二甲双胍对高胰岛素血症肥胖儿童糖代谢和血清脂源性激素的影响

目的观察二甲双胍治疗对高胰岛素血症肥胖患儿血清脂源性激素脂联素、抵抗素、瘦素水平的影响。 方法2004 01—2005 02将武汉市儿童医院和同济医院54例高胰岛素血症肥胖患儿分为轻、中度肥胖组及重度肥胖组,均以二甲双胍治疗12周，测量治疗前后体重、空腹血糖、空腹胰岛素及脂源性激素脂联素、瘦素、抵抗素的变化。 结果治疗前轻、中度肥胖组和重度肥胖组高胰岛素血症患儿空腹血糖水平与健康对照组比较差异无显著性(P>0.05)，血清胰岛素、瘦素、抵抗素及胰岛素抵抗指数(HOMA IR)均高于健康对照组(P<0.01)，脂联素水平明显低于健康对照组(P<0.01)。二甲双胍治疗12周后与治疗前相比,血清胰岛素水平、胰岛素抵抗指数明显降低(P<0.01)，轻、中度肥胖组及重度肥胖组血清瘦素水平分别由治疗前的(24.3±1.8)μg/L、(30.2±5.1)μg/L降低为治疗后的(19.6±6.3)μg/L、(24.7±5.3)μg/L，差异有统计学意义；抵抗素水平分别由治疗前的(16.5±6.0)μg/L、(22.3±5.2)μg/L升高为(22.0±5.1)μg/L、(30.6±11.7)μg/L，差异有统计学意义；轻、中度肥胖组和重度肥胖组血清脂联素水平治疗前分别为(8.4±3.2)mg/L、(6.5±1.2)mg/L，治疗后分别为(8.9±2.3)mg/L、(7.03±3.0)mg/L，治疗前后相比,P>0.05。体重指数(BMI)下降,但差异无显著性。 结论二甲双胍能显著改善肥胖患儿胰岛素抵抗。降低血清瘦素水平可能是其改善胰岛素抵抗机制之一，但在对脂源性激素脂联素、抵抗素水平的改善上，有其局限性。     

丙戊酸钠治疗儿童失神癫疒间的疗效

目的观察丙戊酸钠单剂治疗儿童失神癫疒间的疗效。 方法选择1990-04—2004-05在首都儿科研究所儿童医院诊断失神癫疒间并首选口服丙戊酸患儿123例，发作未能完全控制者加用氯硝西泮，观察其疗效并进行追踪。 结果123例患儿中，丙戊酸单药治疗后发作完全控制者105例，发作完全控制率844%，其余18例单用丙戊酸发作未能完全控制者，加用氯硝西泮后，发作均得到完全控制，全部患儿发作完全控制率为100%。追踪34例停药后的患儿9个月至10年，其中2例复发，占59%。 结论丙戊酸单药治疗失神癫疒间能使844%的患儿发作完全控制，发作不能完全控制者应加用氯硝西泮,二者联合用药可使患儿的临床发作得到完全控制,且起效快。     

多囊卵巢综合征血浆瘦素的改变及相关影响因素的研究

目的探讨多囊卵巢综合征(PCOS)患者血浆瘦素(leptin)水平的变化及其相关影响因素。方法用放射免疫学方法检测63例PCOS患者血浆leptin、血清泌乳素、促黄体生成素、卵泡刺激素、雌二醇、睾酮、雄烯二酮水平,同时行糖耐量及胰岛素释放实验。用相关分析探讨leptin与体重指数(BMI)、性激素、血糖、胰岛素和胰岛素敏感指数的关系。结果PCOS患者空腹胰岛素(r=0.6,P<0.01)和BMI(r=0.351,P<0.01)与血浆瘦素呈显著正相关,且空腹胰岛素对瘦素的影响更显著。结论瘦素可能与PCOS的胰岛素抵抗、高胰岛素血症密切相关。     

多囊卵巢综合征患者血循环中瘦素水平及其相关因素的临床研究

目的 :探讨多囊卵巢综合征 (PCOS)患者血循环中瘦素水平与其它内分泌、代谢指标之间的关系 ,进一步研究瘦素的作用规律。方法 :PCOS患者 82例 ,行葡萄糖耐量试验 (OGTT)、胰岛素释放试验 ,测定 5个时点的血糖、胰岛素以及C 肽 (C P)浓度 ;测定空腹血瘦素、性激素及促性腺激素浓度 ;同时测定患者的体重指数 (BMI)、腰臀比例(WHR) ,观察胰岛素增敏剂治疗对瘦素的影响。瘦素和胰岛素用放免法测定 ,C 肽和性激素用发光免疫法测定。结果 :肥胖组瘦素水平显著高于消瘦组 (P =0 .0 0 0 1 ) ,瘦素水平与体重指数呈高度正相关 (P =0 .0 0 0 1 ) ;与腰臀比例、空腹、60min、1 2 0min胰岛素浓度呈显著正相关 (P分别为 0 .0 1 96、0 .0 3 0 8、0 .0 0 0 6、0 .0 0 1 4) ;与OGTT各时点的血糖、C 肽浓度以及血糖、胰岛素、C 肽曲线下面积之间无显著相关性 (P >0 .0 5 )。二甲双胍、文迪雅对瘦素水平无显著影响。结论 :PCOS患者的瘦素浓度与体内脂肪含量及分布密切相关。PCOS患者可能同时存在瘦素抵抗和胰岛素抵抗。用改善胰岛素敏感性药物治疗对瘦素水平无显著影响。     

托吡酯对戊四氮诱导癫疒间大鼠体重和血清胰岛素及海马胰岛素样生长因子 1水平的影响

目的观察托吡酯(TPM)对戊四氮(PTZ)致癫疒间大鼠血清胰岛素(INS)及海马胰岛素样生长因子 1(IGF 1)水平表达的影响及二者与体重变化的关系，探讨托吡酯引起体重下降的机制。 方法佳木斯大学附属第一医院儿科于2005 03—2005 09将114只大鼠随机分为4组:空白组,TPM对照组,PTZ组,TPM治疗组，每3d测1次体重,在2、4、6周末应用放射免疫法测血清INS水平,免疫组化法测海马IGF 1表达。 结果TPM对照组、TPM治疗组在第3周末较其它两组出现体重下降，4周末降至最低点(P<005)；在4周末TPM对照组、PTZ组、TPM治疗组与空白组相比，TPM治疗组与PTZ组相比，血清INS明显降低，海马IGF 1阳性神经元细胞数明显升高(P<005)。6周末TPM治疗组与空白组、TPM对照组相比血清INS水平均显著降低(P<005)；TPM治疗组与空白组、TPM对照组、PTZ组比较，海马IGF 1阳性神经元细胞数均明显升高(P<005)。 结论托吡酯能使大鼠体重减轻,但不是通过降低大鼠血清INS水平、升高脑海马IGF 1水平实现的。另外,癫疒间大鼠血清INS降低，海马IGF 1阳性神经元细胞数水平升高，二者是否参与了癫疒间的病理生理过程尚待进一步研究。     

妊娠期糖尿病患者血清瘦素肿瘤坏死因子与胰岛素抵抗的关系

目的探讨妊娠期糖尿病患者血清瘦素(Leptin)与胰岛素抵抗水平、肿瘤坏死因子的关系。方法2002年1月至2005年2月解放军181医院对32例妊娠期糖尿病患者(GDM)为观察组,随机选择同期门诊及住院36例糖耐量正常妊娠妇女为对照组,均进行75g葡萄糖耐量试验(OGTT),同时测定空腹血清瘦素(leptin)、肿瘤坏死因子(INFα)、胰岛素(FINS),稳态模型(HOMA)计算胰岛素抵抗指数(HOMAIR),并应用pearson分析妊娠期糖尿病患者胰岛素抵抗与瘦素、INFα、空腹胰岛素、体重指数(BMI)的关系。结果观察组血清瘦素、INFα、FINS及胰岛素抵抗指数均明显高于对照组(P<0.05或P<0.01);血清瘦素、INFα、FINS、BMI与HOMAIR呈正相关(P<0.01)。结论瘦素、肿瘤坏死因子是影响妊娠期糖尿病患者胰岛素抵抗的重要因素之一。     

托吡酯治疗前后癫疒间患儿内分泌激素的变化及分析

目的探讨托吡酯对癫疒间患儿部分内分泌功能的影响。 方法于2003年6月~2004年6月对山东省立医院儿科符合癫疒间诊断的36例患儿分别于治疗前、治疗3个月、治疗6个月测量血中部分内分泌激素，并对其进行比较。 结果血三碘甲状腺氨酸(T3)在治疗3个月时较治疗前明显增高(P<0.05)，6个月时增高不明显；而胰岛素、皮质醇、C-肽在治疗3个月、6个月时则明显降低(P<0.05)，但在治疗3、6个月之间T3、胰岛素、皮质醇、C-肽并无明显变化；T4、TSH、生长激素在治疗过程中无明显变化；体重指数在治疗3个月时明显下降，6个月时又有所回升。 结论托吡酯对生长激素无明显影响，不影响儿童的生长发育。     

脑性瘫痪患儿合并癫疒间32例临床分析

目的探讨合并癫疒间的脑性瘫痪患儿的临床特点及癫疒间治疗效果。 方法总结1999年10月至2004年5月在西安交通大学第二医院住院的合并癫疒间的脑性瘫痪患儿的癫疒间发生率、临床类型、头颅计算机体层成像(CT)和(或)磁共振成像(MRI)、脑电图等方面的特点以及抗癫疒间治疗效果。 结果139例脑性瘫痪患儿中有32例合并癫疒间，占230%(32/139)；常见的癫疒间类型为强直 阵挛发作12例(375%)和部分性发作6例(188%)；25例(781%)癫疒间首发于1岁前；合并癫疒间脑性瘫痪儿童的头颅影像异常及脑电图异常分别占30例(938%)和27例(844%)；常见的头颅影像异常为脑发育不良11例(367%)、脑积水6例(200%)，余为脑萎缩、缺氧缺血性脑病样改变等13例(433%)；脑电图异常中局灶性和弥漫性所占比例分别为482%(13/27)和518%(14/27)；癫疒间多发生于痉挛性脑性瘫痪中(688%)；813%(26/32)的癫疒间需要2种及2种以上的抗癫疒间药物治疗。 结论脑性瘫痪患儿中癫疒间的发生率较高，其头颅影像学和脑电图分别以脑发育不良和弥漫性背景活动异常伴疒间样波发放为主；脑性瘫痪儿童的癫疒间大多为难治性，需要联合用药治疗。     

复方醋酸环丙孕酮和罗格列酮序贯用药对氯米芬抵抗的多囊卵巢综合征患者内分泌及生育功能的影响

目的探讨复方醋酸环丙孕酮和罗格列酮序贯用药对改善多囊卵巢综合征（PCOS）患者生育功能的临床疗效。方法30例氯米芬抵抗的PCOS胰岛素抵抗患者，口服复方醋酸环丙孕酮3个月后，罗格列酮联合氯米芬用药6个月，比较用药前后体重指数、月经周期、生殖激素水平、排卵率、妊娠率、血糖和胰岛素水平的变化。结果与用药前相比，服用复方醋酸环丙孕酮后，雄激素水平和LH／FSH值明显降低（P〈0．05），服用罗格列酮后，胰岛素抵抗指数（Homa IR）、胰岛素分泌指数（Homa β）以及β细胞功能评定指数（MBCI）均较用药前降低（P〈0．05）。结论复方醋酸环丙孕酮和罗格列酮序贯用药可有效地抑制氯米芬抵抗的PCOS患者的高雄激素血症，改善胰岛素抵抗及生育功能。     

单纯性肥胖男性儿童瘦素与几种内分泌指标检测与分析

目的研究肥胖男性儿童的内分泌变化和瘦素(Leptin)对肥胖男性儿童的内分泌功能的作用。 方法肥胖组为2000~2004年在哈尔滨市儿童医院门诊就医体重高于同年龄小儿标准体重20%的患儿90例，对照组为体检正常的男性儿童共90名，年龄在5~16岁。测定身高体重指数(BMI)，Leptin、胰岛素、性腺系列、血脂系列，进行统计学分析。 结果肥胖男性儿童与正常男性儿童比较，Leptin、胰岛素、雌二醇、总胆固醇、甘油三脂、A/B、低密度脂蛋白、极低密度脂蛋白有显著的增加，睾酮、黄体生成素(LH)有显著的减少；肥胖男性儿童身高体重指数与Leptin、胰岛素、黄体酮、催乳素、载脂蛋白A、A/B之间有显著的负相关，与雌二醇、载脂蛋白B、极低密度脂蛋白之间有显著的正相关。 结论Leptin可作为评价肥胖男性儿童内分泌功能的一项指标，Leptin与胰岛素、皮质醇、性激素等可能存在相互作用，对机体发育、能量代谢、应激反应等方面有所影响。     

妊娠妇女及新生儿脐血瘦素水平与体重,胰岛素,C—肽,胰岛 …

目的　探讨妊娠晚期妇女及新生儿脐血瘦素水平与孕妇体重及新生儿体重的关系 ,以及新生儿脐血瘦素水平与C 肽、胰岛素、胰岛素样生长因子 Ⅱ (IGF Ⅱ )等的关系。方法　采用放射免疫法测定 5 0例孕 37～ 38周正常妊娠妇女 (研究组 )及其新生儿、2 9例健康未妊娠妇女 (对照组 )的血瘦素水平 ,并同时测定新生儿脐血C 肽、胰岛素、IGF Ⅱ的水平等。结果　 (1)妊娠晚期妇女血瘦素水平为 (13.6 2± 3.6 8) μg/L ,明显高于对照组妇女的 (6 .6 0± 3.0 4) μg/L及新生儿脐血瘦素的 (8.0 5± 4.6 1) μg/L。 (2 )妊娠晚期妇女血瘦素水平与本身体重及体重指数明显相关 (r分别为 0 .33、0 .35 ,P<0 .0 5 ) ;妊娠晚期妇女血瘦素水平与新生儿体重无明显相关 (r=0 .10 ,P >0 .0 5 )。 (3)新生儿脐血瘦素水平与其体重、体重指数明显相关 (r分别为 0 .5 4、0 .49,P <0 .0 0 1) ;而与妊娠晚期妇女血瘦素水平无明显相关 (r=0 .19,P >0 .0 5 )。 (4 )对照组妇女血瘦素水平与其体重、体重指数明显正相关 (r分别为 0 .72、0 .78,P <0 .0 0 1)。 (5 )新生儿脐血C 肽为 (0 .86± 0 .35 ) μg/L ,胰岛素为 (8.49± 4.76 )mU/L ,IGF Ⅱ为 (0 .2 18± 0 .0 76 ) μg/L ;新生儿脐血瘦素水平与C 肽明显相关 (r=0 .37,P <0 .0 5 )     

Serum leptin levels in patients with polycystic ovary syndrome

OBJECTIVE: To determine whether polycystic ovary syndrome (PCOS) is related to leptin dysregulation. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynecology in a university hospital. PATIENT(S): Fifty patients with PCOS (33 nonobese and 17 obese) and 32 control women (19 nonobese and 13 obese) were included in the study. INTERVENTION(S): Serum leptin levels were measured in patients with PCOS and the controls. Correlations between leptin levels and serum hormone levels (FSH, LH, free testosterone, androstenedione, DHEA-S and fasting insulin) were studied. MAIN OUTCOME MEASURE(S): Serum leptin levels and correlations between leptin levels and the hormonal parameters. RESULT(S): Mean serum leptin levels were not significantly higher in patients with PCOS compared to the control group. Leptin levels were found to be significantly higher in the obese subgroups both in patients with PCOS and in the control women. Leptin levels were found to be higher in obese patients with PCOS compared to obese controls; however, when the levels were evaluated again with covariance analysis excluding body mass index, there was no statistically significant difference. Leptin levels had a positive correlation with body mass index, both in patients with PCOS and the controls. CONCLUSION(S): Leptin levels were not higher in patients with PCOS compared to the control group; the leptin level was correlated with the amount of fat tissue not only in patients with PCOS but also in healthy women.     

正常妊娠妇女及新生儿脐血瘦素水平测定及其临床意义

目的 探讨正常妊娠妇女及新生儿脐血瘦素水平及其临床意义。方法 采用放射免疫法测定对照组的１０例正常未妊娠妇女、观察组的６３例妊娠妇女（其中早孕３１例，中孕１０例，晚孕２２例）、２７例分娩妇女、１８例产后妇女的血甭瘦素水平，及１８例新生儿脐血的瘦素水平。同时测定两组妇女的身高、体重、空腹胰岛素及血脂水平，并分析其与瘦素之间的关系。结果 ⑴妊娠妇女从孕中其开始，空腹胰岛素、胆固醇、甘油三酯明显升高，临     

Serum leptin levels correlate with obesity parameters but not with hyperinsulinism in women with polycystic ovary syndrome

OBJECTIVE: To examine serum leptin concentrations in obese and lean patients with polycystic ovary syndrome (PCOS) to assess whether the changes in leptin levels are due to obesity or hormonal alterations. DESIGN: Controlled clinical study. SETTING: Academic research environment. PATIENT(S): Obese and lean women with PCOS. INTERVENTION(S): Blood samples were collected before and after food consumption. MAIN OUTCOME MEASURE(S): Serum leptin and insulin levels. RESULT(S): Serum leptin concentrations were significantly correlated with body mass index (r = 0.649) and also with HOMA (r = 0.535). However, after controlling for body mass index in a partial correlation analysis, no significant correlation was found between serum leptin levels and HOMA or hyperinsulinemia. While lean patients with PCOS had a significant correlation between leptin concentrations and obesity parameters, they did not show any significant correlation with insulin resistance parameters. CONCLUSION(S): Although leptin concentrations in women with PCOS correlate with insulin resistance/hyperinsulinemia, this is related only to obesity.     

Effects of pregnancy and exercise on concentrations of the metabolic markers tumor necrosis factor alpha and leptin

OBJECTIVE: Pregnancy and exercise have opposite effects on fat mass and insulin resistance. We therefore designed this study to test the hypotheses that exercise during pregnancy alters the pregnancy- associated increases in the levels of tumor necrosis factor alpha and leptin and that the changes in tumor necrosis factor alpha and leptin concentrations during pregnancy continue to reflect changes in fat mass. STUDY DESIGN: The levels of tumor necrosis factor alpha and leptin were measured longitudinally in a control group of physically active women, a group of women who performed endurance exercises >/=4 times a week throughout pregnancy, and a group of women who initially performed endurance exercises but then stopped exercising during midpregnancy. Exercise was monitored, and longitudinal estimates of maternal total mass and fat mass were obtained. RESULTS: Tumor necrosis factor alpha levels were lower during pregnancy in the women who exercised, and the same was true for leptin levels. When women stopped exercising, however, both tumor necrosis factor alpha and leptin concentrations rose at rates comparable to those seen in the physically active control group. Changes in leptin concentration but not those in tumor necrosis factor alpha concentration correlated with the pregnancy-associated increases in total body and fat mass. CONCLUSIONS: Regular weight-bearing exercise during pregnancy suppresses the pregnancy-associated changes normally seen in both tumor necrosis factor alpha and leptin. The decrease in leptin reflects decreased fat accretion, and we speculate that the changes in tumor necrosis factor alpha may reflect a change in insulin resistance.     

The pathophysiological influence of leptin and the tumor necrosis factor system on maternal insulin resistance: negative correlation with anthropometric parameters of neonates in gestational diabetes.

The contribution of the tumor necrosis factor (TNF) system and leptin was studied in insulin resistance and neonatal development during the course of normal pregnancy and gestational diabetes mellitus (GDM). Thirty patients with GDM and their neonates (n = 30), 35 healthy pregnant women (15 in the first, nine in the second and 11 in the third trimester) and their neonates (n = 20), and 25 healthy matched non-pregnant women participated in the study. Significantly elevated levels of maternal TNF-alpha, sTNF receptor (R)-1 and R-2, leptin (detected by enzyme-linked immunosorbent assay) and fasting C-peptide (measured by radioimmunossay and raised body mass index (BMI) were found in GDM patients and in the third trimester of normal pregnancies. TNF-alpha, sTNFR-2, C-peptide, leptin concentrations and BMI positively correlated with each other in GDM. An inverse relationship between the body length, head circumference and body weight of the newborns, and maternal TNF-alpha, leptin and C-peptide concentrations was shown in GDM. In healthy pregnancies the maternal serum leptin level was in a negative linear correlation with the head circumference of the newborns. In conclusion, increased TNF-alpha and leptin levels may contribute to insulin resistance in GDM and in the third trimester of normal pregnancy and may negatively influence the anthropometric parameters of the newborns.     

Evidence for competing effects of body mass,hyperinsulinemia, insulin resistance,and androgens on leptin levels among lean,overweight, and obese women with polycystic ovary syndrome

OBJECTIVE: To evaluate the relationships between leptin, body composition, insulin resistance, androgens, and reproductive indices among women with polycystic ovary syndrome (PCOS).DESIGN: Matched case-control study.SETTING: Academic reproductive endocrine practice; school of public health.PATIENT(S): Forty-six Caucasian women with PCOS and 46 population-based controls matched by age and body mass index (BMI).INTERVENTION(S): None.MAIN OUTCOME MEASURE(S): Leptin, insulin, androgenic hormones, body composition parameters; reproductive parameters.RESULT(S): Overall, leptin levels among women with PCOS did not differ significantly from those of control women (20.4 +/- 14.9 vs. 21.9 +/- 14.3 ng/mL). However, within the lowest BMI tertile, women with PCOS had significantly lower leptin levels (9.6 vs. 18.3 ng/mL), comparable insulin, and higher testosterone concentrations than controls of similar body mass. Within the overweight and obese subgroups, both insulin and testosterone levels were increased among women with PCOS; leptin levels, although higher among obese cases, were not statistically different than those in controls.CONCLUSION(S): Below a certain BMI, hyperandrogenic women with PCOS have lower leptin levels than controls. Conversely, overweight and obese PCOS subjects appear to produce insufficient leptin for a given fat mass, relative to the degree of hyperinsulinemia, potentially because of the competing effects of adipocyte insulin resistance and androgens on leptin.     

Hormone replacement therapy and cancer

The contribution of the tumor necrosis factor (TNF) system and leptin was studied in insulin resistance and neonatal development during the course of normal pregnancy and gestational diabetes mellitus (GDM). Thirty patients with GDM and their neonates (n = 30), 35 healthy pregnant women (15 in the first, nine in the second and 11 in the third trimester) and their neonates (n = 20), and 25 healthy matched non-pregnant women participated in the study. Significantly elevated levels of maternal TNF-α, sTNF receptor (R)-1 and R-2, leptin (detected by enzyme-linked immunosorbent assay) and fasting C-peptide (measured by radioimmunossay and raised body mass index (BMI) were found in GDM patients and in the third trimester of normal pregnancies. TNF-α, sTNFR-2, C-peptide, leptin concentrations and BMI positively correlated with each other in GDM. An inverse relationship between the body length, head circumference and body weight of the newborns, and maternal TNF-α, leptin and C-peptide concentrations was shown in GDM. In healthy pregnancies the maternal serum leptin level was in a negative linear correlation with the head circumference of the newborns. In conclusion, increased TNF-α and leptin levels may contribute to insulin resistance in GDM and in the third trimester of normal pregnancy and may negatively influence the anthropometric parameters of the newborns.