阻塞性睡眠呼吸暂停低通气综合征与代谢综合征关系荟萃分析

目的荟萃分析方法评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与代谢综合征的关系。方法计算机检索PUMEd、中国学术期刊全文数据库等全文数据库并手工检索相关期刊,全面收集阻塞性睡眠呼吸暂停低通气综合征与代谢综合征关系的临床研究,按照纳入、排除标准选择试验并评价质量,采用Revman 5.0软件进行荟萃分析。结果最终纳入6篇文献,荟萃分析结果表明OSAHS患者发生代谢综合征的危险性是非OSAHS患者的3.56倍(95%CI 2.61-3.86)。进一步分析表明,OSAHS患者发生高血压、血脂紊乱、高血糖的危险性分别是非OSAHS患者的3.19倍(95%CI 2.28-4.45)、2.06倍(95%CI 1.48-2.86)、2.58倍(95%CI 1.85-3.61)。结论 OSAHS与代谢综合征之间有联系,可能增加其发病危险性。     

Factor analysis of metabolic syndrome components in obese women

Background and aimFactor analysis is a multivariate correlation technique that is frequently employed to characterise the clustering of intercorrelated abnormalities, which underlie the metabolic syndrome in cohorts of individuals with different characteristics. To our knowledge, it has never been used to identify the components of this syndrome in obese subjects. The purpose of this study was to use factor analysis to investigate the clustering of features, which characterise the metabolic syndrome, in a cohort of 552 obese women aged 18–83 years (mean body mass index: 43.0 kg/m² ± 5.7 SD).Methods and resultsPrincipal component analysis reduced ten correlated physiological variables, to four uncorrelated factors that explained 72.2% of the variance in the original parameters. These factors were interpreted as: (1) an insulin resistance factor, with positive loading of fasting serum insulin and homeostatic model assessment of insulin resistance; (2) a metabolic glucose/lipid factor, with positive loading of fasting plasma glucose, triglycerides, waist-to-hip ratio, and inverse loading of high density lipoprotein cholesterol; (3) a body mass factor, with positive loading of body mass and waist circumference; and (4) a blood pressure factor, with positive loading of systolic and diastolic blood pressure.ConclusionThe identification of four independent factors is consistent with previous findings among samples of different populations and may also support, in obese women, the hypothesis that multiple physiological determinants are responsible for the abnormalities underlying the metabolic syndrome. Nonetheless, findings in this cohort of obese women suggest that the absolute degree of adiposity is not correlated with any tested component of the metabolic syndrome, but that the relative fat distribution is highly correlated with the development of hyperglycaemic and dyslipidaemic phenomena. Furthermore, insulin resistance appears to be a major factor in obese individuals, independent of other metabolic and anthropometic abnormalities.     

Relationship between metabolic syndrome and follicle-stimulating hormone in postmenopausal women

Depletion of ovarian reserve during menopausal transition raises follicle-stimulating hormone (FSH) markedly and menopause is related to an increased risk for metabolic syndrome (MetS). This study examined the relationship between FSH and MetS in postmenopausal women.We evaluated the anthropometric values, lipid profiles, high-sensitivity C-reactive protein (hs-CRP) level, Homeostasis model assessment for insulin resistance (HOMA-IR), and serum adipokines levels in 219 postmenopausal women. Serum FSH and estradiol levels were significantly lower in the MetS group than in the non-MetS group. An inverse correlation was observed between FSH with body fat mass (BFM), and HOMA-IR, and a positive correlation was found between FSH and adiponectin level after adjustment for age, years since menopause, BMI, and serum estradiol.The odds ratio for MetS was higher significantly in the lowest quartile of FSH level than the highest quartile of FSH level (odd ratio = 1.32, 95% CI = 1.09–1.75). Our study showed an increased FSH level favored insulin sensitivity with a higher adiponectin and lower HOMA-IR as well as a lower incidence of MetS in postmenopausal women.These findings suggest a new approach to the role of FSH for regulating energy metabolism and for use as a biomarker of MetS risk in postmenopausal women.This systematic review is based on published researches, so there is no ethical approval required.     

绝经后代谢综合征女性雌激素水平的变化

目的观察绝经后代谢综合征(metabolic synd rome,MS)女性雌激素及性激素结合球蛋白的变化。方法随机调查绝经期后女性168例,其中健康体检者78例(对照组),MS患者90例(MS组)。测静脉血雌二醇、性激素结合球蛋白、黄体生成素及卵泡刺激素水平。结果与绝经≤10年女性比较,绝经11～20年、≥21年的对照组和MS组女性雌二醇均明显降低,差异有统计学意义(P0.05)。与对照组比较,MS组女性绝经≤10年、11～20年、≥21年者体重指数明显升高,性激素结合球蛋白明显降低;绝经≤10年女性雌二醇、黄体生成素、卵泡刺激素明显降低,绝经11～20年女性卵泡刺激素、黄体生成素明显降低,差异有统计学意义(P0.05,P0.01)。结论低雌激素水平对代谢的影响在绝经10年内;低性激素结合球蛋白水平是预示绝经后女性MS的独立危险因素。     

糖负荷后1h血糖值与绝经后女性代谢综合征相关研究

目的探讨绝经前后非糖尿病人群代谢综合征（MS）及动脉粥样硬化因素与糖负荷后lh血糖（1h-PG）的关系,及1h-PG在绝经后MS人群的可能切点值。方法以2013年8月～10月在中山大学孙逸仙纪念医院进行健康体检年龄30～70岁女性为研究对象,收集身高、体质量、腰围、血压、血脂及葡萄糖耐量试验（OGTT）0,1,2h相对应的血糖、胰岛素水平。根据OGTT结果剔除糖尿病患者,按照不同绝经阶段分为两组：绝经前组143例,绝经后组145例,根据国际糖尿病联盟（IDF）MS定义标准,分析1h-PG与MS的相关性及在绝经后女性MS的切点值。结果（1）绝经后组年龄、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、收缩压、舒张压均高于绝经前组,差异均有统计学意义（P〈0．05）。（2）各组受检者行OGTTN试后,相比于绝经前组,绝经后组各时点葡萄糖、胰岛素及恒稳态模型评价。胰岛素抵抗（HOMA-IR）水平均显著增高,差异均有统计学意义（P〈0．05）。（3）绝经前组中,检出MS患者22例（13．39％）,绝经后组中,检出MS患者47例（32．40％）,两组MS发生率比较,差异有统计学意义（x2=11．46,P=0．01）。（4）MS相关影响因素的logistic回归分析结果显示,1h-PG与MS显著相关（OR=1．849,95％CI=1．557-2．195,P〈0．001）。（5）当lh-PG以8．70mmol／L为临界值时,1h．PG对绝经后组MS预测的敏感度为87．50％,特异度为81．44％,Youden指数为0．689,受试者工作特征（ROC）曲线下面积（AUC）为0．907。结论绝经前后非糖尿病人群MS与1h-PG均密切相关,推测1h-PG预测绝经后女性MS的可能切点值为8．70mmol／L,可以作为预测绝经后女性MS的一个可选指标,对早期临床干预或治疗有指导意义。     

Plasma endothelin in postmenopausal women with type 2 diabetes mellitus and metabolic syndrome: a comparison of oral combined and transdermal oestrogen-only replacement therapy

SUMMARY
Aim   Type 2 diabetes and metabolic syndrome are major cardiovascular risk factors in postmenopausal women, but the role of vasoconstrictive endothelin-1 (ET-1) in these conditions is not known. We studied the levels of ET-1 and the effect of postmenopausal hormonal therapy on ET-1 levels in postmenopausal women.
Methods   We compared plasma levels of ET-1 in 22 postmenopausal type 2 diabetic women and 14 postmenopausal women with metabolic syndrome with plasma levels in 10 healthy postmenopausal control women. The basal values for ET-1 were measured for all groups. These women were then randomised to receive in a double-dummy, crossover trial: either oral continuous oestradiol (2.0 mg) + norethisterone acetate (1.0 mg) per day or continuous transdermal oestrogen-only (50 μg/day) for 3 months. Between the active therapy there were 3-month wash-out periods. ET-1-values were measured again at the end of each treatment period.
Results   The type 2 diabetic women had significantly (p < 0.003) elevated ET-1 levels (4.8 ± 1.0 pg/ml) whereas those with metabolic syndrome (4.4 ± 1.7 pg/ml) had non-significantly (NS) elevated ET-1 levels compared to controls (3.6 ± 0.3 pg/ml). Both oral and transdermal hormone replacement therapy (HRT) failed to affect plasma ET-1 except in 14 hypertensive women from the diabetes and metabolic syndrome groups who were on angiotensin convertase enzyme (ACE) inhibitors. These women's ET-1 levels before oral HRT (4.6 ± 1.1 pg/ml) fell to 4.1 ± 0.9 pg/ml (p < 0.05).
Conclusions   Type 2 diabetes in postmenopausal women is associated with elevated ET-1 levels. Oestrogen replacement therapy does not affect the levels of ET-1 in postmenopausal women with type 2 diabetes or metabolic syndrome.     

Diagnosis and management of the metabolic syndrome in obesity

The metabolic syndrome is a constellation of interrelated abnormalities that increase the risk for cardiovascular disease and progression to type 2 diabetes. The prevalence of this syndrome is increasing because of the 'obesity epidemic'. The National Cholesterol Education Program Adult Treatment Panel III defined practical criteria for the diagnosis of the metabolic syndrome and established the basic principles for its management. Also, the International Diabetes Federation recently proposed another definition. The metabolic syndrome is a secondary target for cardiovascular risk reduction. Clinicians should identify individuals with this condition, assess their cardiovascular risk and treat them by an aggressive and multifaceted approach. The most effective therapeutic intervention in patients with the metabolic syndrome should focus on modest weight reduction and regular physical activity. Adoption of a healthier diet and smoking cessation are necessary. Drug therapy may be needed to achieve recommended goals if therapeutic lifestyle changes are not sufficient. Low-density lipoprotein cholesterol is the primary target of therapy (new aggressive goals should be achieved). Statins are probably the drugs of choice. Fibrates and nicotinic acid are also useful options. Hypertension should be managed aggressively probably starting with an inhibitor of the renin-angiotensin system or a calcium channel blocker and adding a low dose of a thiazide diuretic if necessary. Aspirin should be administered if the cardiovascular risk is high. In the future acarbose, metformin, meglitinides and thiazolidinediones may be used in patients with the metabolic syndrome to delay the onset of type 2 diabetes and reduce cardiovascular risk. Such an intense and multifactorial approach is likely to reverse the bad prognosis associated with the metabolic syndrome.     

Platelet count can predict metabolic syndrome in older women

Platelet count (PC) has been found to be related to the metabolic syndrome (MetS). However, the role of PC on MetS remained unclear. In order to evaluate the relationship between PC and MetS components cross-sectionally and determine the optimal cutoff PCs for predicting the subsequent risk of MetS development with sex specificity, two stages included cross-sectional (stage 1) and prospective (stage 2) cohort study were conducted. Stage 1 involved 10?579 subjects aged ≥60 years, of which 7718 subjects advanced to stage 2 with a mean 3.8 year follow-up were enrolled. The MetS components and PC were determined. The PC cutoffs for higher chances of developing MetS in stage 1 were calculated using receiver operating characteristic (ROC) curve analyses. In stage 2, non-MetS subjects were classified into high-PC (HPC) and low-PC (LPC) groups according to the cutoff values from stage 1. We examined the difference of future MetS incidence and calculated the odds ratio (OR) between these two groups. In stage 1, multiple regression showed that age and triglyceride (both sexes) and waist circumstance and high-density lipoprotein cholesterol (only women) were independently correlated with PC. There was significant difference in the area under the ROC curve (AUC) only of HPC women, which exceeded the standard curve (AUC?=?0.542, p?<?0.001), with a cutoff PC of 223?×?10³/μl. HPC women had an OR of 1.287 (95% confidence interval: 1.135–1.461) of developing MetS after 3.8 years. The Kaplan–Meier curve demonstrated a higher incidence of MetS development in HPC women. In conclusion, our results suggest that PC was associated with MetS with sex effects. Most of the MetS components were independent factors for increasing PC, and the risk for subsequent development of MetS was noted when PC >223?×?10³/μl in elderly women.     

血清明胶酶与绝经后女性代谢综合征的关系

目的 通过测定绝经后女性代谢综合征（MS）患者血清明胶酶[基质金属蛋白酶-2（MMP-2）和基质金属蛋白酶-9（MMP-9）]水平的变化,探讨明胶酶与绝经后女性代谢综合征的关系.方法 选择2010年4月至2011年4月我院体检科、心内科及内分泌科患者,分为绝经后健康女性对照组27例及绝经后代谢综合征女性患者28例,采用酶联免疫的方法测定血清中MMP-2及MMP-9水平,用胶乳增强免疫比浊法测定血清高敏C反应蛋白（hs-CRP）水平,对两组结果进行比较分析.结果 绝经后女性代谢综合征患者血清MMP-9水平显著高于绝经后女性非代谢综合征者水平,两组比较差异有统计学意义（P＜0.01）;而两组MMP-2水平比较差异无统计学意义（P＞0.05）.结论 绝经后女性代谢综合征患者血清中可见明显高水平的MMP-9,其可能参与了动脉血管粥样硬化的早期病理生理进程.     

The metabolic syndrome: evolving evidence that thiazolidinediones provide rational therapy

The metabolic syndrome, also known as the dysmetabolic syndrome, syndrome X or the insulin resistance syndrome, refers to the clustering of cardiovascular disease risk factors that are present in many individuals who are at increased risk for both cardiovascular events and type 2 diabetes. Prediabetic subjects typically exhibit an atherogenic pattern of cardiovascular risks that is associated with hyperinsulinaemia. Thus, identification of components of the metabolic syndrome is important if patients are to be treated early enough to prevent cardiovascular events and other complications related to diabetes. Therapies targeted to specific components of the metabolic syndrome such as improving glycaemic control, managing dyslipidaemia and reducing the prothrombotic state should help to minimize cardiovascular risk, particularly if initiated early. Traditional pharmacologic agents used to manage the individual components of the metabolic syndrome do not typically impact the other components. The thiazolidinediones, a new class of agents that improve insulin resistance, have the ability, in addition to their glucose-lowering effects, to exert several powerful anti-atherogenic properties, including anti-inflammatory effects in the vascular endothelium, redistribution of visceral fat and reduction of insulin resistance, hyperinsulinaemia and hyperproinsulinaemia. This makes the thiazolidinediones ideal candidates for the early treatment of many components associated with the metabolic syndrome.     

Sleep duration and metabolic syndrome in adult populations: a meta-analysis of observational studies

Objective:

Epidemiological studies have repeatedly investigated the association between sleep duration and metabolic syndrome. However, the results have been inconsistent. This meta-analysis aimed to summarize the current evidence from cross-sectional and prospective cohort studies that evaluated this.

Data sources:

Relevant studies were identified by systematically searching the PubMed, Cochrane CENTRAL, EMBASE and PsycINFO databases through November 2012 without language restriction.

Study selection:

We identified 12 cross-sectional studies with 76 027 participants including 14 404 cases of metabolic syndrome, and 3 cohort studies with 2055 participants and 283 incident cases of metabolic syndrome.

Results:

For short sleep durations (<5 to 6 h), the odds ratios (OR) was 1.27 (95% confidence interval (CI)=1.10–1.48, I²=75.5%) in the 12 cross-sectional studies and 1.62 (95% CI=0.74–3.55, I²=71.4%) in the 3 cohort studies; for long sleep durations (>8 to 10 h), the OR was 1.23 (95% CI=1.02–1.49, I²=75.8%) in the 11 cross-sectional studies and 1.62 (95% CI=0.86–3.04, I²=0.0%) in the 2 cohort studies.

Conclusions:

Short and long sleep durations are risky behaviors for increasing the risk of metabolic syndrome and thus have important public health implications, as sleep habits are amenable to behavioral interventions. The available data are sparse, and further studies, especially longitudinal studies, are needed to facilitate a better understanding of these associations.     

The effect of the metabolic syndrome on the risk and outcome of coronary artery bypass graft surgery

Background

The individual components of the metabolic syndrome are risk factors for coronary artery disease. The underlying pathophysiology of a low-grade inflammatory process postulates that the metabolic syndrome could compromise a procedure such as coronary artery bypass graft surgery (CABG) done on cardiopulmonary bypass (CPB).

Methods

From a single institution, 370 patients with the metabolic syndrome (IDF and ATP III criteria) and 503 patients without the metabolic syndrome were identified. The influence of the metabolic syndrome on the pre-operative core risk factors for CABG mortality as well as its effect on the mortality and major morbidity post surgery were investigated.

Results

Patients with the metabolic syndrome were operated on less urgently than those without the metabolic syndrome. The EuroSCORE was also lower in those with the metabolic syndrome. Patients with the metabolic syndrome required fewer units of homologous red blood cells, but stayed statistically longer in hospital.

Conclusions

In this surgical population the metabolic syndrome had no detrimental clinical effect on either the pre-operative risk factors or the outcome after CABG.     

Characteristics of US adults with the metabolic syndrome and therapeutic implications

BACKGROUND: The third Adult Treatment Panel (ATP III) of the National Cholesterol Education Program defines clinical criteria for diagnosis of the metabolic syndrome, which increases cardiovascular risk and is a target for therapy. AIM: We analysed the third National Health and Nutrition Examination Survey (NHANES III; 1988-94) to determine how many US adults meet these criteria and are recommended for lipid-modifying drug therapy by ATP III. METHODS: NHANES III data were used to estimate the number of individuals with the metabolic syndrome and the number recommended for treatment by ATP III, based on 1990 census data. RESULTS: An estimated 36.3 million (23%) US adults have the metabolic syndrome. Of these, 84% met the criterion for obesity, 76% for blood pressure, 75% for HDL-C, 74% for triglycerides and 41% for glucose. Most (54%) are in the higher risk categories of ATP III, yet only 39% overall are recommended for drug therapy by ATP III cutpoints; of these, most will achieve LDL-C targets with reductions of 35-40%. Of the 15.3 million individuals with the metabolic syndrome and triglycerides > or = 2.26 mmol/l (200 mg/dl), non-HDL-C is above ATP III recommendations in 11.6 million. CONCLUSIONS: Of the large number of Americans with the metabolic syndrome, ATP III recommends drug therapy for only a minority, because LDL-C typically is not substantially elevated. Instead, high triglycerides and low HDL-C are more common; clinical trial data are needed to determine whether optimal therapy should focus on reductions in LDL-C or on comprehensive improvements to the lipid profile.