代谢综合征对高血压患者血管内皮功能与颈动脉粥样硬化的影响

目的探讨代谢综合征（MS）对高血压患者血管内皮功能及颈动脉粥样硬化的影响。方法选取120例高血压患者，根据有无合并MS将其分为2组：MS组（65例）和非MS组（55例），彩色多普勒超声测定肱动脉反应性充血内径、颈动脉内膜厚度及斑块情况。选取健康体检者40名作为对照组（NC组）。结果①MS组的体重指数（BMI）、甘油三酯（TG）、空腹血糖（FPG）均高于非MS组和NC组，P〈0．05，P〈0．01。②内皮依赖性血管舒张功能（FMD％）：MS组明显低于非MS组和NC组[（7．15±2．46）％、（8．45±4．13）％和（12．23±5．12）％，P均〈0．05]。③三组颈动脉内膜厚度（IMT）依次为：（0．84±0．21）mm、（0．78±0．24）mm和（0．64±0．14）mm，P均〈0．01；颈动脉斑块发生率依次为29．3％、21．8％和5．0％，P均〈0．01。④相关分析显示，FMD％与年龄、SBP、TG、FPG呈负相关（r=-0．359、r=-0．357、r=-0．346、r=-0．413，P均〈0．01），与HDL—C呈正相关（r=0．341，P〈0．01）；IMT与年龄、SBP、BMI、TG呈正相关（r=0．431，r=0．442，r=0．315，r=0．342，P均〈0．01），与HDL—C呈负相关（r=-0．313，P〈0．01）。结论并发MS可加重高血压患者血管内皮功能失调及促进颈动脉粥样硬化的发生。     

代谢综合征患者血脂异常类型与颈动脉粥样硬化的关系

目的研究代谢综合征（MS）患者不同类型血脂异常对颈动脉粥样硬化（AS）的影响。方法将918例AS患者分为3组：正常胆固醇（N-TC）组（502例）、单纯高胆固醇（HC）组（190例）和混合性HC（M-HC）组（226例）;N-TC组再分为4个亚组：TG与HDL-C均正常组（112例）、高TG（H-TG）组（61例）、低HDL-C（L-HDL-C）组（186例）、高TG与低HDL-C混合（H-TG＋L-HDL-C）组（143例）,分析各血脂异常组对颈动脉损害的影响。结果HC组与M-HC组的颈动脉内膜中层厚度（IMT）、斑块数目均显著高于N-TC组（P〈0.05）;M-HC组斑块发生率（65.9%）显著高于N-TC组（44.5%）和HC组（56.0%）（P〈0.01）。N-TC的4个亚组中,IMT、斑块数目、斑块发生率在各组间差异无统计学意义（P〉0.05）;多元逐步回归分析表明：年龄和DBP与IMT最相关,年龄与斑块数目最相关。结论MS合并HC对颈AS的影响显著高于高TG或低HDL-C血症;N-TC的MS患者,年龄和DBP对颈AS具有显著影响。     

代谢紊乱患者脂联素水平和颈动脉粥样硬化的研究

目的　探讨代谢紊乱患者脂联素水平、颈动脉粥样硬化的变化。方法　入选研究对象共 90例 ,根据代谢紊乱数目 ,分为无代谢紊乱组 (M0 )、1种代谢紊乱组 (M1)、2种代谢紊乱组(M2 )和 2种以上代谢紊乱组 (M3 )。评价了内皮依赖性舒张功能、颈总动脉内膜 中层厚度 (IMT) ,并测定了脂联素 (adiponectin)水平。 结果　M2 组和M3 组颈总动脉IMT分别高于M0 组和M1组(P <0 .0 5 )。M3 组颈总动脉斑块发生率高于M0 组 ,脂联素水平低于M1组 (P <0 .0 5 )。校正了影响因素后 ,M3 组脂联素仍与HOMA IR呈负相关。结论　代谢紊乱患者脂联素水平降低 ,颈总动脉粥样硬化加速     

代谢综合征患者颈动脉硬化与超敏C反应蛋白相关性研究

33例正常人和83例代谢综合征（MS）患者的研究显示，MS患者颈总动脉平均和最大内膜中膜厚度（IMT）及超敏C反应蛋白（hsC-RP）均明显高于正常对照组；在MS组中平均和最大IMT分别与hsC-RP独立相关，提示C-RP在动脉粥样硬化中有一定的作用。     

女性冠状动脉粥样硬化与代谢综合征的相关研究

目的:探讨女性动脉粥样硬化(As)发病与代谢综合征、血管内皮功能的关系。方法:有完整的临床和冠状动脉造影资料以及无严重的肝肾和甲状腺疾病的女性参与本研究。根据冠状动脉造影结果,将其分为轻度As组(n=23)、严重As组(n=26)和对照组(n=20)。分别测定各组的临床资料(如血压、体重指数、家族史以及腰围臀围比值等)、生化指标(如血脂、血糖和胰岛素浓度等)以及血管内皮功能。结果:1.As患者(包括轻度和严重As组)甘油三酯(TG)浓度[(2.0±0.5)mmolL和(2.3±0.4)mmolL]高于对照组[(1.4±0.4)mmolL],而高密度脂蛋白_胆固醇(HDL_C)则低于对照组;2.As患者餐后胰岛素水平和胰岛素血糖比值显著升高,23的As患者存在代谢综合征;3.轻度和严重As组之间各种血脂水平、血糖以及餐后胰岛素浓度无明显差异,但严重As组平均年龄[(60.5±6.9)岁]和绝经人数(76.9%)显著大于轻度As组[(51.1±9.3)岁和34.8%];4.轻度As组(7.9%±3.7%)和严重As组(8.7%±3.5%)的血管内皮依赖性的血流介导的舒张显著低于对照组(14.1%±4.7%),而血管内皮非依赖性硝酸甘油介导的舒张与对照组无差异。结论:女性As患者即使在As早期或绝经以前就存在血管内皮功能异常和多种代谢异常。     

221例代谢综合征人群颈动脉内膜中层厚度研究

在221例有代谢异常倾向的个体检测代谢参数，并测量颈动脉内膜中层厚度（IMT），以研究代谢综合征（MS）的早期动脉粥样硬化特征。结果发现MS人群各IMT指标均显著高于非MS人群（均P〈0．01）；随MS组分数量的增多，IMT呈现逐渐增高的趋势。     

藏族人群代谢综合征对早期动脉粥样硬化的影响

目的:探讨藏族人群代谢综合征对早期动脉粥样硬化的影响。方法:在查体的藏族人群中筛选代谢综合征(MS)患者。记录身高、体重、腰围、血压,测定空腹血糖(FPG)、空腹胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)。超声检查颈动脉内中膜(IMT)厚度。结果:总共1187人参加筛选,其中MS患者206人。分为MS组和对照组。MS组的体重指数、收缩压、舒张压、TC、TG、FPG、FINS、胰岛素抵抗指数(HOMA指数)均显著高于对照组(P<0.01)。MS组的IMT较对照组增厚(P<0.001)。多元回归分析结果显示FPG、收缩压、舒张压、TG、HDL-C、腰围和HOMA指数均为颈动脉IMT的危险因子(P<0.05)。结论:藏族人群代谢综合征对早期动脉粥样硬化的形成有不利影响。     

代谢综合征患者颈动脉内膜-中层厚度变化及与动脉粥样硬化程度的关系

目的探讨代谢综合征(MS)患者颈动脉内膜-中层厚度(CAMT)的改变,及其与各种危险因素的关系。方法51例代谢综合征患者,按其血糖水平分为糖耐量减低(MS-IGT)组27例和2型糖尿病(MS-DM)组24例;另选25例健康者为对照组。均行超声检查,测定CAMT,并做血脂、血糖等检查。结果代谢综合征组CAMT高于对照组(P<0.01)。CAMT与年龄、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、空腹血糖(FPG)、餐后2h血糖(2hPG)、空腹胰岛素(FINS)、2h胰岛素(2hINS)、血总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白-B(Apo-B)呈正相关(P<0.01)。多元逐步回归分析,年龄、SBP、DBP、BMI、FPG、2hPG、2hINS、TC、LDL-C与CAMT关系较为密切。结论代谢综合征患者可加速动脉粥样硬化的进展。CAMT能在早期反映高血压、高血糖和高血脂对动脉粥样硬化的促进作用。     

代谢综合征患者氧化型低密度脂蛋白与颈动脉硬化的相关性

目的探讨血清中氧化型低密度脂蛋白（oxidized low density lipoprotein,ox-LDL）水平与代谢综合征（metabolic syndrome,MS）患者危险因素和颈动脉内膜中层厚度（intima-media thickness,IMT）的关系及临床意义。方法入选86例MS患者和39例正常体检者,根据危险因素的数目分为低危MS组（n=42）和高危MS组（n=44）,用彩色超声多普勒测定IMT,ELISA方法检测受试者血清中ox-LDL,进行单因素方差分析和Logistic回归分析。结果血清ox-LDL水平、IMT在正常对照组、低危MS组和高危MS组中依次增高,各组间差异有显著性（P〈0.01）。以IMT〉0.9mm为颈动脉硬化（carotid atherosclerosis,CA）,Logistic回归分析结果示ox-LDL与CA独立相关,优势比为1.189（95%CI：1.078～1.312）。结论 ox-LDL是MS患者的CA的独立危险因素之一,血清ox-LDL可作为临床评价MS病情发展和CA的危险因子。     

肥胖儿童血清脂联素水平与代谢综合征、早期动脉粥样硬化的相关性研究

目的 研究脂联素在肥胖儿童极早期动脉粥样硬化形成过程中所起的保护性作用,评价血清脂联素水平对儿童代谢综合征的诊断价值.方法 选择176例肥胖和88名非肥胖年龄9～12岁的儿童,酶联免疫法(ELISA)检测血清脂联素水平,收集身高、体重、腰围、血压、胰岛素、超敏C反应蛋白(hsCRP)、血脂、血糖等临床资料,计算稳态模型评估的胰岛素抵抗指数(HOMA-IR).超声测量颈动脉内中膜层厚度(IMT)、颈动脉血管顺应性(CAC)、内皮依赖的血管舒张功能(FMD)和最大的腹膜前脂肪厚度(Pmax).结果 (1)脂联素与肥胖指标、血压、低密度脂蛋白胆固醇、空腹胰岛素、HOMA-IR、hsCRP、IMT呈显著负相关(P<0.05或P<0.01),与甘油三酯、空腹血糖、CAC、高密度脂蛋白胆固醇(HDL-C)、FMD无显著相关性(P>0.05).(2)以脂联素水平7.060 mg/L为切点,<7.060 mg/L的儿童发生代谢综合征的危险是>7.060 mg/L的4.43倍.(3)用血清脂联素水平判断代谢综合征诊断的敏感性,曲线下面积为0.769(95%CI0.714～0.816,P<0.01).(4)根据血清脂联素水平将肥胖儿童分为高、中、低3组,重度肥胖、内脏脂肪积聚、高血压、高胰岛素血症、低HDL-C、代谢综合征患病率3组间比较有显著性差异(P<0.05).结论 提高肥胖儿童血清脂联素水平有助于预防极早期动脉粥样硬化的发生.脂联素越低的儿童,患代谢综合征的可能性似越大.     

Oxidized to non-oxidized lipoprotein ratios are associated with arteriosclerosis and the metabolic syndrome in diabetic patients

Background and aimType 2 diabetic patients have a greater prevalence of the metabolic syndrome, oxidative stress and accelerated atherosclerosis, compared to non-diabetics. We examined the association between biomarkers of lipid peroxidation and the presence of atherosclerosis and the metabolic syndrome in diabetic patients.Methods and resultsWe studied oxidized LDL (OxLDL), OxLDL/LDL, OxLDL/HDL, lipoperoxides, autoantibodies against OxLDL (OxLDL-Ab), diene formation of LDL (lag phase), vitamin E, vitamin E/cholesterol and PON1 polymorphisms (−108C > T, 55T > A, and 192A > G) in 166 non-smoking type 2 diabetic patients, 119 fulfilling the criteria for the metabolic syndrome, 73 with atherosclerosis and 93 without atherosclerosis. Patients with macrovascular disease had higher values of OxLDL/LDL (11%; P = 0.016), OxLDL/HDL (18%; P = 0.024) and OxLDL-Ab (12%; P = 0.046). OxLDL/LDL and OxLDL/HDL were correlated with the number of components of the metabolic syndrome (P < 0.001). PON1 polymorphisms were not associated to LDL oxidation markers, only PON1 (−108TT) was weakly associated with higher OxLDL-Ab concentrations (22%; P = 0.040) in patients with atherosclerosis.ConclusionOxLDL/LDL, OxLDL/HDL and OxLDL-Ab are the most useful clinical parameters of lipoprotein oxidation for discriminating the presence of macrovascular disease in diabetic patients. The presence of the metabolic syndrome in these patients is also associated with an increase in the oxidized lipoprotein ratios.     

代谢综合征颈动脉斑块相关因素分析

目的研究代谢综合征(MS)患者颈动脉斑块的危险因素及不同程度颈动脉斑块的相关因素。方法将上海复旦大学附属华山医院老年病科2005年1月至2007年1月收治患者按2005年国际糖尿病联盟的MS诊断标准分为MS组219例,非代谢综合征(NMS)组182例。测定血压、血脂、血糖、胰岛素、C-反应蛋白、尿蛋白等指标,计算胰岛素敏感指数,询问用药史。B超测定双侧颈动脉观察指标,半定量估计斑块的范围及严重程度,分为4级。结果与NMS组患者比较,MS组颈动脉斑块的发生率更高,颈动脉斑块的程度更严重(P<0.05),MS者发生颈动脉斑块的危险性是NMS者的2.01～4.12倍。餐后2h血糖、脂蛋白a、胰岛素敏感指数、胰岛素抵抗指数、体重指数、C-反应蛋白等检验指标与颈动脉斑块严重程度相关;颈动脉斑块程度越重,TC/HDL比值越高(F=5.89,P=0.003)。尿蛋白、尿肌酐、尿蛋白肌酐比值在各组间差异也有统计学意义。结论MS是颈动脉斑块的危险因素,抗血小板及降脂药物者可能有助于减少颈动脉斑块的发生,减缓颈动脉斑块的发展。TC/HDL比值的临床意义有待进一步研究。     

代谢综合征患者颈动脉粥样硬化的观察

目的探讨代谢综合征（MS）患者颈动脉粥样硬化的特征。方法108例患者分别为MS 40例、高血压病（EH）33例、糖尿病（DM）35例,并以此相应分成3组,比较3组患者血脂改变及颈动脉超声检测结果,以125例健康体检者作对照组。结果MS组和DM组患者血浆TG水平均明显升高。DM组和MS组颈动脉阻力指数均显著升高,3组颈总动脉内-中膜厚度明显增厚。MS组患者斑块指数较单纯EH组明显增高。结论MS患者发生颈动脉粥样硬化的危险性较单纯高血压组明显增加。     

Increased epicardial adipose tissue in type 1 diabetes is associated with central obesity and metabolic syndrome

Aims

The present study evaluated the relationship between metabolic syndrome (MS), body fat composition and epicardial adipose tissue (EAT) in type 1 diabetes. Epicardial adipose tissue is a new independent marker of coronary artery disease (CAD).

Methods

Forty-five type 1 diabetic women were evaluated (age 36 ± 9 years; body mass index 24.6 ± 4.4 kg/m²). Metabolic syndrome was defined by the World Health Organization criteria. Body fat composition and EAT were analyzed by dual-energy-X-ray absorptiometry and echocardiogram, respectively.

Results

Twenty patients (45%) had MS. Patients with MS had greater android (central) fat deposition than patients without MS (41.9 ± 2.0% vs. 33.7 ± 1.8%, p = 0.004). Total body fat and gynoid (peripheric) fat distribution were similar between the groups. Mean EAT was higher in patients with MS (6.15 ± 0.34 mm vs. 4.96 ± 0.25 mm; p = 0.006) and EAT was positively correlated with android (central) fat distribution (r = 0.44; p = 0.002), however no correlation was found with gynoid (peripheric) fat distribution.

Conclusions

There was a high incidence of MS in type 1 diabetes related to increased central adiposity, despite the absence of obesity. Metabolic syndrome and central obesity were associated with increased EAT. Thus, young non-obese type 1 diabetic women with central adiposity and/or MS may have increased EAT, what may predict CAD risk.     

代谢综合征患者血浆网膜素1水平与HDL亚类分布的相关性分析

目的探讨代谢综合征(MS)患者血浆网膜素1(Omentin-1)水平对高密度脂蛋白(HDL)亚类分布的影响。方法收集在南华大学附属医院就诊的MS患者102例和对照组81例的血样,采用全自动生化分析仪测定血脂浓度及载脂蛋白含量,酶联免疫吸附法测定Omentin-1的含量,双向电泳-免疫印迹法测定人血浆HDL亚类的相对含量。按Omentin-1浓度均值加减去一个标准差作为分割点,将MS患者分为3组:低Omentin-1组(Omentin-1≤9.10μg/L)、中Omentin-1组(9.10μg/LOmentin-126.68μg/L)、高Omentin-1组(Omentin-1≥26.68μg/L)。结果随着Omentin-1浓度的降低,MS患者血浆甘油三酯(TG)、总胆固醇(TC)及ApoB100/AⅠ和LDLC/HDLC比值均显著性增高(P0.05或P0.01),高密度脂蛋白胆固醇(HDLC)、ApoAⅠ含量显著降低(P0.05或P0.01)。与低Omentin-1组相比,高Omentin-1组中小颗粒的preβ1-HDL和HDL3b含量显著下降(P0.05或P0.01),而大颗粒的HDL2a含量显著上升(P0.05)。结论 MS患者血浆Omentin-1水平降低,且HDL颗粒呈变小趋势,低水平的Omentin-1可能与HDL亚类分布异常和血脂紊乱有关。     

2型糖尿病合并代谢综合征患者颈动脉硬化的影响因素分析

目的分析2型糖尿病合并代谢综合征（MS）患者颈动脉硬化的影响因素。方法用超声多普勒检查205例2型糖尿病合并MS患者双侧颈动脉。根据超声特征分为内膜正常组、内膜增厚组、稳定性斑块组、不稳定性斑块组,测定空腹血糖（FPG）、空腹胰岛素（FINS）、餐后两小时血糖（2hPG）、餐后两小时胰岛素（2hINS）、糖化血红蛋白（HbA1c）、血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和尿酸（UA）等指标。分析以上因素与颈动脉硬化程度的相关关系。结果四组间FPG、HbA1c、FINS、2hINS和舒张压（DBP）均无明显差异;而颈动脉内膜增厚组、稳定斑块组、不稳定斑块组的年龄、2hPG、TG、TC、LDL-C、UA、收缩压和脉压明显高于颈动脉正常组,而HDL-C明显低于颈动脉正常组,且差异均有统计学意义（P均〈0．05）。不稳定斑块组的年龄、2hPG、TG、LDL-C及UA均高于其他组;不稳定斑块组的HDL-C均低于稳定斑块组,内膜增厚组及颈动脉正常组。多元逐步回归分析结果显示患者的年龄、TG、LDL—C、2hPG进入回归方程,与颈动脉粥样硬化评分呈正相关。结论2型糖尿病合并MS患者颈动脉硬化程度与年龄、血压、血脂及餐后血糖等多种因素有关,提示2型糖尿病合并MS患者在降低空腹血糖的同时,也应控制餐后血糖,更应重视血压、血脂的干预。     

The metabolic syndrome is associated with complicated gallstone disease

BACKGROUND:

Gallstone disease (GD) is a common condition worldwide. Several studies demonstrated that the presence of gallstones is strongly associated with cardiovascular disease. The metabolic syndrome is a highly prevalent cardiovascular condition.

OBJECTIVE:

To examine the relationship between complicated GD (CGD) and the metabolic syndrome or its components.

METHODS:

Two hundred seventeen patients with gallstones were examined. All patients underwent biliary ultrasonography after a complete medical history and laboratory examination. Data collection for the diagnosis of metabolic syndrome included measurements of waist circumference, blood pressure and lipids, and biochemical tests.

RESULTS:

Of the 217 patients examined, 115 patients (53%) had CGD and 102 patients (47%) had uncomplicated GD (UCGD). There was a significant difference between the number of patients with large gallstones in the CGD and UCGD groups (n=14 [12%] versus n=2 [2%], respectively; P=0.004). Metabolic syndrome, diabetes mellitus and large waist circumference were more prevalent in the CGD group than in the UCGD group. Homeostatic model assessment of insulin resistance scores were higher in the CGD group than in UCGD group (2.51 [95% CI 0.57 to 23.90] versus 2.20 [95% CI 0.09 to 8.87], respectively; P=0.032). Logistic regression analysis revealed that the presence of metabolic syndrome (OR 1.434; 95% CI 1.222 to 1.846, P=0.014), diabetes mellitus (OR 1.493; 95% CI 1.255 to 1.953; P=0.035) and large gallstones (OR 1.153; 95% CI 1.033 to 1.714; P=0.017) were independent predictors of CGD.

CONCLUSION:

Results of the present study demonstrated that metabolic syndrome, diabetes and gallstone size were associated with CGD. Further prospective studies are needed to understand the clinical importance of this association.     

A comparison of the NCEP-ATPIII, IDF and AHA/NHLBI metabolic syndrome definitions with relation to early carotid atherosclerosis in subjects with hypercholesterolemia or at risk of CVD: evidence for sex-specific differences

The metabolic syndrome is associated with increased risk of cardiovascular disease. However, the association between metabolic syndrome and atherosclerosis in hypercholesterolemic patients remains unknown. We examined the association between carotid atherosclerosis and metabolic syndrome definitions using the NCEP-ATPIII, International Diabetes Federation (IDF) and American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definitions in 1782 subjects at risk of cardiovascular disease including 926 with hypercholesterolemia (LDL cholesterol ≥160 mg/dL; mean = 203 mg/dL).

Irrespective of definition, carotid intima-media thickness was significantly higher in both men and women diagnosed with the MetS compared to those without MetS. This relationship persists in males with hypercholesterolemia, independently of LDL cholesterol level. Regression analyses, both unadjusted and adjusted for traditional risk factors, indicate that in males the AHA/NHLBI definition, and in females the IDF definition are the strongest predictors of carotid atherosclerosis.

These results highlight important gender differences that exist in the current clinical definitions of the metabolic syndrome, with regards to predicting early atherosclerotic lesions. In addition, this study shows that in males with hypercholesterolemia, MetS is independently associated with increased atherosclerosis, supporting screening for MetS among people at risk of CVD.     

骨保护素与代谢综合征

骨保护素(OPG)是一种分泌型糖蛋白,属于肿瘤坏死因子受体超家族成员,不仅在骨代谢过程中起重要作用,而且是重要的血管调节因子,能够保护血管内皮细胞,抑制血管钙化和动脉粥样硬化.代谢综合征(MS)包括腹型肥胖、胰岛素抵抗、血脂异常、高血糖、高血压等.MS各组分均为心血管疾病的危险因素,2型糖尿病患者血OPG水平明显升高,但是OPG与MS其他各组分之间的关系日前还存在争议.