)、空腹血糖(FPG)、Bp、BMI。结果显示，2型DM患者血清sICAM—1显著高于正常对照组(P＜0．01)，且血清sICAM—1与BMI、GHbAlc及收缩压呈正相关，相关系数r分别为0．441、0．435、0．311，P＜0．01、0．01、0．05。提示2型DM血清sICAM—1水平升高可能由肥胖和高血糖引起，控制血糖、减轻体重有助于降低sICAM—1。     

Serum adiponectin in women with polycystic ovarian syndrome and its relation to clinical, metabolic and endocrine parameters

Several studies have demonstrated that low levels of serum adiponectin are present in obesity, insulin resistance, hypertension and hyperlipidemias. The aim of our study was to determine whether serum adiponectin level is different between patients with polycystic ovarian syndrome (PCOS) and control subjects. We also investigated relationships between various cardiovascular risk factors, levels of serum adiponectin and other hormones, such as androstendione, testosterone, estradiol, DHEAS, sex hormone binding globulin (SHBG), and leptin. We also analysed the correlation between serum adiponectin and free androgen index. Ninety-one women with clinical diagnosed PCOS and 53 healthy control subjects, carefully matched by body mass index (BMI) and age, were enrolled in the study. The fasting blood samples were obtained and all participants underwent an oral 75 g glucose tolerance test. The prevalences of impaired glucose tolerance (IGT), hypertension and hypertriglyceridemia were higher in the PCOS group. PCOS women had increased androgen concentrations and higher free androgen index and decreased level of serum SHBG. Lower serum adiponectin concentrations were observed among cases than in controls (median 13.7 microg/ml vs 17.8 microg/ml, p<0.001) despite being matched by BMI. In the PCOS group adiponectin levels correlated significantly with: BMI (r=-0.32, p=0.002), waist circumference (r=-0.32, p=0.003), waist-to-hip ratio (WHR, r=-0.38, p=0.001), triglycerides (r=-0.31, p=0.007), SHBG (r=0.30, p=0.003) and free androgen index (r=-0.29, p=0.02). In contrast, the adiponectin level does not appear to be related to total testosterone, DHEAS and leptin levels. The adiponectin and SHBG levels were found to be decreased in PCOS women with IGT compared to PCOS women with normal glucose tolerance, but after adjustment by BMI or WHR, the differences were no longer statistically significant. To exclude a possible confounding effect due to a higher prevalence of IGT in the PCOS group, this comparison was repeated for the subgroup of 58 PCOS women and 48 control women after excluding those with IGT. Neither adiponectin nor SHBG were significantly different between those subgroups. Multiple regression analysis revealed that serum adiponectin concentrations were best predicted by WHR, free androgen index and presence of IGT when all patients were considered. In PCOS subjects, the only independent predictor of adiponectin concentrations was glucose tolerance status. CONCLUSIONS: Lower adiponectin levels were observed in PCOS group than in control women, and these differences were probably due to higher prevalence of IGT in these cases.     

Plasma visfatin levels in patients with newly diagnosed and untreated type 2 diabetes mellitus and impaired glucose tolerance

Visfatin, a new adipokine, facilitates adipogenesis and has insulin-mimetic properties. We aimed to investigate the plasma visfatin levels in patients with newly diagnosed and untreated type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT), who had no obesity or hypertension. Twenty-two patients with T2DM, 18 subjects with IGT and 40 healthy controls were enrolled. Visfatin levels were measured along with the BMI, blood pressure, lipids, glucose, insulin, adiponectin and hsCRP levels, and HOMA-IR indexes. Age, sex and BMI were similar in all groups. Visfatin levels were higher in the diabetic group than the controls (p=0.01). There was no significant difference in the visfatin levels between the T2DM and IGT groups as well as IGT group and healthy controls. Plasma visfatin concentrations did not differ between men and women. Visfatin levels did not correlate with BMI, blood pressure, plasma adiponectin, insulin, hsCRP, glucose and lipid levels or HOMA-IR indexes in the three groups. These results indicate that hyperglycemia causes an increase in plasma visfatin levels and, as in people with T2DM but not with IGT, this increase gets more prominent as the glucose intolerance worsens.     

Role of Insulin in the Pathogenesis of Hypertension Associated with Glucose Intolerance

The role of insulin in the pathogenesis of hypertension was explored in normal men and male patients with impaired glucose-tolerance. They were classified as normal (n = 94), borderline (n=164), impaired tolerance (IGT, n = 104), or diabetes mellitus (n = 100) according to their response to an oral 75g glucose challenge. Besides routine laboratory examinations, fasting immunore-active insulin and post-glucose insulin levels at 30 minutes were measured.

Patients with impaired glucose tolerance were older and more obese than the normal subjects. Serum cholesterol and triglyceride concentrations increased with severity of the glucose tolerance impairment. However, renal function, as estimated by blood urea nitrogen levels did. not differ among these four groups. Multiple regression analysis revealed that blood pressure correlates significantly with the obesity index, blood glucose, serum cholesterol and serum in sulin in all four groups. Among these groups, the partial Fratios for the obesity index were the greatest i n both normal and diabetic groups, but i n both borderline and IGT groups those for insulin were the greatest. These results indicate that in patients with impaired glucose tolerance is hypertension associated more closely with hyperinsulinemia than it is in normal subjects or diabetic patients.     

High plasma insulin and triglyceride concentrations and blood pressure in offspring of people with impaired glucose tolerance

The plasma glucose and insulin response to an oral glucose challenge, fasting plasma lipid concentration, and blood pressure were compared in 13 offspring of parents previously diagnosed as having impaired glucose tolerance (IGT) and 13 offspring of parents previously shown to have normal glucose tolerance. The parents with IGT had higher plasma glucose, insulin and triglyceride concentration, and blood pressure than parents with normal glucose tolerance. The two groups of offspring were young and non-obese, and similar in terms of age, gender distribution, and body mass index. However, the total integrated plasma insulin response during a 75 g oral glucose tolerance test was significantly higher (p less than 0.05, Student's t-test) in offspring of parents with IGT (718 +/- 71 pmol l-1 h) than in the subjects whose parents had normal glucose tolerance (524 +/- 47 pmol l-1 h). In addition, serum triglyceride concentration was somewhat higher in offspring of parents with IGT (1.17 +/- 0.11 vs 0.92 +/- 0.08 mmol l-1, 0.10 greater than p greater than 0.05), as were both systolic (132 +/- 5 vs 118 +/- 3 mmHg, p less than 0.05) and diastolic (79 +/- 3 vs 70 +/- 2 mmHg, p less than 0.05) blood pressure. Demonstration of similar abnormalities in plasma insulin response to glucose and blood pressure regulation in patients with IGT and in their offspring is consistent with the view that these changes have a genetic component.