2型糖尿病患者血清炎症因子和脂联素水平与动脉粥样硬化的关系

目的探讨2型糖尿病患者血清炎症因子和脂联素水平与动脉粥样硬化的关系。方法将125例2型糖尿病患者根据颈动脉内膜中膜厚度分为非动脉粥样硬化组(n=65)和动脉粥样硬化组(n=60),并配对选取30例健康者为对照组。收集临床资料,检测空腹血糖、糖化血红蛋白、空腹胰岛素、餐后2 h血糖、血脂谱等生化指标,并测定血清脂联素、细胞间黏附分子1、肿瘤坏死因子α和高敏C反应蛋白水平。计算稳态模型评估的胰岛素抵抗指数。结果糖尿病患者血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、空腹血糖、餐后2 h血糖和糖化血红蛋白水平均高于对照组(P<0.05),糖尿病动脉粥样硬化组血甘油三酯和低密度脂蛋白胆固醇水平高于糖尿病非动脉粥样硬化组(P<0.05),糖尿病动脉粥样硬化组血清肿瘤坏死因子α和高敏C反应蛋白水平、胰岛素抵抗指数均高于非动脉粥样硬化组及对照组,而糖尿病动脉粥样硬化组血清脂联素水平低于非动脉粥样硬化组及对照组(P<0.05)。相关性分析显示,血清脂联素水平与内膜中膜厚度、细胞间黏附分子1、肿瘤坏死因子α、高敏C反应蛋白和胰岛素抵抗指数之间呈负相关(r值分别为-0.574、-0.635、-0.681、-0.768及-0.752...     

血浆脂联素与2型糖尿病大血管并发症的关系

目的 观察2型糖尿病患者及糖尿病合并颈动脉增厚患者血浆脂联素水平的变化,探讨血浆脂联素与2型糖尿病大血管并发症的关系.方法 选取2型糖尿病无颈动脉增厚患者61例及2型糖尿病合并颈动脉增厚患者37例,另选健康者30名作为对照组.测定受试者血浆脂联素水平、身高、体重等,比较脂联素水平的改变,以及与其他因素的相关性.结果 2型糖尿病患者血浆脂联素水平低于健康对照组(P<0.01),糖尿病合并颈动脉增厚患者血浆脂联素水平又低于糖尿病无颈动脉增厚患者(P<0.01).在受试者中,血浆脂联素与颈动脉内膜-中层厚度(IMT)、体重指数(BMI)呈负相关(P<0.01).结论 脂联素参与了糖尿病大血管病变的发生发展.如将血浆脂联素测定与颈动脉彩超结合应用,有助于早日诊断糖尿病大血管病变;提高血浆脂联素水平,为防治糖尿病大血管并发症提供新的途径.     

2型糖尿病合并脑梗死患者脂联素水平的变化及其意义

目的探讨2型糖尿病合并脑梗死患者血清脂联素的变化规律及其与脑梗死的相关性。方法采用前瞻性观察研究临海市第一人民医院住院的2型糖尿病合并脑梗死患者38例(A组)、单纯2型糖尿病32例(B组)及正常对照组38例(C组),用酶联免疫法分别测定各组患者血清脂联素及C反应蛋白水平(CRP),并分析血清脂联素浓度与体质量指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、糖化血红蛋白(HbA1c)及CRP等各项指标的相关性。结果 A组、B组脂联素水平均显著低于C组(P<0.01),A组脂联素又显著低于B组(P<0.01);脂联素与BMI(r=-0.50,P<0.01)、HbA1c(r=-0.56,P<0.01)、CRP(r=-0.24,P<0.05)呈负相关,与HDL呈正相关(r=0.35,P<0.01);进入回归方程的因素为BMI(b=0.04,P<0.05)、HDL(b=-0.29,P<0.01)、HbA1c(b=0.03,P<0.01)、CRP(b=0.02,P<0.01)、脂联素(b=-0.32,P<0.01)。结论低脂联素水平是2型糖尿病合并脑梗死的独立危险因素。     

血清脂联素与心力衰竭患者心功能的相关性

目的 探讨血清脂联素(adiponectin,APN)水平与心力衰竭患者心功能、肿瘤坏死因子α(TNF-α)、高敏C反应蛋白(hsCRP)及胰岛素抵抗(HOMA-IR)的相关性.方法 选择心力衰竭患者100例(心衰组),按NYHA心功能分级分为三亚组:NYHAⅡ级34例;Ⅲ级32例;Ⅳ级34例.健康对照组30例.采用酶联免疫吸附法测定血清脂联素水平,免疫比浊法测定高敏C反应蛋白,放射免疫分析法测定TNF-α与空腹胰岛素(FINS)水平,氧化酶法测定空腹血糖(FBG)水平,并计算胰岛素抵抗指数.结果 心衰组脂联素水平较对照组明显降低(P＜0.05),且随着心衰程度加重,APN水平降低更加明显.APN与TNF-α、hsCRP、HOMA-IR呈负相关(r=-0.118,P<0.01;r=-0.578,P<0.01;r=-0.446,P<0.01).结论 心衰患者血清脂联素水平明显降低,且随着心功能损害程度加重而降低更加明显.脂联素在心衰过程中起着重要作用,可作为评价心衰患者病情严重程度的检测指标.     

外周血内脂素水平与冠心病的相关性

目的 结合血清高敏C反应蛋白,探讨血清内脂素在预测冠心病斑块稳定性及冠状动脉病变程度的价值.方法 对入选对象行冠状动脉造影,同步进行心电图、外周血内脂素、高敏C反应蛋白、肌酸激酶同工酶、心肌肌钙蛋白Ⅰ参数检测和常规身体检查后设正常对照组(25例)和冠心病组(78例);再将冠心病组分为稳定型心绞痛组(34例)、不稳定型心绞痛组(20例)和急性心肌梗死组(24例);同时也将78例冠心病病例分为冠状动脉单支病变(24例)与多支病变(54例).比较组间外周血内脂素、高敏C反应蛋白水平差异,评价两者在冠心病患者中的相关性及其与冠状动脉病变程度的相关性.结果 冠心病组血清内脂素、高敏C反应蛋白水平显著高于正常对照组(P<0.05);血清内脂素、高敏C反应蛋白水平急性心肌梗死组显著高于不稳定型心绞痛组(P<0.05),不稳定型心绞痛组显著高于稳定型心绞痛组(P<0.05);血清内脂素与高敏C反应蛋白水平无明显相关性(P>0.05);多支病变组与单支病变组内脂素水平差异无显著性(P>0.05),而多支病变组高敏C反应蛋白显著高于单支病变组(P<0.05).结论 内脂素和高敏C反应蛋白在预测冠心病中有重要价值,它们在冠心病外周血中浓度的升高可以提示冠状动脉粥样斑块的不稳定,但两者无相关性;高敏C反应蛋白在预测冠状动脉病变程度方面有一定作用,但还不能以内脂素作为预测冠状动脉病变程度的指标.     

社区中老年人群脂联素水平及其影响因素

目的 调查社区中老年人群的血清脂联素水平,分析其影响因素.方法 对仪征地区2个社区50岁以上退休人群,进行流行病学调查并应用ELISA法检测血清脂联素水平.结果 587人的平均血清脂联素水平为(8.15±3.00) mg/L.2型糖尿病(T2DM)组、高脂血症组的低脂联素水平(四分位分级)的比例分别高于无T2DM组、无高脂血症组,差异有统计学意义(P<0.01).多因素Logistic回归分析结果显示,血清低脂联素水平(低于中位数水平)与T2DM(OR=2.659,95%CI=1.667,4.238)、腹型肥胖(OR=1.528,95%CI =1.002,2.328)之间的关系有统计学意义.未发现年龄、性别、吸烟及饮酒等因素与血清脂联素水平间的联系.结论 低血清脂联素水平可能与T2DM、腹型肥胖存在相关性.     

冠心病合并代谢综合征患者脂联素水平与炎症因子及冠状动脉病变的关系

目的:探讨冠心病合并代谢综合征(metabolic syndrome,MS)患者脂联素水平与炎症因子及冠状动脉病变的关系.方法:将102例患者分为2组,冠心病合并代谢综合征57例(代谢综合征组);冠心病不合并代谢综合征45例(非代谢综合征组).检测血清脂联素、肿瘤坏死因子-白细胞介素－6、超敏C反应蛋白,并以冠状动脉病变积分评价其病变程度.结果:代谢综合征组和非代谢综合征组年龄、性别、总胆固醇、低密度脂蛋白－胆固醇、空腹胰岛素水平差异无统计学意义(P>0.05);代谢综合征组脂联素水平显著低于非代谢综合征组(P<0.05),肿瘤坏死因子-a、白细胞介素6、超敏C反应蛋白浓度显著高于非代谢综合征组(P<0.05～0.01),冠状动脉三支病变发生率和病变总积分显著高于非代谢综合征组(P<0.05).脂联素与肿瘤坏死因子－白细胞介素6、超敏C反应蛋白及冠状动脉病变程度呈负相关(P<0.05).结论:冠心病患者合并代谢综合征较为普遍,且脂联素水平降低,炎症因子水平升高,冠状动脉病变程度严重.     

急性脑梗死患者脂联素、胰岛素与高敏C反应蛋白表达的相关性

目的 探讨脂联素、胰岛素和高敏C反应蛋白表达在急性脑梗死中的意义.方法 比较45例急性脑梗死患者与36例健康对照组之间空腹血脂联素、胰岛素和高敏C反应蛋白的表达有无差异和它们之间的相互关系.结果 急性脑梗死患者中胰岛素和高敏C反应蛋白明显高于对照组,脂联素明显低于对照组,高敏C反应蛋白的表达变化与胰岛素、脂联素含量改变有关.结论 急性脑梗死患者存在高胰岛素血症、高高敏C反应蛋白和低脂联素血症,高敏C反应蛋白含量的改变与患者血中胰岛素、脂联素的表达有关.     

2型糖尿病患者血清脂联素/瘦素比值与冠状动脉病变的关系

目的 探讨2型糖尿病患者血清脂联素、瘦素及二者比值与冠状动脉病变的关系.方法 对行冠状动脉造影的180例2型糖尿病患者的大血管病变危险因素进行采集,分为冠心病组和对照组,冠心病组又分为单支病变组、双支病变组和多支病变组,测量脂联素和瘦素的变化,分析脂联素/瘦素比值与冠状动脉病变的关系.结果 与对照组比较,冠心病组总胆固醇、纤维蛋白原定量和空腹血C反应蛋白升高,高密度脂蛋白胆固醇、脂联素和脂联素/瘦素比值(2.78比1.16)降低.相关分析表明,冠心病组中冠状动脉狭窄程度与年龄、纤维蛋白原定量和C反应蛋白呈正相关,与脂联素和脂联素/瘦素比值(r=-0.314)呈负相关.在校正体质指数后,冠状动脉狭窄程度与脂联素/瘦素比值仍呈负相关(r=-0.541).多因素Logistic回归分析显示,脂联素/瘦素比值降低是冠状动脉病变的危险因素.脂联素/瘦素比值随冠状动脉病变支数增加而变小(2.10比1.37比 0.72 ),组间差异有统计学意义.分层结果显示,当冠状动脉病变支数逐渐升高时,脂联素/瘦素比值与冠状动脉危险因素仍然相关,而稳态胰岛素评估模型胰岛素抵抗与冠状动脉危险因素不再相关.结论 2型糖尿病患者中,脂联素/瘦素比值降低与动脉粥样硬化的形成有关.脂联素/瘦素比值可望作为评估动脉粥样硬化程度的血清学标志.脂联素/瘦素比值相对于稳态胰岛素评估模型胰岛素抵抗是一个较好评估胰岛素抵抗致冠状动脉病变的指标.     

2型糖尿病大血管病变与血清脂联素及C反应蛋白关系的研究

目的 探讨2型糖尿病患者血清脂联素及C反应蛋白水平与大血管病变的关系.方法 糖尿病患者63例,按颈动脉内膜中层厚度(CIMT)将其分为:CIMT≥1 mm者为A组;CIMT＜1 mm者为B组;健康体检者作为对照C组.分别检测身高、体重、血脂、血糖、空腹胰岛素、脂联素(APN)、C反应蛋白(CRP),计算体重指数及胰岛素抵抗指数(IRI),并进行统计学分析.结果 A组及B组血清APN水平低于C组(P<0.01),A组血清APN水平低于B组(P<0.01);A组及B组血清CRP水平高于C组(P<0.01),A组血清CRP水平高于B组(P<0.05).CIMT与APN、HDL呈显著负相关,与HOMA-IR、CRP呈显著正相关.进入回归方程的因素为CRP、APN、FBG、HDL、HOMA-IR.结论 血清APN水平降低、CRP水平升高是2型糖尿病患者颈动脉内膜增厚的主要危险因素,参与2型糖尿病大血管病变的发生和发展.     

Serum CRP levels are equally elevated in newly diagnosed type 2 diabetes and impaired glucose tolerance and related to adiponectin levels and insulin sensitivity

AIMS: To measure the serum highly sensitive C-reactive protein (hs-CRP) and adiponectin levels, assess insulin sensitivity index (SI) and acute insulin response (AIR) in normal control (NC) subjects, patients with impaired glucose tolerance (IGT) and newly diagnosed type 2 diabetes mellitus (DM), and further explore the possible correlation between hs-CRP and SI, AIR and adiponectin in IGT and newly diagnosed type 2 DM groups. METHODS: Age and sex matched 28 normal subjects, 31 patients with IGT, and 31 patients with newly diagnosed type 2 DM were included in the study. SI and AIR were assessed by the reduced sample number of Bergman's minimal model method with intravenous glucose tolerance test in subjects of each group. RESULTS: Compared with NC group, serum hs-CRP was significantly increased in IGT and type 2 DM groups (p < 0.001), although there was no significant difference between the latter groups. Hs-CRP was negatively correlated with high density lipoprotein cholesterol (HDL-C), SI and adiponectin levels (p < 0.05 to p < 0.001), and positively correlated with systolic blood pressure (SBP), fasting plasma glucose (FPG), BMI, waist-to-hip ratio (WHR), postprandial 2h plasma glucose (2hPG), fasting serum insulin (FINS) and postprandial serum insulin (PSI) in IGT and newly diagnosed type 2 DM groups (p < 0.05 to p < 0.001). In general multivariate regression, only adiponectin was the significantly independent determinant for serum hs-CRP (regression coefficient -1.380; 95% CI -2.062 to 0.698, p < 0.001); meanwhile, TG, SI, hs-CRP, FINS, 2hPG and WHR were significantly independent determinants for serum adiponectin concentration (p < 0.05 to p < 0.001). CONCLUSIONS: Elevated serum hs-CRP may play a role in the development of insulin resistance syndrome and type 2 diabetes. This elevation is accompanied by the opposite changes of adiponectin.     

波动性高血糖对血管内皮功能的影响

目的观察波动性高血糖对血管内皮功能的影响,探讨其致动脉粥样硬化的机制。方法选择新诊断的2型糖尿病患者72例,根据动态血糖监测结果分持续性高血糖组33例和波动性高血糖组39例,检测患者的肱动脉内皮依赖性舒张功能(EDD)及颈动脉内膜中层厚度(IMT)、血脂、空腹血糖、空腹胰岛素、餐后2 h血糖(2hPG)及餐后2 h胰岛素(2hINS)、高敏C反应蛋白(hs-CRP)、血管性假血友病因子(vWF)及尿微量白蛋白(MAU)。结果与持续性高血糖组比较,波动性高血糖组的2hPG、2hINS、hs-CRP、vWF、MAU及IMT明显升高(P<0.05,P<0.01),肱动脉EDD明显降低[(6.61±0.79)%vs(5.21±0.88)%,P<0.01]。结论波动性高血糖较持续性高血糖对血管内皮功能危害更大,可能与餐后高血糖、胰岛素抵抗和炎性因子增多有关。     

Decreased plasma adiponectin concentrations in women with low-grade C-reactive protein elevation

OBJECTIVE: Inflammation has been suggested as a risk factor for the development of atherosclerosis, while some components of metabolic syndrome X have been related to inflammatory markers. We hypothesized that adipocyte secreting protein, adiponectin and leptin, for which have been demonstrated an association with metabolic syndrome X and coronary artery disease, may be associated with inflammatory markers in nondiabetic humans. DESIGN AND METHODS: We measured high-sensitivity C-reactive protein (hs-CRP), as an inflammatory marker, and adiponectin and leptin concentrations in 384 nondiabetic Japanese women (mean+/-s.e.m. age 53.6+/-0.8 Years, body mass index (BMI) 23.0+/-0.2 kg/m(2)) undergoing measurement of markers of metabolic syndrome X. RESULTS: The women who had a low-grade hs-CRP elevation (>2.0 mg/l) were significantly older and had higher BMI, body fat mass (BFM), total cholesterol (TC), triglyceride (TG), atherogenic index (AI=(TC-HDLC)/HDLC), where HDLC is high-density lipoproten-cholesterol), fasting blood glucose and leptin concentrations before and after adjustment for BMI or BFM, while lower HDLC and adiponectin concentrations before and after adjustment compared with women with normal CRP levels (<0.5 mg/l). BMI, BFM, TG, AI and leptin before and after adjustment were found to be correlated with hs-CRP levels, while HDLC and adiponectin before and after adjustment were inversely correlated (all P<0.0001). hs-CRP was independently associated with white blood cell count, blood urea nitrogen and AI and inversely with adiponectin/BFM in the stepwise regression analysis model. CONCLUSIONS: These data demonstrate a significant decrease in plasma adiponectin in low-grade chronic inflammation, and suggest that there is an important linkage between inflammation/adipose tIssue/atherosclerosis.     

2型糖尿病患者血清护骨素水平与大血管并发症的关系

目的探讨2型糖尿病患者血清护骨素水平与大血管并发症的关系。方法88例2型糖尿病患者根据有无大血管并发症分为2型糖尿病并发大血管病变组(46例)及无大血管病变组(42例),同时选择年龄、性别相匹配的40例健康者为对照组。采用酶联免疫吸附法测定各组血清护骨素水平,并进行组间比较。结果2型糖尿病并大血管病变组血清护骨素水平(4.12±0.64 ng/L)显著高于无大血管病变组(2.78±0.59 ng/L)与对照组(2.29±0.37 ng/L,P<0.01),无大血管病变组与对照组比较差异无显著性(P>0.05)。相关及回归分析表明2型糖尿病血清护骨素水平与空腹血糖、餐后2 h血糖、糖化血红蛋白、胰岛素抵抗指数及高敏C反应蛋白呈明显正相关(P<0.05)。结论血清护骨素水平与糖尿病大血管并发症相关联,护骨素可能在2型糖尿病慢性血管并发症的发生中起一定作用。     

Association between hypoadiponectinemia and cardiovascular risk factors in nonobese healthy adults

Adiponectin levels are significantly lower in obese adult patients with type 2 diabetes mellitus, essential hypertension, dyslipidemia, and cardiovascular disease. However, the role of hypoadiponectinemia in nonobese healthy adults has not been fully elucidated. In this study, we examined the association between hypoadiponectinemia and cardiovascular risk factors and estimated plasma adiponectin values in nonobese, apparently healthy adults. A total of 204 male and 214 female healthy individuals aged 20 to 80 years, with a body mass index (BMI) of less than 25 kg/m2, were included in this study. We measured patients' plasma adiponectin levels, serum lipid profiles, high-sensitivity C-reactive protein (hs-CRP) levels, fasting glucose levels, and fasting insulin levels. Mean values of plasma adiponectin were 5.45 +/- 3.3 microg/mL in male and 8.16 +/- 4.6 microg/mL in female subjects. The hypoadiponectinemia group (< 4.0 microg/mL) had significantly higher levels (P < .01) of BMI, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and triglycerides, but lower levels of high-density lipoprotein cholesterol (HDL-C). In males, plasma adiponectin levels were inversely correlated with BMI (r = -0.32, P < .01), HOMA-IR (r = -0.14, P < .05), triglyceride levels (r = -0.17, P < .05), and hs-CRP levels (r = -0.15, P < .05), and positively correlated with HDL-C (r = 0.24, P < .01). In females, plasma adiponectin levels were negatively correlated with BMI (r = -0.31, P < .01), fasting glucose (r = -0.18, P < .01), fasting insulin (r = -0.23, P < .01), HOMA-IR (r = -0.24, P < .01), and triglyceride (r = -0.18, P < .01) levels, and positively correlated with HDL-C (r = 0.37, P < .01). Sex, age, BMI, and HDL-C (P < .01 for each) were found to be independent factors associated with plasma adiponectin levels in multivariate analysis. Hypoadiponectinemia is significantly associated with cardiovascular risk factors such as insulin resistance and atherogenic lipid profiles in nonobese, apparently healthy subjects.     

血清脂蛋白相关磷脂酶A2及超敏C反应蛋白与急性冠脉综合征的关系

目的 探讨脂蛋白相关磷脂酶（Lp-PL）A2及超敏C反应蛋白（hs-CRP）与急性冠脉综合征（ACS）的发生及冠脉病变严重程度的相关性。 方法 2017年6月~2018年10月于西安交通大学医学院第一附属医院心脏内科住院并行冠脉造影（CAG）确诊为ACS的患者373例,另外选择同期CAG结果正常的107例患者作为非冠心病组。将ACS患者根据冠脉Gensini积分的中位数进一步分为两组,定义为轻度病变组及重度病变组;根据冠脉病变支数分为三组,分别为单支病变组、双支病变组、三支病变组。 结果 与非冠心病组相比,ACS组患者的血清Lp-PLA2和炎症指标hs-CRP明显升高,差异均有统计学意义。冠脉重度病变组的血清Lp-PLA2和hs-CRP水平高于冠脉轻度病变组,差异均有统计学意义（ P<0.01）。随着冠心病患者病变累及支数的增多,Lp-PLA2水平和Gensini积分也逐渐增加。相关分析显示Lp-PLA2、hs-CRP水平与 Gensini 积分呈正相关。多因素Logistic回归分析显示,hs-CRP和Lp-PLA2是冠脉病变重度病变的独立危险因素。利用ROC曲线显示Lp-PLA2诊断冠心病的曲线下面积为0.836（95%CI:0.802~0.869）。当Lp-PLA2诊断临界值取129.03 ng/ml时,其诊断效能最高,灵敏度为64.1%,特异度为96.6%。 结论 血清Lp-PLA2和hs-CRP与ACS冠状动脉病变严重程度成正相关,是冠脉严重病变的独立危险因素。血清Lp-PLA2对ACS有一定的诊断价值。     

空腹血糖受损冠心病患者冠脉病变特点与血高敏C反应蛋白的关系

目的探讨空腹血糖受损(IFG)冠心病患者冠状动脉病变特点,与血高敏C反应蛋白(hs-CRP)水平的关系及意义。方法对经冠脉造影确诊的冠心病患者行口服葡萄糖耐量试验(OGTT),据结果用1999年WHO标准选取冠心病合并IFG组69例,另设糖代谢正常冠心病组64例(对照组)。测定两组体重、血压、血脂、血肌酐、血hs-CRP,记录其年龄、冠心病危险因素(性别、高血压、高胆固醇血症、吸烟)和冠状动脉造影结果并计算冠脉病变积分。结果血hs-CRP水平、冠脉病变积分在IFG组较对照组明显升高(P<0.01);相关分析显示,在冠心病合并IFG患者中,空腹血糖水平、血hs-CRP水平与冠脉病变Gensini评分呈正相关(r分别=0.2685,0.5232均P<0.05)。结论冠心病合并IFG患者冠脉病变严重,多支冠脉病变发生率高,病变呈弥漫性狭窄。冠心病合并IFG患者存在炎症反应,血hs-CRP水平与冠脉狭窄程度相关。     

A novel index of insulin resistance determined from the homeostasis model assessment index and adiponectin levels in Japanese subjects

Insulin resistance is the principal cause of glucose intolerance and type 2 diabetes and induces progression of severe atherosclerosis in these patients. Adiponectin, the adipose-specific proteins, is known to correlate negatively with insulin resistance in patients with obesity and type 2 diabetes. The purpose of this study was to evaluate the potential of using serum adiponectin levels as a marker of insulin resistance in various states of insulin resistance. Furthermore, we attempted to establish a modified index of the homeostasis model assessment index (HOMA-IR), calculated from the product of serum insulin and plasma glucose levels divided by serum adiponectin levels (HOMA-AD). We recruited 117 Japanese subjects with various degrees of glucose tolerance and determined serum adiponectin levels and insulin sensitivity (M-value) by using the euglycemic hyperinsulinemic clamp technique. M-value, the gold standard index of insulin resistance, correlates significantly and independently with fasting insulin (r=-0.313, P<0.001), glucose (r=-0.319, P<0.001), and adiponectin (r=0.241, P<0.002) levels. M-values were more significantly correlated with HOMA-AD (r=-0.643, P<0.001) than HOMA-IR values (r=-0.591, P<0.001). In subjects with moderate hyperglycemia (fasting glucose levels>8.0mmol/L, n=30), HOMA-AD showed a more significant correlation with the M-value than HOMA-IR (r=-0.535, P=0.005 versus r=-0.461, P=0.010). We would therefore like to propose a novel index, HOMA-AD, as a simple and adequate index for determining insulin resistance even in diabetic patients with overt hyperglycemia.     

极低碳水化合物饮食对肥胖症患者心血管危险因素的影响

 目的 观察极低碳水化合物饮食(VLCD)治疗对单纯性肥胖患者心血管危险因素的影响。 方法 观察35例肥胖患者经VLCD治疗8周后,体重、腰围及血压改善的同时,空腹血糖(FPG)、空腹胰岛素(FIns)、血脂谱、尿微量白蛋白/肌酐(UACR)、C反应蛋白(CRP)、TNFα、脂联素(adiponectin)等心血管危险因素的改变。另采集35例健康志愿者作为基线对照组。 结果 基线时肥胖组较正常对照组有更显著的心血管危险因素(P值均<0.05)。试验结束时肥胖患者的体重与腰围分别减少了(8.5±0.7)kg与(6.6±1.1)cm(P值均<0.01);收缩压、舒张压、FIns、TC、TG等指标均较前显著降低(P值均<0.05);FPG、LDL-C及HDL-C等的改变无统计学意义;UACR、CRP、TNFα分别减少了(1.86±0.86)μg/mg、(1.15±0.45)mg/L及(0.94±0.21)ng/L(P值均<0.05);脂联素水平增加了(2.12±0.59)mg/L(P<0.01)。结论 8周的VLCD治疗肥胖症可有效减重并显著改善多种心血管危险因素。     

The effects of aerobic, resistance, and combined exercise on metabolic control, inflammatory markers, adipocytokines, and muscle insulin signaling in patients with type 2 diabetes mellitus

The purpose of this study was to compare the effects of 3 different modalities of exercise on metabolic control, insulin resistance, inflammatory markers, adipocytokines, and tissue expression of insulin receptor substrate (IRS)-1 after 12 weeks of training among patients with type 2 diabetes mellitus. Forty-eight patients with type 2 diabetes mellitus were randomly assigned to 4 groups of training (3 times a week, 60 minutes per session): aerobic group (n = 12), resistance group (n = 12), combined (aerobic and resistance) group (n = 12), and control group (n = 12). Fasting and postprandial blood glucose, glycated hemoglobin, lipid profile, insulin resistance index (homeostasis model assessment of insulin resistance), adipocytokines (adiponectin, visfatin, and resistin), tumor necrosis factor, interleukin, and high-sensitivity C-reactive protein (hs-CRP) were measured at baseline and at the end of the study. Patients also underwent a muscle microbiopsy before and after training to quantify IRS-1 expression. All 4 groups displayed decreases in blood pressure, fasting plasma glucose, postprandial plasma glucose, lipid profile, and hs-CRP (P < .05); and there was no difference across the groups. After training, the IRS-1 expression increased by 65% in the resistance group (P < .05) and by 90% in the combined group (P < .01). Exercise training favorably affects glycemic parameters, lipid profile, blood pressure, and hs-CRP. In addition, resistance and combined training can increase IRS-1 expression.