肥胖的非糖尿病患者胰岛素抵抗与促甲状腺激素水平的关系

目的 评估肥胖的非糖尿病患者胰岛素抵抗(IR)与促甲状腺激素(TSH)水平之间的关系。方法 选择2016年8月～2018年5月在扶风县人民医院内分泌科门诊接受治疗的肥胖的非糖尿病患者110例作为研究对象。收集所有患者的临床资料、实验室检查结果和甲状腺形态功能性评估结果。采用多元线性回归分析计算TSH水平与胰岛素抵抗指数(HOMA-IR)的关系。结果 在整个队列中，TSH水平与HOMA-IR(r=0.24，P=0.028)、血清胰岛素(r=0.23，P=0.037)和甘油三酯水平(r= 0.30，P=0.006)均呈正相关，而与血清高密度脂蛋白胆固醇(HDL-C)水平呈负相关(r=-0.25，P=0.002)。HOMA-IR与甘油三酯(r=0.25，P=0.026)、ALT(r=0.37，P=0.001)和γ谷氨酰转肽酶(r=0.32，P=0.003)水平均呈正相关。多元线性回归分析结果显示，TSH(β=0.620，95%CI0.482～0.758，P=0.015)、BMI(β=0.147，95%CI0.111～0.184，P=0.034)均与HOMA-IR显著相关。结论 TSH与肥胖的非糖尿病患者出现胰岛素抵抗相关，表明甲状腺功能筛查对肥胖患者较为重要。     

Roles of insulin resistance and beta cell dysfunction in macrosomia among Chinese women with gestational diabetes mellitus

Aims

The aim was to examine associations of insulin resistance and beta cell dysfunction with macrosomia in Chinese women with gestational diabetes mellitus (GDM).

Loss of beta cell function as fasting glucose increases in the non-diabetic range

Aims/hypothesis Our aim was to define the level of glycaemia at which pancreatic insulin secretion, particularly first-phase insulin release, begins to decline.Methods Plasma glucose and insulin concentrations were measured during an IVGTT in 553 men with non-diabetic fasting plasma glucose concentrations. In 466 of the men C-peptide was also estimated. IVGTT insulin secretion in first and late phases was assessed by: (i) the circulating insulin response; (ii) population parameter deconvolution analysis of plasma C-peptide concentrations; and (iii) a combined model utilising both insulin and C-peptide concentrations. Measurements of insulin sensitivity and elimination were also derived by modelling analysis.Results As fasting plasma glucose (FPG) increased, IVGTT first-phase insulin secretion declined by 73%, 71% and 68% for the three methods respectively. The FPG values at which this decline began, determined by change point regression, were 4.97, 5.16 and 5.42 mmol/l respectively. The sensitivity of late-phase insulin secretion to glucose declined at FPG concentrations above 6.0 mmol/l. Insulin elimination, but not insulin sensitivity, varied with FPG.Conclusions/interpretation The range of FPG over which progressive loss of the first-phase response begins may be as low as 5.0 to 5.4 mmol/l, with late-phase insulin responses declining at FPG concentrations above 6.0 mmol/l.Abbreviations f fractional hepatic insulin throughput - FPG fasting plasma glucose - FSD fractional standard deviation - k_c the plasma C-peptide elimination constant - k_i the plasma insulin elimination constant - MFG mean fasting glucose - SG minimal model glucose effectiveness - SI minimal model insulin sensitivity In the course of this work, our colleague and co-author James Jeffs died unexpectedly after a short illness. His contribution will be greatly missed.     

血清瘦素水平与胰岛素原、真胰岛素及胰岛素敏感性的关系

目的　研究中国人群空腹瘦素水平与真胰岛素 (TI)、胰岛素原 (PI)、PI/TI比值及胰岛素敏感性之间的关系。方法　 90 2例非糖尿病者均系 2 0 0 0年接受糖尿病流行病学调查者。测定空腹瘦素、TI和PI浓度以及空腹及餐后 2h血糖。瘦素、TI及PI检测采用本室建立的特异的酶联免疫分析法 (ELISA)。胰岛素敏感性以HOMA胰岛素抵抗指数 (HOMA IR)评价。结果　血清瘦素水平女性高于男性。相关分析显示血清瘦素水平与空腹TI、PI及HOMA IR显著正相关 (男性 792例 ,r分别为0 345、0 2 36和 0 364 ;女性 1 1 0例 ,r分别为 0 574、0 375和 0 576 ,P <0 0 0 1 ) ,但与空腹血糖仅在男性呈弱相关 (r=0 1 5 ,P =0 0 1 5) ,与空腹PI/TI比值不相关。在调整年龄、体重指数 (BMI)和腰臀围比(WHR)后 ,尽管相关性减弱 ,瘦素水平仍然与TI、PI以及HOMA IR显著相关。结论　本组的血清瘦素浓度与TI、PI以及胰岛素抵抗显著正相关 ,且在一定程度上独立于肥胖和脂肪分布。瘦素水平高或瘦素抵抗的个体可能存在高胰岛素血症和胰岛素抵抗 ,提示其瘦素 胰岛素轴的调节异常。本研究未发现瘦素水平与空腹PI/TI比值的相关 ,提示瘦素可能与这一反映胰岛 β细胞的功能异常的标志无关。本研究揭示的高瘦素 高胰岛素血症或胰岛素抵抗之间的     

脑卒中患者急性期动态脉压和脉压指数与近期预后的关系

目的　探讨脑卒中患者急性期动态脉压 (PP)和脉压指数 (PPI)的变化及与近期预后的关系。方法　利用动态血压监测 (ABPM )手段 ,测定 76例脑卒中患者急性期 2 4hABPM变化 ,与 45例健康人ABPM值做对比 ,并在患者入院第 1 5天做神经功能缺损程度评分。结果　脑卒中患者急性期 2 4h平均PP(2 4hPP)、2 4h平均PPI(2 4hPPI)均高于对照组 (P <0 0 5)。其中 ,重度神经功能缺损者 2 4hPP、2 4hPPI均高于轻度和中度患者 (P <0 0 5)。中度患者 2 4hPPI高于轻度患者 (P <0 0 5) ,2 4hPP差异无显著 (P >0 0 5)。 2 4hPP与神经功能缺损评分间呈弱的正相关(P <0 0 5) ,2 4hPPI与评分间呈强的正相关 (P <0 0 1 )。结论　脑卒中患者急性期PP和PPI发生异常 ,并对预后的判断有一定的指导意义。     

高血压病血压动态变化与胰岛素变化相关性的研究

目的 调查高血压病血压动态变化与胰岛素变化的相关关系.方法 对30例Ⅰ、Ⅱ期高血压(EH)患者,排除饮食因素对血清胰岛素浓度的影响,在24小时动态血压监测(ABPM)的同时,进行血清胰岛素浓度动态变化监测,每隔4小时观测一次血清胰岛素浓度,证明所测24小时血清胰岛素浓度值存在动态变化(P<0.001).同时对每名患者所测得的各胰岛素浓度值分别与其动态血压进行秩相关分析.结果 所测各点血清胰岛素浓度分别与收缩压、舒张压的均值呈正相关关系(0.429相似文献   

Differences in insulin sensitivity, pancreatic beta cell function and circulating adiponectin across glucose tolerance status in Thai obese and non-obese women

Although adiponectin levels are associated with obesity and insulin insensitivity, the role of adiponectin in the progression to diabetes in non-obese subjects is unclear. Therefore, 289 women aged 50–80 years without previous history of diabetes or impaired glucose tolerance (IGT) were studied. They were classified as normal glucose tolerance (NGT), IGT or diabetes based on WHO criteria. Insulin sensitivity (S) and beta cell function (B) indices were calculated using homeostasis model assessment (HOMA). In obese women with BMI ≥ 25 kg/m² (n = 161), there were declines in HOMA-%S (P < 0.001), HOMA-%B (P < 0.05) and circulating adiponectin (P < 0.001) across glucose tolerance status. In non-obese women with BMI < 25 kg/m² (n = 128), there was no significant change in HOMA-%S in women with IGT and diabetes as compared to women with NGT. However, HOMA-%B (P < 0.05) and serum adiponectin levels (P < 0.001) were significantly decreased across glucose tolerance. Serum adiponectin levels were correlated to HOMA-%S in both obese and non-obese women while negative correlations between circulating adiponectin and HOMA-%B were demonstrated only in obese women. We have demonstrated in the present study the predominant role of beta cell dysfunction as compared to that of insulin resistance in the deterioration of glucose tolerance in non-obese women. Circulating adiponectin appears to be inversely related to beta cell dysfunction in addition to insulin resistance only in obese women.     

高血压患者脉压和脉压指数与血管内皮功能的关系

目的研究原发性高血压(EH)患者的脉压(PP)和脉压指数(PPI)与血管内皮功能的相互关系,探讨EH患者PP增大和PPI增高导致靶器官损害的机制。方法对108例EH患者进行24h动态血压监测。按动态脉压(APP)<40mmHg、40~60mmHg和>60mmHg三组;按PPI<0.35、0.35~0.45和>0.45三组进行分析。结果(1)各亚组年龄、内皮素-1(ET-1)、一氧化氮(NO)、ET-1/NO和假性血管性血友病因子(VWF)差异有显著性,随着24hAPP和PPI的增加,年龄、ET-1、ET-1/NO和VWF也增加(P<0.01或P<0.05),而NO减少(P<0.05)。(2)多元逐步回归分析显示在排除众多因素后,24h APP或PPI与ET-1和VWF呈正相关(P均<0.01),与NO呈负相关(P<0.01)。(3)在与血管内皮功能的相关性方面,PPI与PP具有很好的一致性,但PPI相关性更好(r值更接近于1)。结论PP升高和PPI增大导致血管内皮功能受损。     

高血压病患者脉压与细胞内胞浆游离钙、左心功能的关系

目的　研究高血压患者脉压与细胞内钙 ,左心功能的关系。方法　对 5 8例高血压患者分别应用动态血压检测仪检测 2 4h动态血压及Fura 2荧光光谱法测定淋巴细胞内胞浆游离钙浓度 ,超声心动图测量左室收缩 ,舒张功能。根据脉压将病人分为两组 :①脉压大组 (n =32 ) ,平均脉压6 5mmHg ;②脉压小组 (n =2 6 ) ,平均脉压≤ 6 5mmHg。结果　脉压与细胞内胞浆游离钙浓度呈正相关 (P <0 0 0 1)。与EF斜率及E/A比值呈明显负相关 (P <0 0 5及P <0 0 1) ,与收缩功能指标 (EF % )无相关关系。结论　高血压患者脉压大者 ,细胞内钙浓度增高 ,对心脏的损害亦更明显     

Association between serum transaminase levels and insulin resistance in euthyroid and non-diabetic adults

AimTo evaluate the association between elevated serum transaminase levels and insulin resistance (IR) in a population of healthy individuals.MethodsWe define IR with a cut-off point of homeostatic model assessment (HOMA-IR) ≥ 3.8. For aspartate aminotransferase (AST), we consider elevated values >30 U/L in women and values >36 U/L in men. For alanine aminotransferase (ALT), we consider elevated values >30 U/L in women and values >40 U/L in men. We performed a crude and adjusted generalized linear model from Poisson family with robust variance, in order to evaluate the association between elevated serum transaminase levels and IR. The associations were presented as prevalence ratio (PR) with their respective 95% confidence intervals (95% CI).ResultsWe included 261 participants in the study. The median age was 39 years (31–45) and 23.7% of the participants were men. The prevalence of elevated serum transaminase for AST and ALT were, 13.8% and 26.1%, respectively. The prevalence of IR was 34.1%. In the crude analysis we found statistical significance between elevated AST and ALT with IR (PR = 3.18; 95% CI: 2.33–4.34 and PR = 2.44; 95% CI: 1.88–3.30; respectively). However, in the multivariate analysis, the association only remained statistically significance with ALT, but lost its significance with AST, PR = 1.90; CI 95%: 1.31–2.77 and a PR = 1.23; CI 95%: 0.93–1.61; respectively.ConclusionElevated serum levels of ALT were associated with insulin resistance. ALT could be used in clinical practice as an additional tool to assess IR in apparently healthy people.     

脂联素与炎症及胰岛素抵抗关系的研究进展

胰岛素抵抗是由免疫系统介导的慢性、非特异性炎症过程。而脂联素具有抗炎、促炎的双重作用。其与炎症因子的相互作用可能是脂联素增强胰岛素敏感性的机制之一,也可能是胰岛素抵抗时低脂联素血症的原因。对脂联素与炎症、胰岛素抵抗关系的研究可为胰岛素抵抗的治疗提供新的思路。     

老年人脉压指数与冠状动脉病变的关系

目的 :探讨脉压指数与冠状动脉病变严重程度的关系。方法 :82 0例均经冠状动脉造影检查 ,外周肱动脉压力测定收缩压 (SBP)、舒张压 (DBP) ,冠状动脉病变的严重程度用冠状动脉病变的血管支数表示。分别以脉压≤ 6 0mmHg(1mmHg =0 .133kPa)、>6 0～ 80mmHg、>80～ 10 0mmHg及 >10 0mmHg和脉压指数≤0 .4 0 0、>0 .4 0 0～ 0 .5 0 0、>0 .5 0 0～ 0 .6 0 0、 >0 .6 0 0 4个组进行分析。结果 :随着脉压和脉压指数的增加 ,冠心病患病率均随之增加 (P <0 .0 5 ) ,年龄呈增大趋势 ,双支和 3支冠状动脉病变患病率显著增高。Logistic回归分析 ,年龄、脉压、脉压指数对冠状动脉病变有最好的预测价值。结论 :脉压和脉压指数是最为方便的反映大动脉弹性的参数 ,与冠状动脉病变的严重程度密切相关 ,脉压指数比脉压在预测心血管事件危险性方面具有一定的优越性     

The relationship between pulse pressure and leukoaraiosis in the elderly

Leukaraiosis and a higher level of pulse pressure are well-recognized as associated with cardiovascular disease, vascular angiopathy, and geriatric syndrome. A cross-sectional study was conducted to examine the relation between pulse pressure and leukoaraiosis based on brain magnetic resonance imaging (MRI) scans in the apparently healthy elderly (147 men aged 60-84 years and 89 women aged 60-82 years). The odds ratios (OR) and 95% confidence interval (CI) for leukoaraiosis were calculated using multivariate logistic regression analyses according to each quartile of pulse pressure. The percentage of leukoaraiosis gradually increased in accordance with pulse pressure quartiles: 5.1%, 8.6%, 16.1%, and 26.2% for men, and 4.5%, 8.7%, 13.0%, and 23.8% for women. In comparison with subjects in the lowest quartile, the OR (95%CI) for leukoaraiosis in the highest quartile was 6.80 (1.20-38.45) in men after adjusting for age, body mass index, fasting plasma glucose, HDL-cholesterol, triglyceride (TG), smoking status, and current drinking. However, the relationship was not evident in women after adjusting for the same co-variables. In conclusion, pulse pressure was found to be independently associated with leukoaraiosis regardless of classical cardiovascular risk factors in elderly men.     

老年2型糖尿病和空腹血糖受损患者血小板功能与胰岛素抵抗相关性分析

目的 探讨60岁以上老年2型糖尿病（T2DM）和空腹血糖受损（IFG）患者血小板功能与胰岛素抵抗（IR）的相关性.方法 入选2型糖尿病组患者769例,IFG组患者856例和正常组（NGT） 764例,比较各组间血小板参数差异.采用稳态模型评估胰岛素抵抗（HOMA-IR）,用Spearman相关分析和Stepwise多元逐步回归分析评价血小板参数对胰岛素抵抗的影响.结果 2型糖尿病组血小板平均体积（MCV）为（11.0±1.1）、血小板分布宽度（PDW）（14.6±2.5）均显著高于对照组（MCV：10.8±1.0;PDW：14.0±2.2）和IFG组（MCV：10.9±1.0;PDW：14.2±2.3）（P＜0.01）;所有入组患者HOMA-IR四分位分组,PDW及MCV随着HOMA-IR的水平升高而逐步升高;MCV及PDW四分位组,第二分组（Q2）的HOMA-IR水平最低;Spearman相关分析显示,血小板计数（PLT）（r=0.04）、PDW（r=0.073）、MCV（r =0.061）与HOAM-IR呈正相关;Stepwise多元逐步分析显示,PDW与HOMA-IR独立相关.结论 老年2型糖尿病患者血小板体积增大,体积变异度增大,胰岛素抵抗与血小板分布宽度独立相关.     

Gender difference in the relationship between uric acid and pulse pressure among Korean adults

Hyperuricemia is associated with cardiovascular disease, but the relationship between uric acid (UA) and pulse pressure (PP) is unclear. Therefore, the present study assesses the relationship between UA and PP among Korean adults. Data from 6,310 subjects (2,800 men and 3,510 women) in the seventh Korean National Health and Nutrition Examination Survey (2016) were analyzed. After adjusting for related variables, the odds ratios (ORs) of hyperuricemia (UA ≥ 7.0 mg/dL in men or ≥ 6.0 mg/dL in women) in the high PP group (PP > 65.0 mmHg) in overall populations (OR, 1.563; 95% confidence interval [CI], 1.144–2.136) and women (OR, 1.631; 95% CI, 1.046–2.544) were significantly higher than those in normal PP, but not in men (OR, 1.309; 95% CI, 0.840–2.040). In conclusion, uric acid was positively associated with pulse pressure in women, but not in men.     

Oral taurine but not N-acetylcysteine ameliorates NEFA-induced impairment in insulin sensitivity and beta cell function in obese and overweight, non-diabetic men

Aims/hypothesis Antioxidants have been shown to ameliorate lipid-induced impairment of insulin action and beta cell function, both in vitro and in animal studies. The aim of the present study was to examine the effects of two orally administered antioxidants, N-acetylcysteine (NAC) and taurine (TAU), on lipotoxicity in humans. Methods Nine non-diabetic men, who were either overweight or obese, underwent three studies each, 4–6 weeks apart, in random order: (1) i.v. infusion of saline for 48 h (SAL); (2) i.v. infusion of Intralipid and heparin for 48 h to mimic chronic elevation of plasma NEFA (IH); and (3) IH infusion for 48 h with concurrent oral NAC (IH+NAC). Six men underwent similar studies except for study 3, where instead of NAC they received a 2 week pretreatment with oral TAU (IH+TAU). Results For both the NAC and TAU studies, a 48 h IH infusion alone without antioxidant impaired insulin sensitivity (S _I, 63% and 62% of SAL in NAC and TAU studies, respectively) and beta cell function, as evidenced by a reduction in disposition index (DI, 55% and 54% of SAL in NAC and TAU studies, respectively). NAC failed to prevent the lipid-induced increase in levels of the plasma oxidative stress marker malondialdehyde and did not prevent the lipid-induced reduction in S _I or DI, whereas TAU completely prevented the rise in malondialdehyde and decreased 4-hydroxynonenal, and significantly improved S _I (91% of SAL) and DI (81% of SAL). Conclusions/interpretation Oral TAU ameliorates lipid-induced functional beta cell decompensation and insulin resistance in humans, possibly by reducing oxidative stress. ClinicalTrials.gov ID no. NCT0018873 Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorised users.     

Change in insulin resistance,beta cell function,glucagon-like peptide-1 and calcitonin levels two weeks after bariatric surgery

Aim of the studyBariatric surgery causes profound improvement in metabolic parameters by increasing plasma glucagon like peptide - 1 (GLP-1) level even few weeks after surgery. GLP-1 analogues can cause calcitonin secreting medullary thyroid carcinoma in animals. The studies relating to the mechanisms that underlie these changes are few. The objectives of the study were to measure the change in insulin resistance, beta cell function, GLP-1 and calcitonin levels before and 2 weeks after bariatric surgery.MethodsPatients above 18 years of age who underwent either laparoscopic sleeve gastrectomy or Roux-en Y gastric bypass were recruited into the study. Measured indices were homeostatic model assessment 2 for insulin resistance (HOMA2-IR), an index for hepatic insulin resistance; Matsuda index, an index of whole body insulin sensitivity; and insulin secretion and sensitivity index (ISSI-2), a marker of beta cell secretion.ResultsTwenty eight patients completed the study. HOMA2-IR was lower (2.72 ± 1.28 vs. 2.04 ± 0.9; P = 0.001) and ISSI-2 was higher (0.80 (0.51–1.26) vs. 1.04 (0.56–1.38); P = 0.019) at 2 weeks after surgery compared to baseline. Matsuda index also improved after surgery but was not statistically significant (2.02 (1.1–2.94) vs. 2.84 (1.56–4.12); P = 0.078). Fasting GLP-1 and calcitonin levels did not change while both peak GLP-1, and area under curve for GLP-1 were higher after surgery.ConclusionsAt 2 weeks following bariatric surgery, hepatic insulin resistance decreased while beta cell function improved due to increase in postprandial GLP-1 level without any change in fasting calcitonin levels.     

Serum bone morphogenetic protein 7, insulin resistance, and insulin secretion in non-diabetic individuals

This study was to explore the relationship of serum BMP7 with insulin secretion and metabolic parameters in non-diabetic individuals. Serum BMP7 concentrations positively correlated with HOMA2-%B (insulin secretion index) and fasting insulin. Our findings suggested that BMP7 may stimulate insulin secretion and improve islet cell function in humans.     

Impaired beta cell glucose sensitivity and whole-body insulin sensitivity as predictors of hyperglycaemia in non-diabetic subjects

Aims/hypothesis The aim of this prospective study was to investigate predictors of deteriorating glucose tolerance in subjects of British extraction. Methods A total of 156 non-diabetic subjects (86 with a family history of type 2 diabetes) underwent a 75-g OGTT and anthropometric assessment at baseline and 5 years later. Pancreatic beta cell function and whole-body insulin sensitivity were studied by model assessment. Subjects were classified as progressors if glucose tolerance moved one or more steps from normal, impaired fasting glucose, impaired glucose tolerance and diabetes over the follow-up period. Results At baseline, the progressors (n=22) had increased adiposity and a higher proportion of familial diabetes and abnormal glucose tolerance than non-progressors. Baseline pancreatic beta cell sensitivity to changes in glucose (p<0.02) and whole-body insulin sensitivity (p<0.0001) were decreased in the progressors. Logistic regression revealed that baseline and follow-up changes in beta cell glucose sensitivity and insulin sensitivity, rather than the classical clinical predictors (adiposity, familial diabetes and glucose levels), were the key independent predictors of progression (explaining over 50% of the progression). Conclusions/interpretation Impaired pancreatic beta cell glucose sensing and whole-body insulin sensitivity predict progression to hyperglycaemia. Strikingly, these pathophysiological changes override the importance of the clinical risk factors and highlight potential metabolic targets for prevention strategies. An erratum to this article can be found at     

高血压患者心电图异常与脉压的关系

目的　研究高血压病人心电图异常和心电图左心室肥厚与脉压的关系。方法　在中美心血管病流行病学合作研究队列南方人群 1993～ 1994年随访复查资料中 ,选择血压和心电图资料齐全的高血压患者 114 3(男 6 2 6 ,女5 17)例进行分析。血压采用国际标准化测压方法测定 ,收缩压与舒张压取 3次测压平均值 ,心电图描记和编码使用明尼苏达编码方法。以平均动脉压的中位数 (10 9mmHg)为界值分为两组 ,再以脉压的四分位数法按≤ 4 8mmHg、4 9～5 8mmHg、5 9～ 6 8mmHg、>6 8mmHg分为 4个亚组 ,分析在不同的平均动脉压和脉压组心电图主要异常码、次要异常码和左心室肥厚编码率的变化。数据分析使用SAS软件。结果　①随着脉压增加 ,心电图异常、左心室肥厚均逐渐增加 ,P <0 0 5。Logistic回归分析证明 ,脉压增大会使心电图异常和左心室肥厚的危险增加 (P <0 0 0 1)。②BMI与心电图异常、左心室肥厚无关 ,P >0 0 5。舒张压与心电图异常码的发生率无相关关系。结论　脉压与心电图异常、左心室肥厚呈正相关关系 ,在降压治疗的同时 ,应缩小增大的脉压