代谢综合征和高尿酸血症对冠状动脉疾病患者心血管风险的影响

目的评估高尿酸血症对代谢综合征患者心血管风险的影响。方法选取2963例患有冠状动脉疾病的患者参与到预防心梗的研究中,其中,1410位患有代谢综合征,具有以下5类中3类及以上症状:血清空腹血糖>110mg/dl;甘油三酯>150mg/dl;高密度脂蛋白胆固醇<40mg/dl(男性)和<50mg/dl(女性);收缩期和舒张期血压分别>130mmHg和>80mmHg;体重指数>28kg/m2。其余1553名患者无代谢综合征。主要观察终点定义为急性心肌梗死和心源性猝死的发生。高尿酸血症定义为血清尿酸水平>7.0mg/dl(男性)以及>6.0mg/dl(女性)。结果相比对照组代谢综合征患者(n=1126)来说,主要终点发生率出现在高尿酸血症组患者(n=284)中(分别是15.3%和20.1%,P=0.05)。在对年龄、性别、吸烟、糖尿病、既往心肌梗死、高血压、估计肾小球滤过率、体重指数、总胆固醇、甘油三酯、利尿剂、抗血小板药物、血管紧张素转换酶抑制剂、β受体阻滞剂进行调整后,患有代谢综合征的高尿酸血症患者,相对于对照组来说,在最主要终点方面显示出明显地高风险(HR1.45,95%CI1.00~2.17,P=0.05)。结论高尿酸血症与代谢综合征患者在心肌梗死和心源性猝死方面风险增加有关。     

高尿酸血症与代谢综合征的相关性研究

目的了解和掌握本地区高尿酸血症(HUA)与代谢综合征(MS)的相关性,为通过行为干预方式降低HUA发生风险提供依据。方法选择健康体检人群1093例为研究对象,对其病史、体质量指数(MBI)、血压、血糖、血尿酸(UA)、血浆三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)等数据进行统计分析。结果超重52.33%(572),其中男性58.63%(435),女性39.03%(137);HUA10.61%(116),其中男性11.99%(89),女性7.69%(27);高血压59.19%(647),其中男性66.71%(495),女性43.30%(152);高TG37.97%(415),其中男性42.32%(314),女性28.77%(101);糖调节受损17.47%(191),其中男性19.14%(142),女性13.96%(49);低HDL-C2.74%(30),其中男性2.83%(21),女性2.56%(9)。结论 MS人群UA水平及HUA患病率均明显高于非MS人群,血UA水平随MS指标异常个数的增多而有所增高。     

高尿酸血症与代谢综合征的相关性研究

目的探讨高尿酸血症与代谢综合征(MS)的相关性。方法选取在我院体检的354例健康体检者,根据尿酸水平分别高尿酸血症组合正常尿酸组,对比两组病例的血脂、血压、血糖指标;统计分析MS的发病率及其与高尿酸血症的相关性。结果高尿酸血症组高血压病发生率、空腹血糖、血脂水平均高于正常尿酸组,差异有统计学意义(P<0.05);高尿酸血症组MS发病率高于正常尿酸组,差异有统计学意义(P<0.01)。MS组血尿酸显著高于非MS组,差异有统计学意义(P<0.01)。结论高尿酸血症患者存在显著的血压、血糖、血脂异常;高尿酸血症与MS密切相关,可能为MS的危险因素之一。     

高尿酸血症与代谢综合征的关系

近年来随着经济的快速发展,人民生活水平较前有很大的提高,饮食结构发生改变,高尿酸血症（HUA）的发病率在我旧不仅有逐渐升高的趋势,患病年龄也有提前的趋势。血清尿酸水平升高与多种疾病密切相关,人体血尿酸水平升高是机体代谢紊乱的反应之一。     

老年人高尿酸血症与代谢综合征组分的关系

目的：分析老年人（〉60岁）高尿酸血症患者代谢综合征组分的患病情况,探讨老年人高尿酸血症与代谢综合征组分的关系。方法：采用整群抽样的方法,通过对华泾镇社区2006位老年人进行统一体检和病史采集,收集研究对象的血尿酸、BMI、血压、血糖、甘油三酯、总胆固醇水平及糖尿病、高血压的病史资料。采用SPSS13.0统计软件进行分析。结果：本组人群高尿酸血症患病率为19.59%,男性患病率高于女性。高尿酸血症组中肥胖的患病率为61.07%;高血糖的患病率为59.54%;高血压的患病率为76.34%;高三酰甘油的患病率为35.11%;高胆固醇的患病率为8.65%,与非高尿酸血症组比较差异有统计学意义。结论：老年人高尿酸血症与代谢综合征各组分之间具有显著相关性,能增加心脑血管事件发生的危险性。     

老年人高尿酸血症特点及与代谢综合征的相关性

目的 探讨老年人高尿酸血症发病特点及与代谢综合征各组分之间的相关性。 方法 观察老年离退休干部2052人,男1710人,女342人,年龄65-95岁,平均年龄74.57±6.43,检测体重指数（BMI）、静息血压、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）、血尿酸（SUA）、血糖（FPG）、血肌酐（Cr）、纤维蛋白原等指标,用SPSS统计软件做统计学分析。 结果 老年人高尿酸血症发病率16.5%,男16.7%,女15.2%,而非老年组发病率13.09%,男17.52%,女4.98%;老年人不同年龄组间血尿酸水平无统计学差异,但男女性别间具有统计学差异。高尿酸者与非高尿酸者代谢指标比较,除血糖外,BMI、收缩压、舒张压、TG、TC、HDL-C、LDL-C、SUA、纤维蛋白原、Cr均有统计学差异,P值均小于0.01。经Pearson相关分析,SUA与BMI、收缩压、舒张压、TG、纤维蛋白原、Cr呈正相关,（r=0.238、0.091、0.099、0.200、0.100、0.348,P值均小于0.001）,与HDL-C、FPG呈负相关（r=-0.424,P<0.001、r=-0.162,P<0.05）。 结论 老年人高尿酸血症发病率较高,高尿酸血症与代谢综合征呈明显相关性。     

高尿酸血症与代谢综合征关联性的流行病学研究进展

随着我国经济水平的提高及居民生活方式的改变,代谢综合征(MS)的患病率不断上升.有研究显示我国老年人群MS患病率高达25.5%,现已成为我国重要的公共卫生问题.MS是集肥胖、高血压、血脂紊乱及糖代谢异常于一体的临床症候群,也是心血管疾病重要的危险因素.由于MS发病机制尚缺乏明确认识,对其危险因素进行干预是目前控制MS的重要手段.近年来,大量研究发现高尿酸血症(HUA)不仅是痛风的主要诱因,且与肥胖、高血压、高脂血症、糖尿病等MS主要组分密切相关,是MS和心血管疾病的独立危险因素.鉴于此,笔者从人群流行病学研究着手,就HUA与MS的关联性作一综述,探索采用血尿酸筛选MS高危人群的可行性,为MS及心血管疾病的防控提供科学依据.     

高尿酸血症与代谢综合征相关因素分析

目的:探讨高尿酸血症(HUA)和肥胖、高血压、高血糖、脂代谢紊乱之间的关系.方法:对广州市邮区中心局2 734名职工进行体检,空腹测定血尿酸,空腹血糖和血脂,并对各项结果进行分析比较.结果:≥40岁组的HUA患病率(21.7％)与代谢综合征(MS)患病率(21.2％)明显高于＜40岁组(分别为13.6％、10.6％).HUA组MS的患病率(17.9％)明显高于尿酸正常组(13.6％),差异有统计学意义(P＜0.05).HUA组MS的各组分(肥胖、高血压、高血糖、高血脂)的患病率均高于血尿酸正常组(P＜0.05).结论:随年龄增长,HUA与MS的患病率增高,HUA患者MS发生率较高.     

社区老年男性人群代谢综合征与高尿酸血症相关性分析

目的探讨社区老年男性代谢综合征（MS）与高尿酸血症（HUA）之间的相关性。方法随机抽取已规范建立健康档案的老年男性代谢综合征患者160例,对研究对象进行年度体检,按尿酸水平分为高尿酸血症组与正常尿酸组。比较两组人群的体重指数、腰围、血压、血糖、血脂水平及合并相关疾病的情况。结果高尿酸血症组的体重指数（BMI）、腰围、舒张压（DBP）、餐后2小时血糖（2hPG）、甘油三酯（TG）高于正常尿酸组（P〈0．05）,且高尿酸血症组合并冠心病的患病率高于正常尿酸组（P〈0．05）。结论高尿酸血症与老年男性代谢综合征相关,老年男性MS患者合并高尿酸血症患心血管病的风险增加,应积极进行社区干预。     

老年人高尿酸血症与代谢综合征相关因素研究进展

近年来高尿酸血症(HUA)与代谢综合征(MS)作为心、脑、肾及外周血管性疾病高危因素受到关注,并对其中相关性进行了大量临床和基础研究,获得了许多临床一线研究材料.随着我国人口老龄化,HUA和MS已成为老年人群缺血性、退行性血管病流行的主要病因,严重威胁社会、家庭和人群健康,应引起医疗保健工作者重视.为认识老年人HUA和MS相关因素相互作用、发病机制和流行病学特点,提高防治对策,探讨HUA与MS在老年病防治中的地位和作用.     

Management of dyslipidemia in the metabolic syndrome

The metabolic syndrome consists of a clustering of metabolic derangements that cause the affected individual to have an increased risk for developing cardiovascular disease. Dyslipidemia is an important component of the metabolic syndrome and is included in all the definitions of the metabolic syndrome published by different international committees to identify individuals with the metabolic syndrome. Atherogenic dyslipidemia in the metabolic syndrome comprises of hypertriglyceridemia, low levels of high-density lipoprotein cholesterol and a preponderance of small dense low-density lipoprotein particles. The pathogenesis of dyslipidemia in the metabolic syndrome will be reviewed and the roles of therapeutic lifestyle modification and drug therapies in the treatment of dyslipidemia will be discussed.     

Management of dyslipidemia in patients with metabolic syndrome.

OBJECTIVE: To review the management of dyslipidemia in patients with metabolic syndrome. DATA SOURCES: Medline search (2000-2002) conducted for English language articles using the search terms metabolic syndrome, impaired fasting glucose, glucose intolerance, and antilipemic agents; selective search for clinical trials of lipid therapy conducted in dialogue databases (1990-2002). In addition, current dyslipidemia treatment guidelines reviewed. STUDY SELECTION: By the author. DATA EXTRACTION: By the author. DATA SYNTHESIS: The metabolic syndrome is increasingly recognized as a strong predictor of patient risk for developing coronary artery disease (CAD). It is associated with an atherogenic dyslipidemia characterized by elevated levels of triglycerides, reduced levels of high-density lipoprotein cholesterol (HDL-C) and a preponderance of small dense low-density lipoprotein (LDL) particles. Controlled clinical trials show similar or greater cardiovascular benefits from lipid-modifying therapies in patient subgroups with diabetes, impaired fasting glucose, and metabolic syndrome, compared with overall study populations. Current guidelines recommend intensified lipid management. Therapeutic lifestyle changes, with emphasis on weight loss, are particularly important for patients with metabolic syndrome. Statins are first-line therapy for all patients whose LDL-C levels are above goal. Combination therapy may often be necessary to control all lipid abnormalities adequately. Both niacin and fibrates provide additional benefits, particularly on triglyceride and HDL-C levels. Recent clinical studies show that these agents, in combination with statins, are safe and effective for the treatment of atherogenic dyslipidemia. CONCLUSION: Atherogenic dyslipidemia represents an important modifiable CAD risk factor. Combination therapy with agents that focus on all of the components of the mixed dyslipidemia that often occurs in persons with diabetes and the metabolic syndrome may be expected to reduce cardiovascular morbidity and mortality.     

代谢综合征患者血脂异常的规范化治疗和药学监护

目的探讨临床药师参与代谢综合征患者血脂异常的规范化治疗和药学监护的意义。方法临床药师参与血脂异常的代谢综合征患者的规范化调脂治疗过程,并对患者实施药学监护、健康教育和用药教育等。结果临床药师干预后患者的血脂水平、膳食结构、治疗依从性等均较干预前有明显改善;血脂异常的代谢综合征患者的治疗过程经临床药师干预后,未发生严重药物不良事件。结论临床药师参与代谢综合征患者的调脂治疗并通过药学监护和患者教育,町及时发现和解决患者治疗过程中的潜在问题,有助于提高患者的治疗效果,避免严重药物不良反应的发生。     

替米沙坦对高血压伴代谢综合征患者血脂及胰岛素抵抗的影响

目的 观察替米沙坦对高血压伴代谢综合征患者血脂及胰岛素抵抗的影响.方法 选择昆山市第三人民医院门诊高血压伴有代谢综合征患者56例,完全随机分为替米沙坦组(28例)及苯磺酸氨氯地平组(28例),替米沙坦组给予替米沙坦80mg/次,1次/d;苯磺酸氨氯地平组给予苯磺酸氨氯地平5 mg/次,1次/d.进行为期12周的临床观察.监测治疗前后空腹血糖、餐后2h血糖(2 h PG)、空腹胰岛素(FIns)、餐后2h胰岛素(2 h Ins)、TC、TG、HDL-C、LDL-C及胰岛素抵抗指数(HOMA-IR).结果 2组治疗后空腹血糖、2hPG与本组治疗前比较及组间比较差异均无统计学意义(P＞0.05).替米沙坦组治疗后FIns、2 hIns和HOMA-IR均低于本组治疗前,治疗前后差异有统计学意义[FIns:(12.1±2.4) mIU/L比(16.6±2.7) mIU/L,2 h Ins:(66±4)mIU/L比(80±5)mIU/L,HOMA-IR:(3.1±0.9)比(4.3±1.0),P＜0.05];苯磺酸氨氯地平组治疗后FIns、2 h Ins和HOMA-IR分别为(16.7±1.9) mIU/L、(81±6)mIU/L和(4.4±1.1);2组治疗后FIns、2 h Ins和HOMA-IR差异有统计学意义(P＜0.05).替米沙坦组治疗前后TC分别为(5.53±0.37)、(4.39±0.26) mmol/L,TG分别为(3.3±0.6)、(2.2±0.4) mmol/L,LDL-C分别为(3.5±0.6)、(2.7±0.6)mmol/L,治疗前后差异有统计学意义(P＜0.05);苯磺酸氨氯地平组治疗后TC、TG、LDL-C分别为(5.56 ±0.37)、(3.3±0.5)、(3.5±0.6) mmol/L;2组治疗后TC、TG、LDL-C差异有统计学意义(P＜0.05).结论 替米沙坦在降压的同时具有改善血脂水平及胰岛素抵抗的作用.     

Improvement bioavailability of silymarin ameliorates severe dyslipidemia associated with metabolic syndrome

Abstract

1. To compare the effectiveness of different drug forms of silymarin: standardized extract of silymarin (SS), micronized silymarin (MS) and silymarin in the form of phytosome (PS) on dyslipidemia and liver fat accumulation in a model of metabolic syndrome, in non-obese hereditary hypertriglyceridemic rats. The second aim of this study was to slightly uncover the silymarin action on enzymes and proteins involved in cholesterol metabolism and excretion.

2. Silymarin administered to hereditary hypertriglyceridemic rats as dietary supplements (1%) for 4 weeks significantly lowered the plasma levels of triglycerides, total cholesterol and markedly increased HDL cholesterol level. Western blot analyses showed significant increase in the protein expression of CYP7A1 and CYP4A and increase in protein expression of selected ABC transporters. Silymarin in the form of phytosome and micronized silymarin were more effective forms of silymarin.

3. These findings suggest that silymarin may favorably affect the metabolism of cholesterol and triglycerides in rats with metabolic syndrome. Raising HDL levels suggests potentially important anti-atherogenic effect of silymarin. The changes in expression of cytochromes P450 and ABC transporters involved in cholesterol metabolism and excretion could be partially responsible for the hypolipidemic effect of silymarin.     

Pleiotropic effects of ARB on dyslipidemia

Angiotensin II type 1 (AT1) receptor blockers (ARBs), widely used in the treatment of hypertension, have cardiovascular, cerebral, and renal protective effects beyond blood pressure control. In addition to direct end-organ protection, some ARBs have been suggested to improve abnormalities of glucose and lipid metabolisms, resulting in an anti-atherosclerotic effect in patients with hypertension. In several clinical trials, the effects of ARBs on lipid metabolism have been emerged, although the effects are heterogeneous. Certain subgroups of ARBs such as telmisartan have been identified as partial agonists for the peroxisome proliferators activated receptor (PPAR)-γ, and thus, this class of ARBs has been mostly focused on their effects on lipid metabolism. Based on the pleiotropic effects on lipid metabolism, we can envision that ARBs would provide the promising outcome for hypertensive patients aggregating metabolic risk factors, including dyslipidemia.     

Pleiotropic effects of ARB in metabolic syndrome

Metabolic syndrome comprises of a cluster of several risk factors including abdominal obesity, dyslipidemia, elevated blood pressure, and insulin resistance. Many manifestations occur in sequence which is also referred to as the metabolic domino. Because the renin-angiotensin system (RAS) seems to be involved in this domino effect, RAS blockade by angiotensin II receptor blockers (ARB) offers a therapeutic tool for treating hypertension and ultimately the metabolic syndrome itself. In this paper, I describe the effects of ARBs on adiponectin, blood pressure, and fatty liver. Several clinical studies have reported that ARBs elevate adiponectin. ARBs that activate the PPARγ may be more effective than others. In terms of blood pressure, transient ARB administration may prevent the development of hypertension and high doses of ARB may regress mild hypertension. In terms of fatty liver, several research studies have indicated that ARBs may prevent triglyceride accumulation in liver. Again, ARBs that activate PPARγ may be more effective than others. Thus, PPARγ-activating ARBs offer the most hopeful treatment for metabolic syndrome. Further studies are needed to confirm this hypothesis.     

益肾I方对多囊卵巢综合征—代谢综合征大鼠拮抗胰岛素抵抗抑制氧化应激及调血脂作用

目的观察益肾I方对多囊卵巢综合征-代谢综合征(PCOS-MetS)大鼠胰岛素抵抗(IR)、血脂异常及氧化应激-自由基损伤的作用。方法采用十一酸睾酮加绒毛膜促性腺激素(HCG)建立PCOS-MetS大鼠模型,连续口服给予二甲双胍或不同剂量的益肾I方4周,观察大鼠体质量、血清肿瘤坏死因子-α(TNF-α)、睾酮(T)、丙二醛(MDA)、一氧化氮(NO)、胆固醇(TC)、甘油三酯(TG),低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)和口服葡萄糖后2h血糖(OGTT-2hBG)和胰岛素含量以及超氧化物歧化酶(SOD)和诱导型一氧化氮合酶(iNOS)-一氧化氮合酶(NOS)活性,并计算胰岛素敏感指数(ISI)的变化。结果PCOS-MetS大鼠体质量明显增加,与空白对照组比较,差异有统计学意义(P<0.01);血清TNF-α、T、MDA、NO、TG、TC、LDL-C、FBG、OGTT-2hBG和胰岛素水平以及iNOS-NOS活性,均明显升高,而HDL-C含量、SOD活性和ISI则显著降低,与空白对照组比较,差异有统计学意义(P<0.01);二甲双胍和益肾I方高和中2个剂量均能不同程度地改善PCOS-MetS大鼠体质量增加、高雄激素血症、高血糖血症、高脂血症、高胰岛素血症和IR等病理生理改变(P<0.01或P<0.05),以及增强抗氧化酶SOD活性,抑制NOS和iNOS活性,降低MDA和NO水平(P<0.01或P<0.05)。结论益肾I方能改善PCOS-MetS大鼠胰岛素敏感性,对抗高雄激素血症和脂质代谢异常以及氧化应激-自由基损伤,并提高抗氧化能力。     

The effects of Ficus carica on the activity of enzymes related to metabolic syndrome

The present study aimed to investigate the effects of the various parts of Ficus carica L. (figs) on antioxidant, antidiabetic, and antiobesogenic effects in vitro. Fruit, leaves, and stembark of the F. carica plant were sequentially extracted using organic and inorganic solvents and their total polyphenol and flavonoid contents were estimated. The effects of the extracts on antioxidative, antidiabetic (inhibition of α-amylase and α-glucosidase enzymes), and antiobesogenic (antilipase) activities were measured using several experimental models. The fruit ethanolic extract contained a high quantity of polyphenols and flavonoids (104.67 ± 5.51 μg/mL and 81.67 ± 4.00 μg/mL) compared with all other extracts. The activity of the ethanolic extract of F. carica fruit was significantly (p < 0.05) higher than all other extracts and parts of the plant in terms of antioxidative, antidiabetic, and antiobesogenic effects. The IC₅₀ values of the fruit ethanolic extract in terms of antioxidative (134.44 ± 18.43 μg/mL), and inhibition of α-glucosidase (255.57 ± 36.46 μg/mL), α-amylase (315.89 ± 3.83 μg/mL), and pancreatic lipase (230.475 ± 9.65 μg/mL) activity indicate that the activity of fruit ethanolic extract is better than all other extracts of the plant. The gas chromatography–mass spectroscopy analysis of the fruit ethanolic extract showed the presence of a number of bioactive compounds such as butyl butyrate, 5-hydroxymethyl furfural, 1-butoxy-1-isobutoxy butane, malic acid, tetradecanoic acid, phytol acetate, trans phytol, n-hexadecanoic acid, 9Z,12Z-octadecadienoic acid, stearic acid, sitosterol, 3,5-dihydroxy-6-methyl-2,3-dihydro-4H-pyran-4-one, and 2,4,5-trimethyl-2,4-dihydro-3H-pyrazol-3-one. The results of this study suggest that the ethanolic extract of the fruit of F. carica may have potential antidiabetic and antiobesogenic agents.