The quantitative insulin sensitivity check index is not able to detect early metabolic alterations in young patients with polycystic ovarian syndrome

Objective.?To verify whether QUICKY is a suitable method for the identification of metabolic deterioration in normal weight patients affected by polycystic ovarian syndrome (PCOS).

Design.?Prospective clinical study.

Patient(s).?Seventy-nine PCOS normal weight adolescent subjects, 50 eumenorrheic, normal weight, non-hirsute controls matched for age and BMI.

Method(s).?Quantitative insulin sensitivity check index (QUICKY) and integrated secretory area under the curve of insulin values (I-AUC) during oral glucose tolerance test were calculated.

Result(s).?Seventy-nine PCOS and 50 controls were studied. Normal insulin sensitivity was defined as upper control 95th percentile by QUICKY values?<0.31, I-AUC at 180?min?<?16,645. When applying the calculated I-AUC cut-off, 41 PCOS were classified as normoinsulinemic and 38 as hyperinsulinemic, whereas using the calculated QUICKY cut-off, only 19 PCOS could be classified as insulin resistant (IR). Fifteen out of the 60 non-IR PCOS presented hyperinsulinemia; fasting glucose and insulin levels and QUICKY were not sufficient to identify these subjects. Thus, QUICKY displayed a low sensitivity (44%) and specificity (91%) in the diagnosis of the metabolic disorder disclosed by I-AUC.

Conclusions.?In young normal weight patients with PCOS the prevalence of early alterations of insulin metabolism are not detectable by QUICKY studies.     

正常血糖-高胰岛素血症的研究进展

高胰岛素血症是胰岛素抵抗人群为了维持血糖调节平衡的一种代偿表现,与正常血糖-非高胰岛素血症人群相比,其胰岛β细胞功能已经降低,心脑血管疾病的发病率增加,更容易发展成为2型糖尿病或葡萄糖调节受损的状态。控制体质量,适当的运动,服用双胍类及噻唑烷二酮类药物均可通过改善胰岛素敏感性来减轻胰岛β细胞的负荷,从而降低胰岛素水平。     

吡格列酮对糖耐量减低并高胰岛素血症患者血浆同型半胱氨酸、内皮素的影响

目的 观察吡格列酮对合并高胰岛素血症的糖耐量减低（IGT）患者血浆同型半胱氨酸（Hcy）、内皮素（ET）的影响。方法 将60例IGT并高胰岛素血症患者随机分为吡格列酮组和安慰剂组,各30例,分别予盐酸吡格列酮及安慰剂干预治疗15周,测体重指数（BMI）、空腹血糖（FBG）及负荷后血糖（2 h PG）、胰岛素（Ins）、糖化血红蛋白（HbA1c）、胰岛素敏感性指数（ISI）、Hcy、ET等。结果 治疗前后比较,安慰剂组差异无统计学意义（P〉0.05）;吡格列酮组FBG、2 h PG、HbA1c、空腹胰岛素（FIns）、负荷后2 h胰岛素（2 h Ins）、Hcy、ET水平较治疗前显著下降,ISI显著上升（P〈0.05或P〈0.01）,两组治疗后比较差异有统计学意义（P〈0.05）。结论 吡格列酮在增加胰岛素敏感性同时可降低血浆Hcy、ET水平,保护血管内皮功能。     

高血压病导致冠心病相关因素的分析

分析121例高血压病患者,口服降压药物治疗后,仍有高脂血症、高胰岛素血症及胰岛素抵抗等现象,均为冠心病(CHD)最初危险因素,如能选择适当的药物治疗,可能会使冠心病的发生率和死亡率降低。     

Human growth hormone fragment (hGH44–191) produces insulin resistance and hyperinsulinemia but is less potent than the 22 kDa hGH in the rat

A 17 kDa fragment of human growth hormone (22 kDa hGH), identified as hGH_44–191, has lower binding affinity for growth hormone receptors (GHRs), but has been reported to be more potent in producing glucose intolerance in yellow obese mice. Our aim was to investigate this anomaly by comparing acute development of hyperinsulinemia and insulin resistance (“diabetogenic activity”) during hGH_44–191 or 22 kDa hGH infusion in normal rats. Fasted awake male rats (350–370 g) were infused via a carotid cannula with saline (CON), 22 kDa hGH (at 0.125 μg/min), or hGH_44–191 (at 0.64 or 0.32 μg/min) for 5.75 h. Over the last 2 h, a euglycemic hyperinsulinemic clamp (insulin infusion rate 0.25 U/kg/h) was performed. After 3.75 h infusion, 22 kDa hGH at 0.125 and hGH_44–191) at 0.64 μg/min produced basal (preclamp) hyperinsulinemia compared to CON. During the clamp, insulin resistance was consistently produced by 22 kDa hGH at 0.125 and hGH_44–191 at 0.64 μg/min compared to CON. Using specific radio-immunoassays for 22 kDa hGH and hGH_44–191 we determined that under conditions of equivalent diabetogenic activity, molar circulating levels of hGH_44–191 were 50–60-fold higher than 22 kDa hGH. It was concluded that whereas 22 kDa hGH and hGH_44–191 are both capable of generating acute hyperinsulinemia and insulin resistance in the normal rat, the diabetogenic potency of hGH_44–191 is not enhanced compared to 22 kDa hGH, and that diabetogenic potency is in accord with the reported lower binding affinity of hGH_44–191 to the GHR.     

高胰岛素血症与原发性高血压发病相关性的临床观察

应用放射免疫分析法拴测53例原发性高血压患者血胰岛素的基础值及葡萄糖负荷后的水平。结果：22例空腹糖耐量试验后血清胰岛素水平升高。表明高胰岛素血症与原发性高血压的发病具有相关性。     

CD4+CD28 null T lymphocytes are expanded in young women with polycystic ovary syndrome

Women affected by polycystic ovary syndrome (PCOS) have an increased risk of cardiovascular disease. We demonstrated that women with PCOS showed an expansion of CD4(+)CD28(null) T cells, an aggressive population of T lymphocytes that has been recently associated with recurrent coronary instability and type 2 diabetes mellitus. This sheds new light on possible mechanisms responsible for the higher rate of cardiovascular disease among women with PCOS.     

高血压患者的胰岛素抵抗与血液流变性的关系

为研究高血压病胰岛素抵抗与血液流变性的相互关系，对３０例原发性高血压患者及２０例正常人的血胰岛素含量及血液流变性指标进行观察和对比。结果发现高血压组血糖（Ｇ）、血胰岛素（Ｉｎ）、及Ｇ／Ｉｎ均高于对照组（Ｐ均＜０．０５），血清总胆固醇、甘油三酯、血浆粘度、全血粘度、红细胞聚集指数均高于对照组（Ｐ均＜０．０５），红细胞压积二组比较无差异。结果提示高血压患者存在高胰岛素血症，而胰岛素增高导致血脂代谢、细胞内钙含量异常，从而主要影响红细胞的变形能力及凝聚力，引起血液粘度的增加，血液流变性发生改变；这些因素又是导致循环阻力增加、形成高血压的原因之一     

自发性高血压大鼠高胰岛素血症对血管反应性的影响及药物干预的实验研究

目的和方法：研究自发性高血压大鼠（ＳＨＲ）及合并高胰岛素血症时血管反应性的差异及血管紧张素转化酶抑制剂（苯那普利,ｂｅｎａｚｅｒｐｒｉｌ）、“九七黄”（复合制剂,Ｊｉｕｑｉｈｕａｎｇ）对其影响。ＳＨＲ喂养高糖饲料形成高胰岛素血症观察ＳＨＲ及ＳＨＲ合并高胰岛素血症时血管对缩血管物质及舒血管物质的反应性改变,及用苯那普利,苯那普利与“九七黄”合用时血管反应性的改变;及各组血液亚硝酸盐（ＮＯ２）、内皮素（ＥＴ）、血栓素（ＴＸＡ２）、前列腺环素（ＰＧＩ２）的变化。结果：高胰岛素血症可使血管对缩血管物质反应性增强,对舒血管物质反应性减弱。苯那普利在降低高胰岛素血症的同时使血管对缩血管物质及舒血管物质的反应性有所改善;但加用“九七黄”后,这种改善作用更显著。结论：高胰岛素血症可使ＳＨＲ血管对缩血管物质反应性增强,对舒血管物质反应减弱。苯那普利、“九七黄”可改善这种异常作用,这些均与体内血管活性物质一氧化氮（ＮＯ）、ＰＧＩ２降低,ＥＴ、ＴＸＡ２升高有关。苯那普利、“九七黄”的改善作用也与ＮＯ、ＰＧＩ２升高,ＥＴ、ＴＡＸ２降低有关。