青壮年男性四肢瘫和截瘫患者血脂水平比较研究

摘要 目的：通过回顾性调查资料比较脊髓损伤所致四肢瘫和截瘫青壮年男性血脂水平,探讨在缺乏运动状态下不同运动能力对青壮年男性血脂代谢的影响和差异形成机制,为血脂异常防治提供指导。 方法：对中国康复研究中心2004—2010年因脊髓损伤致瘫痪进行康复治疗的青壮年男性患者进行入院状态回顾性调查,入选要求：①诊断明确（脊髓损伤致瘫痪）;②资料完整;③18周岁≤年龄≤60岁;④非卒中患者。共1812例患者入选,对血脂指标[甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）]进行比较分析。 结果：截瘫组平均TG、TC、HDL水平显著高于四肢瘫痪组(分别为TG 1.79±1.22mmol/L比1.56±0.87mmol/L;TC 4.42±0.92mmol/L比4.25±0.93mmol/L;HDL 1.14±0.35mmol/L比1.06±0.35mmol/L, P＜0.01),高TG发生率显著高于四肢瘫痪组（分别为36%比28%,P＜0.01）,而低HDL血症发生率显著低于四肢瘫痪组（47%比57%,P＜0.01）, 两组患者LDL水平及异常发生率均无显著差异,TC异常发生率两组无显著差异。 结论：男性截瘫患者与四肢瘫患者TG、TC、HDL水平存在显著差异,提示上肢自主活动功能对TG、TC和HDL代谢有显著影响,既有HDL水平提高而获益的一面,也同时有TG、TC异常升高的不利面,其机制可能与运动量和饮食摄入差异有关;LDL的代谢并未受运动量和饮食因素的影响。     

Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men

Liang H, Tomey K, Chen D, Savar NL, Rimmer JH, Braunschweig CL. Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men.

Objectives

To assess the relationship between objective neighborhood environment and self-reported physical activity (PA) and between PA and obesity-related risk factors in people with spinal cord injury (SCI).

Design

A cross-sectional study.

Setting

Urban university.

Participants

Men with SCI (N=131), 20 to 59 years old, at least 1 year postinjury and using wheelchair for mobility most of the time.

Interventions

Not applicable.

Main Outcome Measures

Metabolic syndrome (abdominal obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent score.

Results

Lower PA was associated with higher prevalence rate for elevated triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile, those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio [OR]=.19; 95% confidence interval [CI], .04–.80), metabolic syndrome (OR=.15; 95% CI, .03–.66) and high CRP (OR=.17; 95% CI, .04–.71) while adjusting for relevant factors. In crude analysis, lower PA was associated with neighborhood environmental characteristics including shorter distance to nearest transit stops, smaller mean block area, greater number of transit stops, high vacant housing, and higher neighborhood crime rate. In multivariate analysis higher total crime was the only risk factor significantly associated with lower PA level. Those living in higher crime rate neighborhoods had 86% lower odds of having greater than median PA level (OR=.14; 95% CI, .04–.49) than their counterparts.

Conclusions

In men with SCI, lower PA is independently associated with having elevated triglycerides, metabolic syndrome, and high CRP. Additionally, lower PA is associated with higher neighborhood crime rate.     

Cardiorespiratory fitness attenuates metabolic risk independent of abdominal subcutaneous and visceral fat in men

OBJECTIVE: Moderate to high levels of cardiorespiratory fitness (CRF) are associated with a lower risk of the metabolic syndrome and all-cause mortality. Unknown is whether CRF attenuates health risk for a given level of abdominal visceral fat, subcutaneous fat, and/or waist circumference. RESEARCH DESIGN AND METHODS: The sample studied comprised 297 apparently healthy men with available computed tomography or magnetic resonance imaging scans of the abdomen, metabolic data, and maximal treadmill exercise test results. Men were categorized into low-CRF (20%, n = 56), moderate-CRF (40%, n = 94), and high-CRF (40%, n = 147) groups based on age and exercise test results. All analyses were adjusted for age. RESULTS: For a given level of waist circumference, visceral fat, or subcutaneous fat, the high-CRF group had lower triglyceride levels (P < 0.05) and higher HDL cholesterol levels than the low- or moderate-CRF groups. There was a significant group interaction (P < 0.01) for blood pressure, indicating that the increase in blood pressure per unit increase in visceral fat or waist circumference was greater in men in the low-CRF group compared with the high-CRF group. The relative risks of having the metabolic syndrome were 1.8 (95% CI 1.0-3.1) and 1.6 (0.9-2.7) times higher in the low- and moderate-CRF groups, respectively, compared with the high-CRF group after adjusting for age, visceral fat, and subcutaneous fat (P for trend = 0.06). CONCLUSIONS: High levels of CRF are associated with a substantial reduction in health risk for a given level of visceral and subcutaneous fat.     

Metabolic syndrome: risk factor distribution and 18-year mortality in the multiple risk factor intervention trial

OBJECTIVE: To examine the long-term association of metabolic syndrome with mortality among those at high risk for cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS: A total of 10,950 Multiple Risk Factor Intervention Trial (MRFIT) survivors were followed for mortality an additional median 18.4 years (1980-1999). Proportional hazards models examined multivariate-adjusted risks associated with Adult Treatment Panel III-defined metabolic syndrome conditions, with BMI substituted for waist circumference. RESULTS: At MRFIT annual visit 6, 4,588 (41.9%) men, mean age (+/-SD) 53.0 +/- 5.9 years, had metabolic syndrome and 6,362 did not. Comparing men with metabolic syndrome to men without, adjusted hazard ratios (HRs) were 1.21 (95% CI 1.13-1.29), 1.49 (1.35-1.64), and 1.51 (1.34-1.70) for 18-year total, CVD, and coronary heart disease mortality, respectively. Among men with metabolic syndrome, elevated glucose (1.54 [1.34-1.78]) and low HDL cholesterol (1.45 [1.17-1.54]) were most predictive of CVD mortality, followed by elevated BMI (1.34 [1.17-1.54]), elevated blood pressure (1.25 [0.98-1.58]), and elevated triglycerides (1.06 [0.86-1.30]). In contrast, for men without metabolic syndrome, the HR for low HDL cholesterol was 1.02 (0.86-1.22). Among metabolic syndrome men with no nonfatal CVD event, smokers with elevated LDL cholesterol showed higher CVD mortality (1.79 [1.22-2.63]) compared with nonsmokers without elevated LDL cholesterol; this additional risk was even greater for metabolic syndrome men with a nonfatal CVD event (2.11 [1.32-3.38]). CONCLUSIONS: Metabolic syndrome is associated with an increased risk of mortality. Among those with metabolic syndrome, risk is further increased by having more metabolic syndrome conditions, by cigarette smoking, and by elevated LDL cholesterol. Primary prevention of each metabolic syndrome condition should be emphasized, and presence of each condition should be treated in accordance with current guidelines.     

青壮年男性四肢瘫痪患者血脂状况调查

目的：通过病例回顾性调查来了解青壮年男性四肢瘫痪患者血脂特点,探讨这一特殊人群在绝对缺乏运动的生活方式下血脂代谢情况和可能的心血管疾病风险及对策。方法：对中国康复研究中心2004年1月—2008年12月因四肢瘫痪入院进行康复治疗的男性患者进行入院状态调查。共466例患者入选,对血脂指标进行分析。结果：四肢瘫痪男性平均甘油三酯（TG）全国水平显著高于男性平均水平,达到1.49mmol/L;平均高密度脂蛋白（HDL）水平显著低于全国男性平均水平,只有0.92mmol/L;总胆固醇（TC）、低密度脂蛋白（LDL）平均水平与全国男性平均水平无显著差异。年龄与TC、LDL显著正相关（分别为r=0.160, P＜0.01; r=0.142, P＜0.01）;年龄与TG、HDL无显著相关。瘫痪病程与TG、HDL显著正相关（分别为r=0.097, P＜0.05; r=0.095, P＜0.05）;瘫痪病程与TC、LDL无显著相关。血脂异常者393例(占84%);HDL异常降低者357例（占77%）。结论：青壮年四肢瘫痪男性患者血脂异常发病率很高（达84%）;主要表现为HDL水平显著降低,发病率高（达77%）,但随瘫痪病程延长有升高趋势,而其水平与年龄无关;TG水平显著升高且与瘫痪病程正相关,但与年龄不相关;TC、LDL水平无显著升高,但与年龄正相关,而与瘫痪病程不相关。     

老年急性冠脉综合征患者血脂单项和血脂比值检测的临床价值

目的 探讨血脂比值对老年急性冠脉综合征(ACS)的临床诊断价值.方法 检测241例老年急性冠脉综合征患者和181例对照者的血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、载脂蛋白(Apo)A1、ApoB和脂蛋白a[LP(a)]水平,计算TC/HDL、LDL/HDL、TG/HDL和ApoB/ApoA1比值,进行统计学分析.结果 老年ACS组TG、TC/HDL和LDL/HDL显著高于对照组;HDL和ApoA1水平显著低于对照组.ApoA1是老年ACS独立的保护因素(P=0.012,OR=0.390,95%CI为0.188~0.811).结论 血脂比值可作为老年人ACS的预测指标,对于老年ACS的早期预防和诊断具有一定的临床价值.     

Healthy body mass index values often underestimate body fat in men with spinal cord injury

OBJECTIVE: To examine the relation between body mass index (BMI) and adiposity in men with spinal cord injury (SCI). DESIGN: Cross-sectional study. SETTING: Outpatient study in 2 centers in New Zealand. PARTICIPANTS: Nineteen men with traumatic SCI were age-, height-, and weight-matched with 19 able-bodied men. INTERVENTIONS: Not applicable.Main Outcome Measures: BMI (kg/m(2)) and dual-energy x-ray absorptiometry measures of total and regional lean tissue mass and fat mass. RESULTS: Although the groups had similar BMIs, the total lean tissue mass was 8.9kg lower (95% confidence interval [CI], -12.7 to -5.2; P<.001) whereas total fat mass was 7.1kg greater (95% CI, 1.3-12.8; P<.05) in the SCI group. Body fat percentage was 9.4% (95% CI, 3.6-15.1; P<.01) greater in the SCI group. Regional measures showed a similar pattern. Truncal fat mass increased 3.7kg (95% CI, 0.5-6.9; P<.05) in the SCI group compared with controls. CONCLUSIONS: Body fat mass was greater for any given BMI in the SCI group. Many patients with SCI do not appear to be obese, yet they carry large amounts of fat tissue. BMI is widely used to estimate adiposity, but it may underestimate body fat in men with SCI.     

The effect of saffron supplementation on blood glucose and lipid profile: A systematic review and meta-analysis of randomized controlled trials

BackgroundDespite several studies about the effects of saffron supplementation on serum concentrations of lipid and glucose profiles, no systematic study had summarized the findings. Therefore, we conduct current study to systematically summarize findings from studies about the effect of saffron supplementation on serum levels of glucose and lipid profiles and to do a meta-analysis, if possible.MethodsA systematic literature search was conducted for clinical trials published in PubMed, SCOPUS, EMBASE, Cochrane's Library and ISI Web of Science from the beginning to 22 February 2019. All randomized clinical trials on the effect of saffron supplementation on serum concentrations of lipid and glucose profiles were included.ResultsIn overall, six studies were included in the current study. Pooled analysis of six studies for the effect of saffron on serum TG, TC and FBG concentrations and of five studies for LDL and HDL, showed a significant reduction in TG (WMD: -8.93 mg/dl; 95% CI: -16.49 to -1.37, P = 0.02) and TC levels (WMD: -5.72 mg/dl; 95% CI: -11.10 to -0.34, P = 0.03), a significant increase in HDL levels (WMD: 2.7 mg/dl; 95% CI: 0.22 to 5.18, P = 0.03), and no significant effect on LDL (WMD: -2.30 mg/dl; 95% CI: -11.73 to 7.13, P = 0.63) and FBG levels (WMD: -5.30 mg/dl; 95% CI: -14.20 to 3.60, P = 0.51).ConclusionWe found a significant reduction in serum concentrations of TC and TG and a significant increase in serum levels of HDL following supplementation with saffron. Saffron supplementation had no significant influence on serum FPG and LDL concentrations.     

Cross-sectional study of complement C3 as a coronary risk factor among men and women

In the present study, we examined (i) whether C3 (complement C3) was an independent marker of prevalent CHD (coronary heart disease), and (ii) which preferential associations existed between C3 and some cardiovascular risk factors when jointly analysed with CRP (C-reactive protein) and fibrinogen. In a cohort of 756 unselected adults, 39% of whom had the metabolic syndrome, C3 and other risk variables were evaluated in a cross-sectional manner. In a logistic regression model for the likelihood of CHD, a significant OR (odds ratio) of 3.5 [95% CI (confidence intervals), 1.27 and 9.62)] for C3 was obtained after adjustment for smoking status, TC (total cholesterol) and usage of statins. A similar model, also comprising systolic blood pressure, with a cut-off point of >or=1.6 g/l C3 exhibited a 1.9-fold risk (95% CI, 1.01 and 3.58) compared with individuals below the cut-off point. Both analyses displayed an adjusted OR of 1.37 for each S.D. increment in C3. The significant relationship of C3 with a likelihood of CHD also proved to be independent of CRP. In multiple linear regression models, associations were tested for each acute-phase protein with measures of obesity, fasting insulin, triacylglycerols (triglycerides), TC, HDL (high-density lipoprotein)-cholesterol, physical activity, smoking status, diagnosis of metabolic syndrome and family income. When both genders were combined, C3 was independently associated with serum triacylglycerols, waist circumference, BMI (body mass index) and TC. CRP was independently associated with waist circumference, TC, family income (inversely) and physical activity, and fibrinogen with BMI, TC, smoking status and metabolic syndrome. In summary, elevated levels of complement C3 are associated with an increased likelihood of CHD independent of standard risk factors and regardless of the presence of acute coronary events, suggesting that C3 might be actively involved in coronary atherothrombosis. Unlike CRP and fibrinogen, C3 was preferentially associated with waist girth and serum triacylglycerols.     

Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men

OBJECTIVE: In men, hypoandrogenism is associated with features of the metabolic syndrome, but the role of sex hormones in the pathogenesis of the metabolic syndrome and diabetes is not well understood. We assessed the association of low levels of testosterone and sex hormone-binding globulin (SHBG) with the development of the metabolic syndrome and diabetes in men. RESEARCH DESIGN AND METHODS: Concentrations of SHBG and total and calculated free testosterone and factors related to insulin resistance were determined at baseline in 702 middle-aged Finnish men participating in a population-based cohort study. These men had neither diabetes nor the metabolic syndrome. RESULTS: After 11 years of follow-up, 147 men had developed the metabolic syndrome (National Cholesterol Education Program criteria) and 57 men diabetes. Men with total testosterone, calculated free testosterone, and SHBG levels in the lower fourth had a severalfold increased risk of developing the metabolic syndrome (odds ratio [OR] 2.3, 95% CI 1.5-3.4; 1.7, 1.2-2.5; and 2.8, 1.9-4.1, respectively) and diabetes (2.3, 1.3-4.1; 1.7, 0.9-3.0; and 4.3, 2.4-7.7, respectively) after adjustment for age. Adjustment for potential confounders such as cardiovascular disease, smoking, alcohol intake, and socioeconomic status did not alter the associations. Factors related to insulin resistance attenuated the associations, but they remained significant, except for free testosterone. CONCLUSIONS: Low total testosterone and SHBG levels independently predict development of the metabolic syndrome and diabetes in middle-aged men. Thus, hypoandrogenism is an early marker for disturbances in insulin and glucose metabolism that may progress to the metabolic syndrome or frank diabetes and may contribute to their pathogenesis.     

The prevalence of the metabolic syndrome among arab americans

OBJECTIVE: To estimate the prevalence of the metabolic syndrome in Arab Americans by age, sex, and BMI and to examine the association between insulin resistance and each of the components of the metabolic syndrome. RESEARCH DESIGN AND METHODS: We studied a representative, cross-sectional, population-based sample of 542 Arab Americans aged 20-75 years. The metabolic syndrome was defined by Adult Treatment Panel III (ATP III) and World Health Organization (WHO) diagnostic criteria. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR). RESULTS: The age-adjusted prevalence of the metabolic syndrome was 23% (95% CI 19-26%) by the ATP III definition and 28% (24-32%) by the WHO definition. Although the prevalence increased significantly with age and BMI in both sexes by both definitions, differences in estimates were noted. With ATP III, the age-specific rates were similar for men and women aged 20-49 years but were significantly higher for women aged >/=50 years. With WHO, rates were higher for men than women aged 20-49 years and similar for those aged >/=50 years. The most common component of the metabolic syndrome in men and women was low HDL cholesterol with the ATP III and the presence of glucose intolerance and HOMA-IR with the WHO. Strong associations between HOMA-IR and individual components of the metabolic syndrome were observed. After fitting a model with HOMA-IR as the outcome, waist circumference, triglyceride level, and fasting plasma glucose level were significantly associated with HOMA-IR. CONCLUSIONS: The metabolic syndrome is common among Arab Americans and is related to modifiable risk factors.     

Elevated C-reactive protein associated with decreased high-density lipoprotein cholesterol in men with spinal cord injury

Liang H, Mojtahedi MC, Chen D, Braunschweig CL. Elevated C-reactive protein associated with decreased high-density lipoprotein cholesterol in men with spinal cord injury.

Objectives

To determine if people with spinal cord injury (SCI) have elevated C-reactive protein (CRP), to examine the association of CRP with high-density lipoprotein cholesterol (HDL-C), and to assess the influence of completeness and level of injury on these parameters.

Design

Cross-sectional.

Setting

Urban university.

Participants

Men with SCI (n=129) who were free of infection and/or recent anti-inflammatory medication use as well as their 1:1 age- and race-matched able-bodied counterparts from the 1999-2002 National Health and Nutrition Examination Surveys.

Interventions

Not applicable.

Main Outcome Measures

High CRP was defined as 3mg/L or higher and low HDL-C as less than 1.04mmol/L.

Results

Men with SCI were more likely to have high CRP (odds ratio [OR]=2.29; 95% confidence interval [CI], 1.33-3.95) and low HDL-C (OR=1.81; 95% CI, 1.01-3.27). The OR for low HDL-C in SCI was no longer significant when high CRP was controlled. CRP was higher in complete versus incomplete injury (median, 3.7mg/L vs 1.2mg/L; P=.005), and this elevation was independent of age, smoking, physical activity, waist circumference, and weight. No conclusion can be made on the association of injury level and CRP because of a lack of power.

Conclusions

The elevated CRP, possibly the major risk factor, together with decreased HDL-C may contribute to greater incidence for cardiovascular disease in the SCI population.     

Grip strength and the metabolic syndrome: findings from the Hertfordshire Cohort Study

INTRODUCTION: Sarcopenia, the loss of muscle mass and strength with age, is significantly associated with type 2 diabetes in older people. AIM: To determine whether there is a relationship between grip strength and features of the metabolic syndrome. DESIGN: Cross-sectional study. METHODS: Data were collected on grip strength, fasting glucose, triglycerides and HDL cholesterol, blood pressure, waist circumference and 2 h glucose after an oral glucose tolerance test, in a population-based sample of 2677 men and women aged 59-73 years. RESULTS: In men and women combined, a standard deviation (SD) decrease in grip strength was significantly associated with higher: fasting triglycerides (0.05 SD unit increase, 95%CI 0.02-0.09, p = 0.006); blood pressure (OR 1.13, 95%CI 1.04-1.24, p = 0.004); waist circumference (0.08 SD unit increase, 95%CI 0.06-0.10, p < 0.001); 2 h glucose (0.07 SD unit increase, 95%CI 0.03-0.11, p = 0.001) and HOMA resistance (0.05 SD unit increase, 95%CI 0.01-0.09, p = 0.008), after adjustment for gender, weight, age, walking speed, social class, smoking habit and alcohol intake. Lower grip strength was also significantly associated with increased odds of having the metabolic syndrome according to both the ATPIII (OR 1.18, 95%CI 1.07-1.30, p < 0.001) and IDF definitions (OR 1.11, 95%CI 1.01-1.22, p = 0.03). DISCUSSION: Our findings suggest that impaired grip strength is associated with the individual features, as well as with the overall summary definitions, of the metabolic syndrome. The potential for grip strength to be used in the clinical setting needs to be explored.     

Small dense LDL particles and metabolic syndrome in a sample of middle-aged women. Findings from Progetto Atena

Metabolic Syndrome (MS) is highly prevalent in the general population. Recently, small dense LDL (sd-LDL) particles have been considered a risk marker in MS diagnosis. We analyzed cross-sectionally the association between sd-LDL and MS in a population-based sample of 210 middle-aged southern Italian women; among them 86 participants had MS (prevalence 40.9%). LDL particle separation was performed by Lipoprint System: seven LDL subfractions were obtained and LDL score (% of sd-LDL particles) calculated. Women with the MS diagnosis had significantly higher LDL score as compared to participants without MS diagnosis (median 0 vs. 3.6, p<0.001 by Mann Whitney). The univariate analysis showed a positive and significant association between MS diagnosis (OR 4.80; 95% CI 2.29-10.18; p<0.001 for MS diagnosis) and some MS components Triglycerides (TG), HDL Cholesterol (HDL-C), (OR 14.82; 95% CI 5.24-41.88; p<0.001 for Ln TG); (OR 0.92; 95% CI 0.89-0.95; p<0.001 for HDL-C) and LDL score. Apo B and insulin levels were also positively related to the presence of sd-LDL (OR 31.56; 95% CI 5.58-178.29; p<0.001 for apo B); (OR 1.07; 95% CI 1.00-1.15; p<0.05 for insulin). After controlling for age, insulin and apo B, MS diagnosis (OR 4.0; 95% CI 1.76-9.09; p<0.001 for MS diagnosis) and MS components (TG, HDL-C) (OR 4.41; 95% CI 1.22-15.87; p=0.023 for Ln TG); (OR 0.94; 95% CI 0.89-0.98; p=0.009 for HDL-C) remained significantly associated with high LDL score (upper quintile). Our results suggest that sd-LDL particles could be a valuable marker for diagnosis and severity of the MS. Future prospective epidemiological studies are envisaged to explore the specific contribution of this marker on cardiovascular risk. LDL size measurement could be an useful tool for identifying a subsample patients with prominent lipoprotein abnormality, within the large population with the MS diagnosis, and who are candidates for intensive lipid-lowering interventions.     

Meta-analysis of the comparative efficacy and safety of pitavastatin and atorvastatin in patients with dyslipidaemia

What is known and Objective: Pitavastatin is the latest available statin. It has been shown to be effective in the treatment of dyslipidaemia. This meta‐analysis was aimed at evaluating the effects of pitavastatin on lipid profiles in patients with dyslipidaemia compared with atorvastatin. Methods: Clinical trials were identified through electronic searches (MEDLINE, CINAHL, EBM review, and the Cochrane Library) up to January 2011 and historical searches of relevant articles. Studies were included in the meta‐analysis if they were (i) randomized controlled trials that evaluated pitavastatin at the recommended dose vs. atorvastatin in patients with dyslipidaemia, (ii) lasting at least 6 weeks, (iii) reporting total cholesterol (TC), LDL‐C, HDL‐C or triglyceride (TG) levels and (iv) published in English. Treatment effect was estimated with the mean difference in the per cent changes in lipid profiles from baseline to final assessment between pitavastatin and atorvastatin. Results: Seven trials involving 1529 patients were included. Pitavastatin reduced LDL‐C level as effectively as atorvastatin (mean difference 0.97%, 95% CI ?0.48% to 2.42%). The reductions in TC and TG levels were also comparable between the two drugs. The mean differences were 1.22% (95% CI ?0.55% to 2.99%) and 2.3% (95% CI ?1.06% to 5.65%), respectively. However, HDL‐C levels increased significantly more with pitavastatin than with atorvastatin (mean difference 1.78%, 95% CI 0.20–3.36%, P = 0.03). What is new and Conclusions: Pitavastatin was as effective as atorvastatin in lowering LDL‐C, TC and TG levels. Pitavastatin was marginally superior to atorvastatin in increasing HDL‐C levels.     

Abdominal obesity and insulin resistance in patients with type 2 diabetes in a Swedish community. Skaraborg hypertension and diabetes project

OBJECTIVE: To explore the association between abdominal obesity and insulin resistance in patients with type 2 diabetes. DESIGN: A cross-sectional observational study. SETTING: Primary care in Skara, Sweden. SUBJECTS: A total of 198 men and 186 women with type 2 diabetes who consecutively completed an annual check-up in 1992-1993. MAIN OUTCOME MEASURES: Abdominal obesity was defined according to criteria for the metabolic syndrome using the waist circumference (WC): > 102 cm for men and > 88 cm for women. Insulin resistance was estimated using the Homeostasis Model Assessment (HOMA), and was dichotomized by the 75th percentile (IR). RESULTS: Abdominal obesity was found in 66 men (33%), and in 106 women (57%). Pearson's correlation coefficients between components of the metabolic syndrome and IR were statistically significant for WC, waist-hip ratio, serum triglycerides, and HDL cholesterol, and were higher for WC (0.40) than for waist-hip ratio (0.23) in both genders (p < 0.001). The association between WC and IR was challenged by successively entering other components of the metabolic syndrome into the model in a logistic regression. In the final model, adjusting for differences in age, systolic blood pressure, HbA1c, serum triglycerides, HDL cholesterol, and microalbuminuria, the association remained statistically significant both in men (OR 8.6, 95% CI 3.0-25.2, p < 0.001), and in women (OR 5.6, 95% CI 1.7-18.1, p = 0.004). CONCLUSIONS: WC provides a feasible measure for insulin resistance in the vast majority of subjects with type 2 diabetes. It is convenient and less expensive than direct means and could be used as a proxy for insulin resistance in population studies.     

儿童代谢综合征与颈动脉超声参数和血液生化指标的相关性研究

目的：探讨儿童代谢综合征（MS）与颈动脉超声参数和血液生化指标的相关性。方法将30例儿童代谢综合征患者作为MS组,30例儿童单纯性肥胖者作为肥胖非MS组,随机选择30例健康体检儿童作为正常对照组,测量所有入选儿童身高、体重、腰围、臀围、收缩压、舒张压、空腹血糖、空腹胰岛素、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白,计算体质量指数（BMI）、腰臀比（WHR）、胰岛素抵抗指数（HOMA-IR）和动脉粥样硬化指数（AI）;采用彩色多普勒超声仪观察各组儿童颈动脉内径（CADIA）、颈动脉内膜-中层厚度（CAIMT）;比较MS组、肥胖非MS组和正常对照组各项指标。结果与正常对照组比较,MS组空腹血糖、空腹胰岛素、HOMA-IR、总胆固醇、甘油三酯、低密度脂蛋白升高,高密度脂蛋白降低,其中空腹血糖、空腹胰岛素、HOMA-IR、甘油三酯、高密度脂蛋白、低密度脂蛋白指标差异具有统计学意义（P＜0.01或P＜0.05）;MS组与肥胖非MS组比较R-CAIMT、L-CAIMT增厚,差异具有统计学意义（P＜0.01）,R-CADIA、L-CADIA比较差异无统计学意义（P＞0.05）。结论颈动脉超声参数和血液生化指标能提示 MS 儿童存在血管内皮功能损害,为MS 儿童心血管病变的早期发现和治疗提供客观依据。     

Fractional esterification rate of cholesterol and ratio of triglycerides to HDL-cholesterol are powerful predictors of positive findings on coronary angiography

BACKGROUND: We examined the predictive value of various clinical and biochemical markers for angiographically defined coronary artery disease (aCAD). Specifically, we assessed the value of the ratio of plasma triglyceride (TGs) to HDL-cholesterol (HDL-C) and the fractional esterification rate of cholesterol in plasma depleted of apolipoprotein B (apoB)-containing lipoproteins (FER(HDL)), a functional marker of HDL and LDL particle size. METHODS: Patients (788 men and 320 women) undergoing coronary angiography were classified into groups with positive [aCAD(+)] and negative [aCAD(-)] findings. Patient age, body mass index, waist circumference, blood pressure (BP), medications, drinking, smoking, exercise habits, and plasma total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-unesterified cholesterol, HDL-C, TGs, FER(HDL), apoB, log(TG/HDL-C), and TC/HDL-C were assessed. Lipids and apoproteins were measured by standard laboratory procedures; FER(HDL) was determined by a radioassay. RESULTS: Members of the aCAD(+) group were older and had a higher incidence of smoking and diabetes than those in the aCAD(-) group. The aCAD(+) group also had higher TG, apoB, FER(HDL), and log(TG/HDL-C) and lower HDL-C values. aCAD(+) women had greater waist circumference and higher plasma TC and TC/HDL-C. aCAD(+) men, but not women, had higher plasma LDL-C. In the multivariate logistic model, the significant predictors of the presence of aCAD(+) were FER(HDL), age, smoking, and diabetes. If only laboratory tests were included in the multivariate logistic model, FER(HDL) appeared as the sole predictor of aCAD(+). Log(TG/HDL-C) was an independent predictor when FER(HDL) was omitted from multivariate analysis. CONCLUSIONS: FER(HDL) was the best laboratory predictor of the presence of coronary atherosclerotic lesions.     

2型糖尿病患者血糖对血脂的影响及相关性

目的 探讨2型糖尿病患者的血脂异常及血糖浓度对血脂的影响。方法 对90例住院的2型糖尿病患者的血脂、血糖、胰岛素、糖化血红蛋白（HbAlc）进行多因素逐步回归分析,将病人分为血糖控制良好、控制较差和控制差三组,采用方差分析法观察血糖浓度对血脂的影响。结果 2型糖尿病患者的糖化血红蛋白与甘油三酯（TG）、胆固醇（TC）、低密度脂蛋白（LDL）呈正相关且差异有统计学意义（P〈0．05）,与高密度脂蛋白（HDL）呈负相关（P〈0．05）;随着HbAle水平升高,TG、TC、LDL呈逐渐增高趋势,HDL呈下降趋势。结论 血糖浓度可影响2型糖尿病患者的血脂,控制血糖浓度的同时应注意其对血脂的影响。     

血脂、腰臀比异常对糖尿病血管并发症的影响及护理干预

目的对544例2型糖尿病(T2DM)患者及278例健康人进行空腹血糖(FBG)、总胆固醇(TC)、甘油三酯TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、LDL/HDL及腰臀比(WHR)、体重指数(BMⅠ)的测定,探讨其T2DM血管并发症与血脂代谢及WHR的关系。方法将T2DM组(A、B组)的FBG、TC、TG、HDL、LDL、LDL/HDL及WHR、BMI与正常对照组及组间进行比较分析。结果T2DM组(A、B组)与正常对照组相比FBG、TC、TG、LDL、LDL/HDL及WHR有显著增高,HDL明显降低。特别是有血管病变组与无血管病变组相比TC、LDL、LDL/HDL增高差异有显著意义(P<0.001),HDL也降低,差异有显著意义(P<0.001),同时WHR及BMI增高差异有显著意义。结论血脂代谢紊乱是DM患者导致血管病变的主要原因,而WHR及BMI增高是发生T2DM的重要危险因素,同时,WHR及BMI可作为自我了解健康状况的重要指标之一。