Insulin Resistance and Hypertension

The insulin sensitivity in hypertensive patients with normal glucose tolerance (NGT),impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM) and the insulin resistance (IR) under the disorder or grucose metabolism and hypertension were studied.by glucose tolerance test and insulin release test,insulin sensitivity index (ISI) and the ratio of area under glucose tolerance curve (AUCG) to area under insulin release curve (AUC1) were calculated and analyzed.The results showed that ISI was decreased to varying degrees in the patients with hypertension,the mildest in the group of NGT with hypertension,followed by the group of IGT without hypertension,the group of IGT with hypertension and DM(P=0).There was very significant difference in the ratio of AUCG/AUC1 between the hypertensive patients with NGT and controls (P=0).It was concluded that a significant IR existed during the development of IGT both in hypertension and nonhypertension.The increase of total insulin secretion (AUC1) was associated with nonhypertension simultaneously.IR of the hypertensive patients even existed in NGT and was worsened with the deterioration of glucose metabolism disorder,but the AUC1 in the HT group changed slightly.A relative deficiency of insulin secretion of dysfunction of β-cell of islet existed in IGT and DM of the hypertensive patients.     

胰岛素信号转导与胰岛素抵抗

胰岛素通过与其受体结合可在不同组织细胞内激活不同的信号途径而产生不同的作用，因而信号转导的不同环节出现异常均可能导致胰岛素抵抗。近年来，胰岛素受体、胰岛素底物系列及磷脂酰肌醇-3-激酶等已成为在分子水平上研究胰岛素抵抗的热点。本文就这几方面文献报道作一综述。     

胰岛素抵抗模型建立及其应用研究

目的 探讨胰岛素抵抗模型的建立方法和二苯乙烯对血糖的调节作用。方法 1.给予Wistar大鼠自制脂肪乳建立胰岛素抵抗动物模型。2. 给予HepG2 细胞胰岛素,建立胰岛素抵抗(HepG2/IR)细胞模型。3.分别给予模型大鼠和HepG2/IR细胞二苯乙烯,观察二苯乙烯对血糖的调节作用。结果 给予脂肪乳后,大鼠的血糖和TG、TC、LDL、HDL分别升高了72.87%和16.21%、139.93%、56..93%、18.32%,与建模前比,差异具有显著性意义（P<0.01）;给予二苯乙烯, 模型组动物血糖和血脂水平比给药前明显降低（P<0.05～0.01）;HepG2/IR葡萄糖消耗量比对照组(HepG2)明显增加。结论 给予Wistar大鼠自制脂肪乳或给予HepG2 细胞胰岛素,可建立胰岛素抵抗模型;二苯乙烯具有降低模型动物血糖和血脂、增加HepG2/IR葡萄糖消耗量的作用。     

Insulin resistance and coronary artery disease

A large body of clinical evidence supports aggressive cardiovascular risk management in combination with glycaemic control in patients with type 2 diabetes and insulin resistance. Glycaemic management in a patient with HbA1c that is at or near goal should include an assessment of postprandial glycaemia. Insulin sensitisers have glycaemic and non-glycaemic benefits and warrant consideration even if the HbA1c is not significantly elevated. Oral agents should always be combined with lifestyle modification, including regular exercise and attention to both individual food choices and overall calorie intake to further optimise glycaemic control. For cardiovascular risk reduction, LDL cholesterol as well as HDL cholesterol and triglycerides should be treated appropriately through lifestyle changes. Often pharmacotherapy with at least one lipid-lowering agent is required. Blood pressure control often requires the use of 3 or more antihypertensive agents in patients with diabetes. Clinical data support use of an ACE-inhibitor as first-line therapy for the prevention of micro-albuminuria in patients with diabetes and hypertension. Urine should be tested for micro-albumin at least annually. Low-dose (81 mg) aspirin is appropriate for patients over age 45 years for primary prevention of coronary heart disease. Multifactorial intervention has been shown in large studies such as the Diabetes Prevention Programme and Steno-2 to have significant cardiovascular benefit among patients at risk of developing diabetes and those with type 2 diabetes and micro-albuminuria. Evidence-based treatments and therapeutic goals can build a practical framework for comprehensive outpatient management of patients with type 2 diabetes and insulin resistance. Data from important ongoing studies will continue to shape this framework in the years ahead.     

胰岛素抵抗与冠心病关系的病例对照研究

目的　探讨胰岛素抵抗及其他危险因素与冠心病发病的关系 .方法　选择住院确诊的冠心病患者 84例为病例组 ,排除冠心病的住院患者或健康体检者 16 3例为对照组 ,对冠心病常见危险因素进行调查 ,检测空腹血糖、胰岛素水平、血脂、脂蛋白 (a)等相关指标 ,用单因素和多因素分析计算危险因素的优势比 (OR)及 OR 95 %可信限 (95 % CI) ,比较胰岛素水平和胰岛素敏感性等指标 .结果　病例组的空腹胰岛素水平显著高于对照组 ,胰岛素敏感性指数显著低于对照组 (P<0 .0 5 ) ;其他危险因素的单因素分析显示 ,吸烟、高血压病史、高脂饮食习惯、冠心病家族史 ,脂蛋白 (a)水平升高是冠心病的危险因素 ,其 OR分别为 2 .49,2 .5 5 ,3.2 3,2 .5 1和3.76 ,高密度脂蛋白水平是冠心病的保护因素 ,OR值为 0 .2 1;多因素分析结果显示 ,被筛选进入 L ogistic回归方程的变量分别为高密度脂蛋白、脂蛋白 (a)、胆固醇水平和每日吸烟量 .结论　空腹胰岛素水平显著升高和 (或 )胰岛素敏感性降低与冠心病的发病有病因学联系 (P<0 .0 5 ) ,吸烟、高血压病史、高脂饮食习惯、冠心病家族史、脂蛋白 (a)水平升高是冠心病的危险因素 ,高密度脂蛋白水平是冠心病的保护因素 .     

Insulin resistance and risk of congestive heart failure

Context  Diabetes and obesity are established risk factors for congestive heart failure (CHF) and are both associated with insulin resistance. Objective  To explore if insulin resistance may predict CHF and may provide the link between obesity and CHF. Design, Setting, and Participants  The Uppsala Longitudinal Study of Adult Men, a prospective, community-based, observational cohort in Uppsala, Sweden. We investigated 1187 elderly (70 years) men free from CHF and valvular disease at baseline between 1990 and 1995, with follow-up until the end of 2002. Variables reflecting insulin sensitivity (including euglycemic insulin clamp glucose disposal rate) and obesity were analyzed together with established risk factors (prior myocardial infarction, hypertension, diabetes, electrocardiographic left ventricular hypertrophy, smoking, and serum cholesterol level) as predictors of subsequent incidence of CHF, using Cox proportional hazards analyses. Main Outcome Measure  First hospitalization for heart failure. Results  One hundred four men developed CHF during a median follow-up of 8.9 (range, 0.01-11.4) years. In multivariable Cox proportional hazards models adjusted for established risk factors for CHF, increased risk of CHF was associated with a 1-SD increase in the 2-hour glucose value of an oral glucose tolerance test (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.08-1.93), fasting serum proinsulin level (HR, 1.29; 95% CI, 1.02-1.64), body mass index (HR, 1.35; 95% CI, 1.11-1.65), and waist circumference (HR, 1.36; 95% CI, 1.10-1.69), whereas a 1-SD increase in clamp glucose disposal rate decreased the risk (HR, 0.66; 95% CI, 0.51-0.86). When adding clamp glucose disposal rate to these models as a covariate, the obesity variables were no longer significant predictors of subsequent CHF. Conclusions  Insulin resistance predicted CHF incidence independently of established risk factors including diabetes in our large community-based sample of elderly men. The previously described association between obesity and subsequent CHF may be mediated largely by insulin resistance.      

自发酮症倾向糖尿病患者胰岛素抵抗

目的观察以酮症或酮症酸中毒起病的糖尿病患者胰岛素抵抗的特点。方法以25例2型非酮症糖尿病患者为对照,对21例以酮症或酮症酸中毒起病的糖尿病患者的胰岛素抵抗情况进行观察。结果治疗前酮症组HOMA-IR较非酮症组低（P〈0.05）。治疗后两组HOMA-IR无统计学差异,酮症组△HOMA-IR小于非酮症组（P〈0.05）。结论以酮症为首发症状、自身抗体阴性的糖尿病患者较典型2型糖尿病患者胰岛素抵抗程度轻。在治疗后,胰岛素敏感性可部分恢复但幅度较典型2型糖尿病患者小。     

非糖尿病腹膜透析患者胰岛素抵抗及脂代谢紊乱相关分析

 目的 观测非糖尿病腹膜透析患者胰岛素抵抗和脂代谢紊乱发生情况及分析其相关影响因素。方法 入选非糖尿病透析龄大于3个月规律连续不卧床腹膜透析（CAPD）患者48人，在相同条件下测定其身高、体重、体重指数（BMI），空腹血糖、空腹胰岛素及血脂等生化指标，以生物素-亲和素酶联免疫吸附法（ABC-ELISA）测定脂联素、瘦素、抵抗素等脂质因子。结果 非糖尿病腹透患者48人（男20，女28）稳态胰岛素抵抗指数（HOMA-IR）为6.32±8.97，其中4位患者在透析过程中发展为糖尿病。根据IR中位数2.59分组，IR≥2.59组（n＝24）与﹤2.59组（n＝24）两组比较发现在BMI、三酰甘油、铁蛋白和脂联素、瘦素存在显著差异（P<0.05）。相关分析结果表明IR与铁蛋白（P<0.01）、血脂（胆固醇、三酰甘油）分别成正相关（P<0.05）。结论 非糖尿病腹透患