2型糖尿病一级亲属血清leptin、TNF-α、IL-6表达与胰岛素抵抗的相关性研究

目的研究糖尿病家系中正常糖耐量一级亲属血清瘦素(leptin)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)表达与胰岛素抵抗的相关性。方法将研究对象分为2型糖尿病(T2DM)组134例、一级亲属糖耐量正常(NFDR)组128例、正常对照(NC)组120例。每组按体质量指数(BMI)分为肥胖组(BMI≥25)和非肥胖组(BMI<25)。测定空腹血清leptin、TNF-α、IL-6、血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖、空腹胰岛素并计算胰岛素抵抗指数(HOMA-IR)。结果 NC、NFDR、T2DM组的HOMA-IR依次增高;TG在NC、NFDR、T2DM组中依次递增;HDL-C依次递减(P<0.05),T2DM、NFDR、NC各组中肥胖组leptin、TNF-α、IL-6均高于非肥胖组(P<0.05)。leptin、TNF-α、IL-6在T2DM组、NFDR组、NC组的肥胖组中依次递减(P<0.05)。各组非肥胖组之间差异无显著性(P>0.05)。NFDR组HOMA-IR与BMI、TG、leptin、TNF-α、IL-6呈正相关(P<0.05)。结论 T2DM家系正常糖耐量一级亲属胰岛素抵抗与血清leptin、TNF-α、IL-6正相关,肥胖组中尤为显著。     

脂毒性对肥胖人群胰岛素抵抗的影响

目的探讨脂毒性对肥胖人群胰岛素抵抗(IR)的影响。方法将106例入选者按照体重指数(BMI)的不同分为三组(正常体重组、超重组和肥胖组),测定空腹和餐后2小时血糖(FBG、2hBG)和真胰岛素(FTI、2hTI)、空腹胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、游离脂肪酸(FFA)、瘦素(Lep)、肿瘤坏死因子α(TNFα)含量,计算胰岛素抵抗指数(HOMA-IR),并进行相关分析。结果超重组TG、FFA、Lep、TNFα、FTI、2hTI、2hBG水平和HOMA-IR高于正常体重组但低于肥胖组(P<0.05~0.001);超重组与肥胖组之间TC、LDL-C水平无显著性差异(P>0.05)但均高于正常体重组(P<0.05~0.01);正常体重组FBG、HDL-C水平分别低于和高于肥胖组(P<0.05),但与超重组无显著性差异(P>0.05);TG与FFA、Lep与FFA、Lep与TNFα、TNFα与FFA之间均呈正相关(r分别为0.62、0.49、0.41、0.54,P均<0.01);FFA、Lep、TNFα、腰围臀围比值(WHR)与HOMA-IR独立相关(F值为242.08,偏回归系数分别为1.55、1.69、1.02、0.03,P<0.05~0.01)。结论脂毒性是引起肥胖人群IR的重要因素之一。     

血清抵抗素水平与肥胖及2型糖尿病的关系

目的　研究血清抵抗素水平与肥胖、2型糖尿病 (T2DM )和胰岛素抵抗 (IR)的关系。　方法　用酶免疫测定法检测 31例单纯肥胖、2 7例T2DM及 30名正常人空腹血清抵抗素水平。　结果　单纯肥胖组、T2DM组及正常对照组空腹抵抗素分别为 ( 4 1± 13)、( 4 3± 11)和 ( 5 3± 7) μg/L。单纯肥胖组和T2DM组血清抵抗素浓度均低于正常对照组 (P <0 0 1)。空腹血清抵抗素与体质指数(BMI)、胰岛素抵抗指数 (HOMA IR)分别呈负相关 (r =- 0 2 92及 - 0 319,P <0 0 1) ,与空腹胰岛素、腰围和体脂百分比 (BF % )也呈负相关 (r =- 0 2 5 9,- 0 2 31及 - 0 2 39,P <0 0 5 )。多元逐步回归分析显示 ,HOMA IR为影响抵抗素最为显著的因素 (R2 =0 0 86 )。　结论　肥胖及T2DM患者血清抵抗素水平偏低。血清抵抗素与BMI、体脂百分比、腰围、空腹胰岛素和HOMA IR呈负相关。抵抗素可能在人类IR的发病中起一定的作用     

老年代谢综合征血清Adiponectin,Resistin与IR的相关性研究

90患者分为MS合并T2DM组、肥胖合并T2DM组、单纯肥胖组,健康对照组各30例。结果肥胖各组血清抵抗素、胰岛素抵抗指数(HOMA-IR)均高于对照组(P0.01),血清脂联素水平均低于对照组(P0.01)。多元线性逐步回归分析显示,体质量指数(BMI)、FPG、脂联素、抵抗素是影响老年MS患者IR的独立危险因素。结论老年MS患者在疾病各个时期均存在IR,脂联素、抵抗素可影响老年MS患者IR的程度。     

血清抵抗素水平与肥胖及胰岛素抵抗相关性的研究

目的　探讨 2型糖尿病 (T2DM)患者血清抵抗素水平与肥胖及胰岛素抵抗 (IR)的关系。方法　酶联免疫法测定T2DM患者 86例及对照组 42例的空腹血清抵抗素水平。记录受试对象性别、年龄、病程、身高、体重、腰围 (W )、臀围 (H)、血压 ,并检测空腹血脂、血糖 (Glu)、肾功能、胰岛素 (INS)、雌二醇 (E2 )、睾酮 (T)等生化指标。结果　无论是T2DM组还是对照组 ,肥胖者血清抵抗素水平与非肥胖者比较 ,均具有统计学差异(P <0 0 1 ) ,T2DM组与对照组比较其血清抵抗素水平无显著性差异 ;采用相关分析发现 ,血清抵抗素浓度与BMI、腰围、WHR、BF %、TG、ApoB、FINS、SBP、DBP呈显著正相关 ,与ISI显著负相关 ,男性抵抗素水平与T呈正相关 ;采用多元逐步回归分发现BF %、FINS、ISI、腰围为影响抵抗素最显著的因素 (R2 =0 78)。结论　T2DM组与对照组比较其血清抵抗素水平无显著性差异 ,而无论是T2DM组还是对照组 ,肥胖者血清抵抗素水平与非肥胖者比较 ,差别均具有统计学意义 (P <0 0 0 1 )。血清高抵抗素水平与BF %、FINS、ISI、腰围的相关性提示 ,抵抗素可能在肥胖、IR及T2DM的发病中起一定作用     

脂代谢紊乱对肥胖人群胰岛素抵抗的影响

目的探讨脂代谢紊乱对肥胖人群胰岛素抵抗（IR）的影响。方法将106例入选者按照体质指数（BMI）的不同分为体重正常组（BMI 18．5—24．9kg／m^2）、超重组（BMI25．0—27．0kg／m^2）和肥胖组（BMI〉27．0kg／m^2），做口服葡萄糖耐量试验（OGTT），测定空腹及服糖后2h血糖（FBG、2hBG），同时测定空腹及服糖后2h真胰岛素（FTI、2hTI）、空腹胆固醇（TC）、三酰甘油（TG）、高密度皮脂蛋白（HDL）、低密度脂蛋白（LDL）、游离脂肪酸（FFA）、瘦素（Lep）、肿瘤坏死因子-α（TNF-α），计算胰岛素抵抗指数（HOMA—IR），并对有些数据做相关分析。结果超重组TG、FFA、Lep、TNF-α、FTI、2hBG水平及HOMA—IR高于体重正常组但低于肥胖组（P〈0．05）；超重组与肥胖组之间TC、LDL水平差异无显著性意义（P〉0．05），但均高于正常组（P〈0．05）；正常组FBG、HDL水平分别低于和高于肥胖组（P〈0．05），但与超重组差异无显著性意义（P〉0．05）；TG与FFA、Lep与FFA、Lep与TNFα、TNFα与FFA之间均呈正相关（r=0．62、0．49、0．41、0．54，P〈0．01）；FFA、Lep、TNFα、腰臀围比值（WHR）与HOMA—IR独立相关（F=242．1，偏回归系数分别为1、55、1.69、1．02、0．03。P〈0．05）。结论脂代谢紊乱是引起肥胖人群IR的重要因素之一。     

非酒精性脂肪性肝病患者血清胰腺衍生因子水平及其与胰岛素抵抗的关系

目的探讨血清胰腺衍生因子(pancreatic derived factor,PANDER)在非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者中的水平及其在胰岛素抵抗(insulin resistance,IR)相关代谢性疾病的发生、发展及相互影响中的作用。方法选取单纯NAFLD患者30例、单纯2型糖尿病(T2DM)患者28例、NAFLD合并T2DM患者21例、健康对照者15名。收集体格检查资料,测定肝功、血脂、空腹血糖、FINS、血清FFA、血清PANDER、TNF-α及IL-6浓度。应用SPSS 19. 0进行相关统计学分析。结果 (1)NAFLD患者的血清PANDER水平(72. 33±0. 02)μg/L高于健康对照者(67. 80±0. 02)μg/L,低于T2DM患者(73. 80±0. 02)μg/L,但各组间差异无统计学意义(P0. 05)。(2) NAFLD、BMI及TG水平是HOMA-IR的主要预测因子,而血清PANDER未进入回归方程(回归方程=NAFLD×0. 551+BMI×0. 040+TG×0. 260-1. 710)。(3) HOMA-IR及血清FFA是血清PANDER水平的主要影响因素(回归方程=HOMA-IR×0. 191+FFA×0. 050-3. 181),但其与BMI、腹围、ALT、LDL、TG、HOMA-IR、血清TNF-α、血清IL-6尚无线性相关。(4)健康人群中,腹型肥胖(腹围)是NAFLD最重要的危险因素;而T2DM患者中,高TG血症是T2DM合并NAFLD最重要的危险因素;但不论是健康人群或T2DM人群,血清PANDER水平升高都不是NAFLD的危险因素。结论血清PANDER水平升高可能不是影响IR及NAFLD发病的危险因素,但IR是血清PANDER水平的影响因素之一。     

中老年2型糖尿病血清瘦素水平与超重或肥胖、血糖、胰岛素的关系

目的 研究中老年2型糖尿病（T2DM）肥胖与非肥胖患者血清瘦素与肥胖、血糖、胰岛素抵抗（IR）之间的关系。方法对样本人群进行体检并测定血清瘦素、空腹C肽（FCP）、空腹胰岛素（FINS）及血糖（FPG）等生化指标并对结果进行统计分析。结果 （1）T2DM组无论男女血清瘦素水平均显著高于对照组（P〈0．01），且女性组显著高于男性组（P〈0．01）；（2）T2DM超重或肥胖组血清瘦素水平显著高于非肥胖组且与腹型肥胖密切相关；（3）T2DMIR组血清瘦素水平显著高于胰岛素敏感组（P〈0．01），并与FINS、C肽呈正相关；（4）T2DM肥胖组血清瘦素水平与收缩压（SBP）、舒张压（DBP）、糖化血红蛋白（HbAlc）、甘油三酯（TG）呈正相关。结论 T2DM血清瘦素水平与超重或肥胖、IR、长期的血压、TG及血糖的平均水平关系密切。减肥，改善瘦素抵抗，增加机体对瘦素的敏感性对治疗T2DM可能提供帮助。     

肥胖人群网膜脂肪中抵抗素mRNA的表达及相关因素的研究

目的了解肥胖人群网膜脂肪中抵抗素mRNA的表达以及相关因素。方法43例患者分为肥胖组和正常对照组,用逆转录-聚合酶链反应（RT-PCR）法检测大网膜脂肪组织抵抗素表达情况;测定血清胰岛素、血糖、血脂、肿瘤坏死因子-α（TNF-α）、游离脂肪酸（FFA）、抵抗素。结果肥胖组网膜脂肪抵抗素mRNA表达以及血清抵抗素水平均显著高于正常对照组。相关分析显示,网膜脂肪抵抗素mRNA表达与血清TNF-α、FFA、抵抗素、体重指数（BMI）、腰臀比（WHR）、胰岛素抵抗指数（HOMA-IR）呈显著正相关;逐步回归分析示对抵抗素表达有显著影响的因素为WHR、BMI。结论肥胖患者的网膜脂肪组织中抵抗素表达以及血清抵抗素均明显增高,两者之间存在明显相关性。肥胖可能是网膜脂肪组织抵抗素表达水平的独立影响因素。     

2型糖尿病代谢综合征患者游离脂肪酸与胰岛素抵抗的关系

选择2型糖尿病(T2DM)患者81例、T2DM并代谢综合征(Ms)患者81例及正常对照者34例,测定空腹血清游离脂肪酸(FFA)水平及血糖、血脂等代谢参数.发现T2DM并MS组BMI、WHR、WC、SBP、DBP、TG、FFA水平明显高于对照组和T2DM组,HOMA-IR明显高于T2DM组;FFA与TG、HOMA-IR显著相关,HOMA-IR与FBG、TG、FFA显著相关.提示FFA在T2DM并MS患者中明显升高,其与胰岛素抵抗之间存在明显的正相关关系,降低FFA水平将有助于改善胰岛素抵抗.     

Electrochemical Recovery and Behaviors of Rare Earth (La,Ce, Pr,Nd, Sm,Eu, Gd,Tb, Dy,Ho, Er,Tm, and Yb) Ions on Ni Sheets

The electrochemical behaviors of rare earth (RE) ions have extensively been studied because of their high potential applications to the reprocessing of used nuclear fuels and RE-containing materials. In the present study, we fully investigated the electrochemical behaviors of RE(III) (La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, and Yb) ions over a Ni sheet electrode in 0.1 M NaClO₄ electrolyte solution by cyclic voltammetry between +0.5 and −1.5 V (vs. Ag/AgCl). Amperometry electrodeposition experiments were performed between −1.2 and −0.9 V to recover RE elements over the Ni sheet. The successfully RE-recovered Ni sheets were fully characterized by scanning electron microscopy, energy dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, and photoluminescence spectroscopy. The newly reported recovery data for RE(III) ions over a metal electrode provide valuable information on the development of the treatment methods of RE elements.     

Clinical trials update: highlights of the scientific sessions of The American College of Cardiology 2002: LIFE,DANAMI 2, MADIT-2, MIRACLE-ICD,OVERTURE, OCTAVE,ENABLE 1 & 2, CHRISTMAS,AFFIRM, RACE,WIZARD, AZACS,REMATCH, BNP trial and HARDBALL

This article continues a series of reports updating recent research developments of particular interest to personnel involved in the treatment and management of patients with heart failure. This is a summary of selected presentations made at the American College of Cardiology 51st Annual Scientific Session held in Atlanta on 17-20 March 2002. Reports of the following clinical studies are included: LIFE, DANAMI 2, MADIT-2, MIRACLE-ICD, OVERTURE, OCTAVE, ENABLE 1 & 2, CHRISTMAS, AFFIRM, RACE, WIZARD, AZACS, REMATCH, BNP trial and HARDBALL.     

Prevalence,Self-Awareness,Treatment, and Control of Hypertension in Lhasa,Tibet

To investigate the prevalence, self-awareness, and treatment of hypertension in Lhasa, Tibet, a total of 1370 native Tibetan aged ≥18 years were selected, using stratified proportional sampling. The study showed that the prevalence of hypertension was 51.2%, significantly higher in men (56.0%) than in women (48.0%) (P = .004). The hypertension prevalence increased with increasing age (77.8% in 60–74 y and 82.5% in ≥75 y groups) and was higher in urban, suburban, or agricultural area than in pastoral area (P < .001). The self-awareness, treatment, and control rate of hypertension were 63.5%, 24.3% and 7.7%, respectively. In multivariable regression analysis, age, urban residence, amount of daily intake of fat and oil, and body mass index <18.5 kg/m² were independently associated with hypertension. In conclusion, hypertension was highly prevalent among native Tibetan people in Lhasa, and the rates of self-awareness, treatment, and control of hypertension were low.     

Lack of effect of colesevelam HCl on the single-dose pharmacokinetics of aspirin,atenolol, enalapril,phenytoin, rosiglitazone,and sitagliptin

Aims

Drug interactions with bile acid sequestrants are primarily due to the potential of these agents to bind to concomitant drugs. Six clinical studies were performed to determine the effects of colesevelam on the pharmacokinetics of aspirin, atenolol, enalapril, phenytoin, rosiglitazone, and sitagliptin.

Methods

All six studies enrolled healthy subjects aged 18–45 years. The phenytoin study used a single-dose, three-period crossover design (phenytoin alone, phenytoin simultaneously with colesevelam, and phenytoin 4 h before colesevelam). The other studies used a two-period crossover design (test drug alone and test drug simultaneously with colesevelam). Colesevelam (3750 mg once daily) was dosed throughout the pharmacokinetic sampling period. After each single dose of the test drug, serial blood samples were collected for determination of plasma drug concentrations and calculation of pharmacokinetic parameters.

Results

For all six test drugs, 90% CIs for geometric least-squares mean ratios of AUC and C_max for the measured analytes were within specified limits, indicating no interaction between the test drug and colesevelam.

Conclusions

Aspirin, atenolol, enalapril, rosiglitazone, and sitagliptin may be taken with colesevelam. Although the phenytoin study indicated no pharmacokinetic interaction, phenytoin should continue to be taken ≥4 h before colesevelam in accordance with current prescribing information.     

Biliary microlithiasis,sludge,crystals,microcrystallization,and usefulness of assessment of nucleation time

BACKGROUND:The process of microcrystallization,its sequel and the assessment of nucleation time is ignored.This systematic review aimed to highlight the importance of biliary microlithiasis,sludge,and crystals,and their association with gallstones,unexplained biliary pain,idiopathic pancreatitis, and sphincter of Oddi dysfunction.DATA SOURCES:Three reviewers performed a literature search of the PubMed database.Key words used were"biliary microlithiasis","biliary sludge","bile crystals","cholesterol crystallisation","bile microscopy","microcrystal formation of bile","cholesterol monohydrate crystals","nucleation time of cholesterol","gallstone formation","sphincter of Oddi dysfunction"and"idiopathic pancreatitis".Additional articles were sourced from references within the studies from the PubMed search.RESULTS:We found that biliary microcrystals account for almost all patients with gallstone disease,7%to 79%with idiopathic pancreatitis,83%with unexplained biliary pain, and 25%to 60%with altered biliary and pancreatic sphincter function.Overall,the detection of biliary microcrystals in gallstone disease has a sensitivity ranging from 55%to 87%and a specificity of 100%.In idiopathic pancreatitis,the presence of microcrystals ranges from 47%to 90%.A nucleation time less than 10 days in hepatic bile or ultra-filtered gallbladder bile has a specificity of 100%for cholesterol gallstone disease.CONCLUSIONS:Biliary crystals are associated with gallstone disease,idiopathic pancreatitis,sphincter of Oddi dysfunction, unexplained biliary pain,and post-cholecystectomy biliary pain.Pathways of cholesterol super-saturation,crystallisation, and gallstone formation have been described with scientificsupport.Bile microscopy is a useful method to detect microcrystals and the assessment of nucleation time is a good method of predicting the risk of cholesterol crystallisation.     

Clinical trials update from the American College of Cardiology 2008: CARISMA, TRENDS, meta-analysis of Cox-2 studies, HAT, ON-TARGET, HYVET, ACCOMPLISH, MOMENTUM, PROTECT, HORIZON-HF and REVERSE

This article provides information and a commentary on trials relevant to the pathophysiology, prevention and treatment of heart failure, presented at the American College of Cardiology. Unpublished reports should be considered as preliminary data, as analyses may change in the final publication. CARISMA investigated the use of implantable loop recorders for detecting life-threatening arrhythmias in patients with LVSD after MI and found that brady- and ventricular tachy-arrhythmias predicted an adverse prognosis. The TRENDS study showed that the burden of atrial fibrillation detected by pacemakers or defibrillators predicted the risk of embolic events but not with sufficient precision to justify changes in anti-thrombotic management. A meta-analysis of six trials reported an increased cardiovascular risk associated with celecoxib, particularly for heart failure, which was related to dose and baseline cardiovascular risk. The HAT study failed to show a benefit of providing post-MI patients with a home defibrillator. MOMENTUM, a study of a device designed to augment aortic blood flow, was stopped early due to increased bleeding risk. Results from PROTECT support the use of rolofylline 30 mg/day in acute heart failure, a definitive study is now underway. Istaroxime, an agent that appears to have both inotropic and lusitropic effects, improved haemodynamics when added to standard therapy in patients stabilised after admission with heart failure in HORIZON-HF. The REVERSE study suggested that CRT improves ventricular function and reduces morbidity even in patients with few or no symptoms of heart failure and may delay or prevent worsening heart failure.