血清猪胆酸类胆汁酸与糖脂代谢的相关性研究

目的:探讨人群血清猪胆酸类胆汁酸（HCAs）水平与糖脂代谢的关系。方法:选取2009年12月至2010年6月上海肥胖研究中的受试者进行横断面研究。收集其性别、年龄、身高、体重,并计算体重指数（BMI）。检测研究对象的空腹血糖（FPG）、空腹胰岛素（FINS）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL...     

不同糖代谢状态人群糖化血清白蛋白与HbA1c的相关性分析

ObjeclJve To definine the corresponding value to glycated albumin(GA)for a specific target of HbAlc,and to elvaluate the relationship between GA and HbA1c.Methods From Oct.2006 TO Apr.2009, 2 532 subjects were enrolled who accepted oral glucose tolerance test(OGtt)in out-patient department,including 898 with normal glucose regulation,695 with impaired glucose regulation,and 939 with newly-diagnosed diabetes.GA was measured with liquid enzymatic method.HbA1c was measured with high performance liquid chromatography method.The plasma glucose was measured at fasting,0.5 h,1 h,2 h,and 3h after glucose load.The correlation among GA,HbA1c and the other parameters monitored was analyzed.Results (1)The levels of HbA1c and GA in 2 532 subjects were(6.3±1.1)% and(17.9±4.5)%.The ratio of GA/HbA1c was 2.85±0.51.(2)HbAlc and GA were positively correlated with fasting,0.5 h,1 h,2 h and 3 h plasma glucose(r was in 0.567-0.776,atl P<0.01).(3)GA was significantly correlated with HbA1c(r=0.701,P<0.01).Linear regression analysis,using GA and HbA1c summarized by patient(n=2 532),produced a relationship of GA=2.871×HbA1c-0.112.The change in GA per increase of 1% HbA1c was 2.87%.When HbA1c level was 6.5%,the expected value of GA was 18.5%.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy with GA≤18.5% to predict HbA1c≤6.5% were 82.32%,72.49%,86.48%.65.73%,and 79.19%,respectively.When HbA1c level was 7.0%,the expected value of GA was 20.O%.When HbA1c level was 7.5%.the expected value of GA was 21.4%.Conclusions We initially establish the corresponding value to GA for a specific target of HbA1c and provide the basis for clinical application.     

胃转流手术治疗2型糖尿病机制的研究进展

外科手术已被认可为治疗2型糖尿病（T2DM）的一种新型方式,其中胃转流术是目前备受关注的手术方式,并逐渐进入临床。胃转流术治疗T2DM效果显著,尤其适用于伴肥胖的T2DM患者,甚至可以达到有效控制血糖及缓解糖尿病并发症的目的。然而,其潜在作用机制复杂,主要包括胃肠激素分泌的变化、脂肪因子的作用、胆汁酸代谢等。     

2型糖尿病家系一级亲人群代谢综合征患病情况及与肥胖相关指标的关系

Objective To compare the differences of metabolic syndrome (MS) prevalence by using four working definitions and their relationship with obesity-related indicators in first-degree relatives of type 2 diabetes mellitus pedigrees. Methods Totally, 2 372 first-degree relatives from 715 type 2 diabetic pedigrees were selected in this study. Complete laboratory data, including blood pressure, lipid profile and plasma glucose, were collected. The prevalence rates of MS and obesity of four definitions, as defined by National Cholesterol Education Program Adult Treatment Panel Ⅲ (ATPⅢ) in 2005, International Diabetes Federation (IDF) in 2005,Chinese Diabetes Society (CDS) in 2004 aml Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults (JCDCG) in 2007,were analyzed. Results (1)The prevalence rates of MS were 45.40% ,38.74% ,25.08% and 39.29% aecording to four definitions respectively. The prevalence rates of MS were higher in females than in males by using ATPⅢ and IDF definitions (both P<0. 01). (2)The common comhinations of metabolic abnormality was dyslipidemia, hypertension, obesity and hyperglycemia by using four definitions,except in females by using CDS definition. (3)The prevalence rates of obesity were 58.18% ,58.18% ,33.90% and 42.96% acconling to the four definitions respectively. The prevalence rates of MS in obese subjects were 66.59% ,66.59% ,54.85% and 68.99% according to four definitions respectively. (4) Applying the cutoff point for abdominal obesity according to ATPⅢ, IDF and JCDCG definitions, the prevalence rates of abdominal obesity in subjects with body mass index (BMI) <25 kg/m2 were respectively 28.58% and 16.78%, being higher in females than in males(38.90% vs 15.02% ,21.01% vs 11.22% ,both P<0. 01). Conclusion (1)There is significant familial aggregation of MS and obesity,and the first-degree relatives of type 2 diabetic patients are high risk populations. (2) Waist circumference rather than BMI taken as a discriminating component of obesity in MS seems to be clinically more helpful to the early identification and prevention of MS.     

胃转流手术对糖尿病大鼠肝脏糖代谢相关因子表达的影响

目的：通过建立2型糖尿病（T2DM）胃转流手术（GBP）大鼠模型,探讨对肝脏糖代谢相关因子表达的影响。方法将12只SD大鼠随机分为正常对照组（NCD,n＝4）、高脂组（HFD,n＝4）,高脂手术组（HFD-GBP, n＝4）;HFD组大鼠经高脂饲料喂养4周后,通过腹腔注射链脲佐菌素构建T2DM模型,比较两组体质量、血糖、口服葡萄糖耐量实验（OGTT）、胰岛素耐量实验（ITT）的变化。2周后,构建HFD-GBP组胃转流手术模型,连续观察2周,比较手术前后两组体质量、血糖浓度的变化,并分别提取3组大鼠肝组织的总RNA和蛋白,通过RT-PCR、Western印迹法检测法呢醇X受体（FXR）、磷酸烯醇式丙酮酸羧基激酶（PEPCK）、葡萄糖?6?磷酸酶（G6Pase）、葡萄糖转运体2（GLUT2）和成纤维细胞生长因子-21（FGF-21）的表达水平。结果与HFD组相比,HFD-GBP组大鼠体质量下降,血糖改善（P＜0.05）,术后FXR和GLUT2 mRNA表达明显上调（P＜0.05）,PEPCK、G6Pase和FGF-21 mRNA表达也增加;与NCD组相比,HFD和HFD-GBP两组FXR和PEPCK蛋白表达明显升高（P＜0.05）。结论在T2DM大鼠模型中,GBP能有效改善糖代谢;FXR、PEPCK和GLUT2可能参与GBP术后的血糖调节过程。     

2型糖尿病的遗传学研究:2008年现实评价

2型糖尿病的遗传学领域中正在进行一场真正的革命.不久以前,这方面的综述通常会先介绍糖尿病遗传的流行病学基础,继而谈谈方法 学问题,再重点讨论罕见的单基因糖尿病,最后才提到肯定与2型糖尿病有关的一些遗传变异作为对未来的展望.而如今,数量激增的全基因组关联研究(GWAS)正在发现越米越多影响人类复杂性状的位点.本文着重阐述2型糖尿病遗传学研究的现状,并从实际应用的角度试述临床医师可能获益之处.     

脂联素基因启动子区多态位点与罗格列酮治疗2型糖尿病疗效的相关性

目的研究编码脂联素的ADIPOQ基因启动子区单核苷酸多态性rs266729及rs16861194位点与罗格列酮治疗2型糖尿病疗效的相关性。方法选取103例新诊断的2型糖尿病患者,予罗格列酮口服48周,检测治疗前后与糖脂代谢相关的临床指标,并对患者进行rs266729及rs16861194位点基因分型。结果 rs266729位点少数等位基因(G)频率为22.0%(40/182),CC基因携带者56例,CG基因携带者30例,GG基因携带者5例;rs16861194位点少数等位基因(G)频率为15.2%(28/184),AA基因携带者66例,AG基因携带者24例,GG基因携带者2例。治疗后在rs16861194位点AG+GG基因携带者的空腹胰岛素水平(FIns)和稳态模型胰岛素抵抗指数(HOMA-IR)显著高于AA基因携带者(P值分别=0.0069和0.0104)。多元逐步回归分析显示,rs16861194位点(标准偏回归系数=2.01,P=0.0075)、治疗前的HOMA-IR(标准偏回归系数=0.37,P=0.0002)及体质指数(标准偏回归系数=0.19,P=0.0155)对罗格列酮治疗48周后的HOMA-IR具有独立预测作用。结论 ADIPOQ基因启动子区rs16861194位点与罗格列酮治疗2型糖尿病48周后胰岛素抵抗的改善有关。     

高尿酸血症与糖尿病及其血管并发症

高尿酸血症与糖尿病密切相关,同时参与糖尿病性心血管疾病以及糖尿病肾病的发生和发展。高尿酸血症主要是通过导致胰岛素抵抗参与糖尿病的发生,同时通过引起内皮功能损伤、诱发炎症反应等参与糖尿病性心血管疾病以及糖尿病性。肾病的发生。本文主要探讨高尿酸血症与糖尿病及其血管并发症的发病情况及可能的发病机制。     

松弛素、松弛素样因子在生殖过程中的作用

松弛素类物质通过对成纤维细胞、肌细胞的作用，增加细胞外间质金属蛋白酶，促进胶原分解；促使NO释放并松弛多种不同的肌样细胞，广泛扩张血管和肌样器官。这类物质参与性腺分化，配子发生，精子运动，雌激素作用下的子宫内膜上皮增生及妊娠期的多种适应性生理改变。     

糖化血红蛋白控制理想的2型糖尿病患者血糖波动特征及其与微量白蛋白尿的关系

目的 探讨糖化血红蛋白(HbA1c)控制理想的2型糖尿病患者血糖波动与微量白蛋白尿(MAU)的关系及影响因素.方法 对176例HbA1c<6.5%的2型糖尿病患者及钙名正常糖调节者(对照组)进行动态血糖监测(CGM),分析比较CGM中连续48 h的平均血糖水平(MBG)及平均血糖波动幅度(MAGE).结果 (1)2型糖尿病患者MBG及MAGE分别为(7.0±0.9)mmol/L、(3.8±2.5)mmol/L,均高于对照组(5.4±0.6)mmol/L、(2.0±0.7)mmol/L(P<0.01).(2)以超过对照组MAGE的x+1.96 5(3.4 mmol/L)定为MAGE升高的诊断标准,176例患者中MAGE升高者为91例(51.7%),其MAU的发生率高于MAGE水平正常的2型糖尿病患者(18.7%比7.1%,P<0.05).(3)血MAGE水平与年龄、糖尿病病程、收缩压呈正相关,与肾小球滤过率、空腹及餐后C肽水平呈负相关.逐步多元回归分析显示糖尿病病程及餐后30 min C肽水平与MAGE呈独立相关.(4)MAU组收缩压、舒张压、血尿素氮、血肌酐、血尿酸及MAGE均高于正常白蛋白尿组(均P<0.05),肾小球滤过率低于正常白蛋白尿组(P<0.05),Logistic回归分析显示舒张压、MAGE与患者发生MAU独立正相关.结论 血糖波动是HbA1c控制理想的2型糖尿病患者发生微量白蛋白尿的危险因素之一,糖尿病病程及早期相胰岛素分泌功能是影响血糖波动水平的主要因素.