中风高发区长春、石家在与低发区景洪中风危险因素对比研究

本文于１９９０年１０月至１９９１年１２月在中风高发区长春、石家在与低发区景洪对４０岁以上中风高危人群进行了中风危险因素对比研究。结果：高血压、心脏病、糖尿病、冠心病、ＴＩＡ等患病率，高血脂、高红细胞压积、高血糖等比例，血清胰岛素、胆固醇、ＬＤＬ－ＣＨ、ＡＰＯＢ、Ｃ－肽、血清铁、锌、镁、铜的水平，心电图异常率、心电图ＳＴ－Ｔ改变及心房颤动比例，超体重指数肥胖、吸烟、饮酒量、中风家族史、高血压家族史等比例及中风危险因素积分景洪监测点均低于长春、石家在，并与中风发病率呈正相关。     

APOA—1／APOB初步测定与相关因素分析

本文应用联合免疫火箭电泳法检测了１２０例医院健康人的ＡＰＯＡ－１／ＡＰＯＢ，其结果如下：不分年龄组ＡＰＯＡ－１为１．２９±０．２１ｇ／Ｌ，ＡＰＯＢ为０．９４±０．１９ｇ／Ｌ，二者比值为１．５０±０．２８。按性别统计，各值相差不十分显著（Ｐ＞０．０５），按４０岁上下组统计ＡＰＯＢ、ＡＰＯＡ－１／ＡＰＯＢ比率有非常显著性差异（Ｐ＜０．０１）。同时对ＡＰＯＡ－１／ＡＰＯＢ高值组与低值对照组进行了ＣＬ、ＴＧ、饮食习惯、家族史、运动五项因素的跟踪分析，结果显示：ＡＰＯＡ－１／ＡＰＯＢ与五项因素相关     

心肌梗塞患者血脂、载脂蛋白A_1、B_(100)及脂蛋白(a)的研究

本文对８２例心肌梗塞（ＭＩ）患者和３０例健康人血清血脂、载脂蛋白及脂蛋白（ａ）进行测定，结果发现ＴＧ、ＴＣ与对照组无显著性差异，而ＨＤＬ、ＡｐｏＡ１明显降低，ＡｐｏＢ１００及Ｌｐ（ａ）明显升高。指出高ＡｐｏＢ１００、Ｌｐ（ａ）及低ＨＤＬ与低ＡｐｏＡ１是心肌梗塞的危险因素。     

NIDDM患者血浆纤溶酶原激活物抑制剂-1(PAI-1)与并发冠心病关系的探讨

为明确血浆纤溶酶原激活物抑制剂－１（ＰＡＩ－１）在ＮＩＤＤＭ发生冠心病中所起的作用，并分析其影响因素。将６０例ＮＩＤＤＭ患者分为冠心病（ＣＡＤ）组和非ＣＡＤ组，用底物发光法检测血浆ＰＡＩ－１及组织型纤溶酶原（ｔ－ＰＡ），同时检测血糖、血胰岛素、血脂等指标。结果表明：ＣＡＤ组血浆ＰＡＩ－１活性水平明显高于非ＣＡＤ组，分别为１０．０６±２．５与８．０８±２．６２，单位Ａｕ／ｍｌ，Ｐ＜０．０１。两组ｔ－ＰＡ相似。在ＣＡＤ组，血浆ＰＡＩ－１活性与空腹胰岛素、胰岛素敏感指数均相关，相关系数分别为０．２４（Ｐ＜０．０５）与－０．３（Ｐ＜０．０１），且与甘油三酯呈正相关（ｒ＝０．２４，Ｐ＜０．０５），和ＡｐｏＢ正相关（ｒ＝０．５１，Ｐ＜０．０５）。血浆ＰＡＩ－１活性水平的升高与ＮＩＤ－ＤＭ发生ＣＡＤ危险性存在相关。胰岛素抵抗状态、高胰岛素血症、高ＴＧ水平都可刺激血浆ＰＡＩ－１活性的升高，而高血糖对其无直接的作用。ＡｐｏＢ参与ＰＡＩ－１活性改变这一过程，并在ＣＡＤ发生中可能介导其它脂质异常刺激ＰＡＩ－１升高的作用。     

脑卒中与微量元素关系调查

本文讨论了我国脑卒中高发区、低发区脑卒中高危人群（ｓｐｐ）头发微量元素含量的变化与血压和生化指标的关系。结果发现高发区ＳＰＰ头发Ｋ、ｃａ、ｃｕ及ｃａ／Ｍｇ明显低于对照组（ｓｃ）及低发区ｓｐｐ，而Ｎａ、Ｍｇ、Ｚｎ及Ｎａ／Ｋ、Ｚｎ／Ｃｕ则明显高于ＳＣ和低发区。Ｋ与血压、ＡＰＯＢ呈负相关，与ＨＣＴ、ＡＰＯＡ－Ⅰ及Ｃ肽呈正相关；Ｎａ与增龄、血压、ＡＰＯＢ正相关，与Ｃ肽负相关；Ｃａ、Ｃａ／Ｍｇ与增龄、血压、ＨＣＴ、Ｃ肽负相关，与ＡＰＯＡ－Ⅰ正相关；Ｍｇ与增龄、ＢＭＩ、ＡＰＯＢ正相关，与ＨＣＴ负相关；Ｚｎ与增龄、血压、ＢＭＩ、ＢＳ正相关；Ｆｅ与ＡＰＯＢ及Ｃ肽正相关；Ｍｎ与Ｃｈ、ＬＤＬ负相关，与Ｃ肽和胰岛素正相关。经逐步回归分析发现，Ｋ、Ｎａ、ｃａ与血压关系最密切。     

TG、ApoB、HDL-C预示NIDDM发生脑梗塞可能性探讨

目的：探讨非胰岛素依赖性糖尿病（ＮＩＤＤＭ）患者发生脑梗塞的血脂预示因素。方法：对正常人组、非ＮＩＤＤＭ脑梗塞组、ＮＩＤＤＭ无脑梗塞组、ＮＩＤＤＭ脑梗塞组进行血糖、糖化血红蛋白Ａ１ｃ、血脂、纤维蛋白原的测定，并加以比较。结果：甘油三酯、载脂蛋白Ｂ、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）在ＮＩＤＤＭ脑梗塞组与ＮＩＤＤＭ无脑梗塞组间有显著差异，低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）各组间无显著差异，其余指标ＮＩＤＤＭ脑梗塞组与非ＮＩＤＤＭ脑梗塞组无显著差别。结论：ＮＩＤＤＭ患者是发生脑梗塞的高危人群，其中甘油三酯、载脂蛋白－Ｂ显著升高，ＨＤＬ－Ｃ显著降低，可能是预示ＮＩＤＤＭ患者发生脑梗塞的重要预示因素，总胆固醇、载脂蛋白Ａ１、脂蛋白（ａ）、纤维蛋白原可能仅是次要危险因素。     

锌钙镁与血脂及载脂蛋白关系探讨

报告了８８例中老年干部血清中锌、钙、镁的含量及其与血脂和ＡｐｏＡ－Ⅰ和ＡｐｏＢ的关系。结果显示，低ＡｐｏＡ－Ｉ／ＡｐｏＢ比值组及高血脂组血清锌含量高于其正常组，差异有高度显著性，Ｐ＜０．００１；血脂正常组的ＡｐｏＢ含量低于不正常组，而ＡｐｏＡ－Ｉ／ＡｐｏＢ比值则高于正常组，Ｐ＜０．０５；相关分析表明，钙与ＡｐｏＡ－Ｉ、ＡｐｏＢ之间均呈显著正相关，锌与ＡｐｏＡ－Ｉ／ＡｐｏＢ比值之间呈显著负相关，ＡｐｏＡ－Ｉ与ＡｐｏＢ、钙与镁之间亦呈显著正相关。提示锌、钙元素与血脂及载脂蛋白有密切关系，适当降低体内锌含量会降低血脂、提高ＡｐｏＡ－Ｉ／ＡｐｏＢ比值     

双亲冠心病史与子代危险因素关系的研究

５７例冠心病患者的子女和双亲无ＣＨＤ病史的对照进行了ＣＨＤ危险因素的对比研究，发现双亲具有ＣＨＤ病史者的载脂蛋白Ａ１（ａｐｏＡ１）水平明显低于对照组，载脂蛋白Ｂ（ａｐｏＢ）、脂蛋白（ａ）［Ｌｐ（ａ）］、舒张压水平和体重指数明显高于对照组。吸烟、饮酒、高脂饮食惯、体育锻炼和血脂水平两组间无显著差异。ＣＨＤ患者与其子代间的Ｌｐ（ａ）水平呈正相关。     

脂蛋白（a）与早发脑梗塞

采用１∶１配比的病例－对照研究方法，探讨脂蛋白（ａ）与早发脑梗塞的病因学联系。单因素分析结果显示：高脂蛋白（ａ）（＞３０ｍｇ／ｄｌ）者患病危险性为正常者的３．５倍。多元逐步回归分析结果表明，血ＬＰ（ａ）、吸烟年数、平均动脉压、ＬＤＬ－Ｃ、Ａｐｏ－Ｂ是早发脑梗塞的主要危险因素，而Ａｐｏ－Ａ１则是其保护因素。     

脑卒中与血脂及其相关因素探讨

目的：探讨血脂、载脂蛋白与脑卒中的病因学联系。方法：对２１９例脑卒中患者中脑出血８７例。脑梗塞１３２例均经ＣＴ证实,并配以１６０例不影响血脂代谢无神经系统疾病为正常对照组。测定胆固醇、甘油三酯、载脂蛋白ＡｐｏＡ及ＡｐｏＢ含量。结果：脑卒中患者血脂及其亚型均高于对照组。尤其是患者组高密度脂蛋白胆固醇／低密度脂蛋白胆固醇（ＨＤＬ－Ｃ／ＬＤＬ－Ｃ）比值低于正常组Ｐ〈０．０５。患者组有糖尿病、高血压、冠心     

2型糖尿病患者糖代谢与胰岛B细胞功能关系

目的通过2型糖尿病患者血糖值与胰岛素、C-肽和糖化血红蛋白含量关系,了解2型糖尿病患者糖代谢和胰岛B细胞的关系。方法对51例初诊2型糖尿病患者及48名正常人餐前血糖、胰岛素、C-肽和糖化血红蛋白含量分别采用酶法、放免法、免疫散射比浊法进行测定,采用SPSS15.0软件进行分析。结果实验组空腹血糖、胰岛素、C-肽以及糖化血红蛋白分别为(9.93±2.91)mmol/L,(24.27±11.44)μU/L,(3.93±1.39)μg/L,(6.93±1.63)%,均高于对照组的(5.05±0.57)mmol/L,(15.47±6.26)μU/L,(2.35±0.85)μU/L,(4.74±0.50)%,差异均有统计学意义(P<0.01);2型糖尿病患者不同年龄组间4项指标差异均无统计学意义;空腹血糖与糖化血红蛋白呈高度正相关,且实验组血糖含量的变异有64.4%可由胰岛素、C-肽和糖化血红蛋白的变化来解释(R2=0.644)。结论2型糖尿病患者的血糖、胰岛素、C-肽和糖化血红蛋白均高于正常人。胰岛素、C-肽和糖化血红蛋白的改变可引起血糖升高。     

单纯性肥胖儿童瘦素、胰岛素及其相关性研究

目的 研究单纯性肥胖儿童瘦素、胰岛素及其相关关系。方法 对筛选出来的54名肥胖儿童和60名正常体重儿童进行瘦素、胰岛素、C-肽、血糖水平的测定，并进行相关关系的研究。结果 肥胖组儿童瘦素、胰岛素、C-肽、血糖水平高于非肥胖组儿童，胰岛素敏感性指数肥胖组儿童低于非肥胖组儿童，差异有显性意义(P＜0．05)。瘦素与体质指数、体脂百分比、体脂肪、臀围、胰岛素、C-肽浓度均呈显正相关(P＜0．05)，与血糖、瘦体重、腰臀围比没有相关性。结论 肥胖儿童存在瘦素抵抗、高胰岛素血症和胰岛素抵抗，瘦素与体质指数、胰岛素浓度呈显正相关。     

Upper body adiposity and the risk for atherosclerosis.

Since there is evidence that fat distribution is a better predictor of cardiovascular disease than the degree of obesity, some risk factors for atherosclerosis have been evaluated in middle age Type II male diabetics and in obese subjects with and without glucose intolerance. In non-insulin-dependent diabetics (NIDD), abdominal obesity reflected by the waist/hip-circumference ratio (WHR) is related to parameters of metabolic control, lipid parameters, insulin status and response, hypertension, and vascular complications. High WHR is associated with: (a) significantly (p less than 0.01) higher HbA1 values than in the group without abdominal fat distribution; (b) a highly significant (p less than 0.001) negative correlation with high-density-lipoprotein cholesterol (HDL-C) and a positive correlation with the total/HDL-C ratio, which remains after correction for the body mass index; (c) higher apolipoprotein B concentrations; and (d) an elevated atherogenic index. Both fasting and postprandial insulin and C-peptide values may be a link between abdominal fat deposits and metabolic disturbances. Obese patients with upper body fat accumulation have significantly lower HDL-C levels, and a higher prevalence of glucose intolerance and diabetes than do patients with lower body fat obesity. Fasting glycemia, insulin, and the insulin area under the curve during an oral glucose load are significantly (p less than 0.005) increased in those with the greatest WHR, which is similar to that in NIDD and central obesity. An excess of abdominally located fat, even without manifest obesity, is associated with metabolic disturbances that indicate increased risk of atherogenesis and of higher morbidity and mortality, which may be due to characteristics of abdominally located adipocytes.     

Upper body adiposity and the risk for atherosclerosis

Since there is evidence that fat distribution is a better predictor of cardiovascular disease than the degree of obesity, some risk factors for atherosclerosis have been evaluated in middle age Type II male diabetics and in obese subjects with and without glucose intolerance. In non-insulin-dependent diabetics (NIDD), abdominal obesity reflected by the waist/hip-circumference ratio (WHR) is related to parameters of metabolic control, lipid parameters, insulin status and response, hypertension, and vascular complications. High WHR is associated with: (a) significantly (p less than 0.01) higher HbA1 values than in the group without abdominal fat distribution; (b) a highly significant (p less than 0.001) negative correlation with high-density-lipoprotein cholesterol (HDL-C) and a positive correlation with the total/HDL-C ratio, which remains after correction for the body mass index; (c) higher apolipoprotein B concentrations; and (d) an elevated atherogenic index. Both fasting and postprandial insulin and C-peptide values may be a link between abdominal fat deposits and metabolic disturbances. Obese patients with upper body fat accumulation have significantly lower HDL-C levels, and a higher prevalence of glucose intolerance and diabetes than do patients with lower body fat obesity. Fasting glycemia, insulin, and the insulin area under the curve during an oral glucose load are significantly (p less than 0.005) increased in those with the greatest WHR, which is similar to that in NIDD and central obesity. An excess of abdominally located fat, even without manifest obesity, is associated with metabolic disturbances that indicate increased risk of atherogenesis and of higher morbidity and mortality, which may be due to characteristics of abdominally located adipocytes.     

成人隐匿性自身免疫糖尿病32例临床特征分析

目的观察分析成人隐匿性自身免疫糖尿病(LADA)患者的临床特征,提高其防治水平。方法将32例GAD-Ab阳性LADA患者作为研究对象,均测量身高、体重、腰臀比、血压,并测定空腹血糖、血脂、C肽、HbA1c和标准餐后2h血糖、C肽。结果 LADA患者发病年龄范围较广,胰岛素的分泌能力较T2DM差,存在胰岛素抵抗。部分患者体形肥胖,伴有高血压和(或)血脂异常。结论 LADA患者既存在胰岛素缺乏,又有胰岛素抵抗,LADA患者诊断后需要尽早使用胰岛素治疗,可联用胰岛素增敏剂治疗改善胰岛素抵抗。     

Correlation between insulin resistance and puberty in children with increased cardiometabolic risk

Epidemiologic data provide evidence that the frequency of obesity and cardiometabolic risk factors shows an increasing tendency in childhood. Insulin resistance plays a central role in the pathogenesis of cardiovascular and metabolic consequences of obesity. Transient decrease in the insulin sensitivity during puberty is a well-known physiological process; however, the feature of this phenomenon is not clear in obese children with increased cardiometabolic risk. AIM: The aim of the present study was to assess the effect of puberty on insulin resistance and metabolic parameters in obese children with and without increased cardiometabolic risk. MATERIALS AND METHODS: Anthropometric data, insulin levels during oral glucose tolerance test and lipid status were analyzed of 161 obese children aged 4-18 years. Σinsulin/Σglucose ratio was obtained during glucose load and HOMA index was used to assess insulin resistance. Children were sorted into prepubertal (T1), pubertal (T2-4) and postpubertal (T5) cohorts according to Tanner staging criteria and metabolic and insulin resistance parameters were evaluated. Increased cardiometabolic risk was defined as the presence of any two risk factors (elevated fasting plasma glucose, blood pressure, triglyceride or decreased HDL-cholesterol) in addition to obesity. Results: Out of 161 obese subjects, 43 (26.7%) had increased cardiometabolic risk. Decreased HDL-cholesterol and/or elevated triglyceride was observed in 101 (56.5%) cases. Impaired glucose tolerance and/or impaired fasting glucose was found in 23 (14.4%) cases. In subjects without increased cardiometabolic risk, the Σinsulin/Σglucose ratio in T1 stage was significantly lower than in T2-4 and T5 stages (p = 0.01). In children with increased cardiometabolic risk, the insulin/glucose ratio was similar in T1, T2-4 and T5 stages, however, it was significantly higher in T1 stage as compared to subjects without increased cardiometabolic risk (p = 0.04). In T2-4 and T5 stages, Σinsulin/Σglucose ratio did not differ between children with and without increased cardiometabolic risk. No difference was found in HOMA index between groups with and without increased cardiometabolic risk in T1 stage, however significantly higher levels were observed in subjects with increased cardiometabolic risk at T2-4 stages (p = 0.01), indicating the presence of fasting hyperinsulinemia in this cohort. Elevated HbA1c (≥6.0%) was found in 13 (16%) out of the 81 children investigated, of whom only two cases had abnormal oral glucose tolerance test. In cases having normal HbA1c, oral glucose tolerance test showed impaired glucose tolerance in 5 cases, impaired fasting glucose in 2 cases, both impaired glucose tolerance and impaired fasting glucose in 2 cases, and type 2 diabetes in 2 cases. Conclusion: Increased insulin resistance can be observed in obese children without increased cardiometabolic risk. In obese children with increased cardiometabolic risk, substantial insulin resistance occurs in prepuberty and it is present at similar level throughout puberty. Fasting insulin levels are elevated in obese subjects with increased cardiometabolic risk as compared to those without increased cardiometabolic risk. To reveal type 2 diabetes cases, HbA1c and oral glucose tolerance test results should be assessed parallel.     

Maternal plasma adiponectin concentrations at 24 to 31 weeks of gestation: negative association with gestational diabetes mellitus

OBJECTIVE: Adiponectin is an adipocyte-derived hormone with antidiabetic, antiatherosclerotic, and antiinflammatory properties. This study investigated the relations between maternal adiponectin concentration and gestational diabetes mellitus (GDM) and other metabolic parameters during midpregnancy. METHODS: Two-hour 75-g oral glucose tolerance tests were performed in 253 pregnant women at 24 to 31 wk of gestation. Two hundred nineteen who had normal glucose tolerance (NGT) and 34 women who had GDM and their newborns were investigated. Fasting maternal blood samples were drawn to determine plasma concentrations of adiponectin, glucose, insulin, C-peptide, free fatty acid, and blood lipids. Blood samples at 1 and 2 h after an oral glucose load were obtained to measure plasma glucose, insulin, and C-peptide concentrations. RESULTS: Plasma adiponectin concentrations were significantly lower in women who had GDM than in those who had NGT (P = 0.014). Maternal age, body mass index (before pregnancy and at blood collection), and plasma level of free fatty acid were significantly greater in those who had GDM than in those who had NGT. Logistic regression analysis showed that maternal adiponectin level and GDM were significantly correlated (P = 0.043), but that the correlation became weaker (P = 0.116) after adjusting for maternal body mass index and plasma level of free fatty acid before pregnancy. In the NGT group, maternal adiponectin concentrations were significantly negatively correlated with plasma fasting insulin, fasting C-peptide, fasting C-peptide/fasting glucose ratio, 2-h glucose, triacylglycerol, and maternal body mass index and positively correlated with high-density lipoprotein cholesterol concentration. In the GDM group, maternal adiponectin level was negatively correlated with neonatal birth weight. CONCLUSIONS: Midpregnancy hypoadiponectinemia may be associated with a higher risk of GDM.     

Insulin metabolism in obese children tested by oral and intravenous glucose loading

Authors performed 0.5 g/kg intravenous and 1.75 g/kg p.os glucose tolerance tests in 25 alimentary obese children. C-peptide and Immunoreactive Insulin determinations were performed in every case. The average ratio of the two peptide during i.v. loads was calculated, too. Results were compared with the data of 6 children with ideal body weight respectively, whose results were obtained in similar circumstances. They find that i.v. glucose load produces different degrees in detected by C-peptide insulin secretion in normal as well as in obese children and the secretion rate is practically permanent till the end of the test in both groups. The low C-peptide/insulin ratio during i.v. glucose tolerance test in obese children indicates insulin resistance and explains decreased glucose tolerance. The "early-phase insulin release" detected in insulin curves of i.v. glucose load is resulted not only by the insulin reservoir capacity of beta-cells, but also by the insulin excretion capacity of the liver and the receptor activity of target cells. There is no connection between maximum glucose level responses to i.v. load and maximum C-peptide and insulin responses, whereas increases in maximum C-peptide response are parallel with those of in weight. C-peptide responses, being different in degree and experienced during the two types of tolerance test, support the "incretin" phenomenon. This mechanism may be important in the development of beta-cell hyperfunction which has been proved in obesity.     

瘦素与代谢综合征组成成分的聚集特性分析

目的　探讨瘦素水平与代谢综合征 (MS)组成成分的关系 ,分析MS危险因素聚集的特征和规律。方法　观测 795名非糖尿病成人的空腹血清真胰岛素 (FTI)、瘦素、血脂、血糖水平以及血压、体重指数、腰臀围比值和定量胰岛素敏感检测指数 (QUICKI)等指标 ,采用因子分析等方法探讨瘦素水平与上述变量的关系。结果　血清瘦素浓度随代谢异常组合个数的增多而上升。瘦素水平处于上三分位人群检出肥胖、高血压、血脂紊乱以及MS的比例比处在下三分位的人群明显升高。因子分析结果显示 ,男性与女性组包括瘦素等 11个变量的变化各受 3个因子支配 ,累计方差贡献率分别为6 2 0 %和 6 6 7% ,分别由瘦素与体重指数、腰臀围比值、FTI、QUICKI和高甘油三酯和低的高密度脂蛋白胆固醇等变量构成的核心因子 ,由血糖、FTI、QUICKI和高甘油三酯 (女 )构成的糖耐量因子以及由血压和体重指数 (男 )构成的高血压因子 ,其中高胰岛素和胰岛素抵抗 (IR)同时连接前两个因子。结论　该人群的瘦素水平与MS的多个关键组成成分密切相关 ,高瘦素血症可能是MS的 1个新成分。MS危险因素的聚集受多个因子支配 ,IR虽起重要作用 ,但不能单独解释其成因。     

Regular consumption of pulses for 8 weeks reduces metabolic syndrome risk factors in overweight and obese adults

Pulses are low in energy density, supporting their inclusion in the diet for the management of risk factors of the metabolic syndrome (MetSyn). The aim of the present study was to describe the effects of frequent consumption (five cups/week over 8 weeks) of pulses (yellow peas, chickpeas, navy beans and lentils), compared with counselling to reduce energy intake by 2093?kJ/d (500?kcal/d), on risk factors of the MetSyn in two groups (nineteen and twenty-one subjects, respectively) of overweight or obese (mean BMI 32·8?kg/m2) adults. Body weight, waist circumference, blood pressure, fasting blood parameters and 24?h food intakes were measured at weeks 1, 4 and 8. Blood glucose, insulin, C-peptide, glucagon-like peptide-1 (GLP-1) and ghrelin were measured after a 75?g oral glucose load at weeks 1 and 8. At week 8, both groups reported reductions in energy intake, waist circumference, systolic blood pressure, glycosylated Hb (HbA1c) and glucose AUC and homeostasis model of insulin resistance (HOMA-IR) following the glucose load (P?相似文献