功能性食品与代谢综合征

由于代谢综合征在世界范围内日益增多,饮食干预越发受到人们重视.近年来研究发现一些食物或成分(即功能性食品或成分)有希望改善代谢综合征,尤其是肥胖、糖尿病、血脂异常.此文主要从这三方面举例并评估了一些潜在功能性食品或成分.     

2型糖尿病合并冠心病患者的脂代谢和冠状动脉造影分析

116例2型糖尿病合并冠心病患者的甘油三酯和低密度脂蛋白胆固醇水平明显高于无糖尿病的冠心病患者，高密度脂蛋白胆固醇明显低于无糖尿病的冠心病患者。其中血脂异常者和血脂正常者相比，血管病变的数目更多，程度更重，范围更弥漫。     

甘肃定西市机关及事业单位职工健康状况调查分析

目的了解定西市机关及事业单位职工健康体检血脂与血尿酸水平情况,探讨血尿酸、血脂关系。方法对2010年1285例机关及事业单位职工检测血脂4项[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）]以及血尿酸（UA）。结果 UA偏高（〉420 umol/L）者287例,占总检人数的22.3%,其中男性占31.7%,女性占6.0%,男女之间差异有统计学意义（P〈0.01）。在高尿酸血症人群中TG升高者160例,占48.2%,TC升高者98例,占29.5%。在不同年龄段中,以56-65岁组的UA、TG、TC阳性率最高。结论本市机关及事业单位职工高尿酸血症与高脂血症患病率较高,应加强健康教育,注意合理的饮食结构及科学的工作和生活方式,定期健康体检,提高人们的健康水平。     

4784例老年男性血脂分布的特点及与体质指数关系的研究

目的 了解老年男性血脂分布的规律及与体质指数(BMI)的关系,从血脂紊乱的角度探讨老年男性的体质量控制问题.方法 对4784例老年男性体检者进行调查并测定血脂水平,按年龄分为60～69岁组、70～79岁组和80～96岁组,按BMI水平分为低体质量组(BMI<18.5 kg/m2),正常体质量组(BMI:18.5～23.9 kg/m2),超质量组(BMI:24.0～27.9 kg/m2),肥胖组(BMI≥28.0 kg/m2).结果 4784例老年男性总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)分别为(5.1±0.9)mmol/L、(3.0±0.8)mmol/L、(1.5±1.0)rmmol/L、(1.3±0.3)mmol/L,血脂异常的检出率为44.8%(2141例),其中TC、TG、HDL-C异常的检出率分别为10.4%(497例)、9.3%(445例)、29.8%(1425例)和19.4%(928例).不同年龄组随增龄TG水平降低,HDL-C水平升高(均P<0.01),80～96岁组的TC和LDL-C水平有降低趋势(P<0.05).老年男性超体质量占46.8%(2239例),肥胖占15.5%(740例).随BMI水平的升高,TG水平亦升高,而HDL-C则随BMI升高降低,不同体质量组TC和LDL-C比较差异无统计学意义.80～96岁组亦以高TG和低HDL-C为主要类型的血脂异常,其血脂分布特点与70～79岁组相似.80～96岁组肥胖和超体质量的检出率最低,分别为44.6%(228例)和11.9%(61例).结论 老年男性血脂异常以高TG和低HDL-C为主,TC升高的检出率高于2002年全国普查的结果;超体质量、肥胖的检出率接近发达国家水平;老年男性随增龄TC和LDL-C水平下降,而HDL-C水平有上升趋势.     

极低密度脂蛋白与胰岛素抵抗患者的脂代谢紊乱

极低密度脂蛋白(VLDL)是机体转运内源性甘油三酯的主要形式,可分为大颗粒的VLDL1和小颗粒的VLDL2。VLDL血浓度升高是胰岛素抵抗(IR)脂代谢紊乱的主要特征,以VLDL1升高为主。其升高的机制与IR密切相关,包括:磷脂酰肌醇3激酶信号转导途径受损,固醇调节元件结合蛋白-C表达上调,游离脂肪酸大量内流,载脂蛋白(apo)B-100稳定性增加、肠内apoB-48水平升高,脂蛋白脂酶活性下降及低密度脂蛋白受体清除途径受损,导致VLDL生成过度、清除减弱,从而使其血浓度升高。     

Erosive esophagitis associated with metabolic syndrome,impaired liver function,and dyslipidemia

AIM:To investigate whether erosive esophagitis is correlated with metabolic syndrome and its components,abnormal liver function,and lipoprotein profiles.METHODS:We conducted a cross-sectional,case control study of subjects who underwent upper endoscopy during a health examination at the Health Management and Evaluation Center of a tertiary medical care facility located in Southern Taiwan.Metabolic syndrome components,body mass index(BMI),liver function,dyslipidemia,and cardiovascular risk factors,as defined by the ratio of total cholesterol to high-density lipoprotein cholesterol(HDL-C),and the ratio of low-density lipoprotein cholesterol to HDL-C were compared betweenindividuals with and without erosive esophagitis.Risk factors for erosive esophagitis were evaluated by multivariate logistic regression.RESULTS:Erosive esophagitis was diagnosed in 507of 5015 subjects who were individually age and sex matched to 507 esophagitis-free control subjects.In patients with erosive esophagitis,BMI,waist circumference,blood pressure,fasting plasma glucose,triglyceride levels,aspartate aminotransferase,alanine aminotransferase,the ratio of total cholesterol to HDL-C,and the ratio of low-density lipoprotein cholesterol to HDL-C were significantly higher and HDL-C was significantly lower compared to patients without erosive esophagitis(all P<0.05).In a multivariate analysis,central obesity(OR=1.38;95%CI:1.0-1.86),hypertension(OR=1.35;95%CI:1.04-1.76),hypertriglyceridemia(OR=1.34;95%CI:1.02-1.76),cardiovascular risk factors as defined by a ratio of total cholesterol to HDL-C>5(OR=1.45;95%CI:1.06-1.97),and aspartate aminotransferase(OR=1.59;95%CI:1.08-2.34)were significantly associated with erosive esophagitis.CONCLUSION:Metabolic syndrome,impaired liver function,and a higher ratio of total cholesterol to HDL-C were associated with erosive esophagitis.     

慢性肾脏病临床危险因素研究

归纳慢性肾脏病危险因素,应用于临床中可以对病情的发生发展进行评估。我们通过查阅近些年的国内外文献,对临床试验进行梳理,总结慢性肾脏病临床危险因素。研究发现,高血压、高血糖、蛋白尿、血脂异常等因素作为慢性肾脏病的危险因素,与慢性肾脏病的发生发展具有一定的联系,一些临床生物标志物也可以应用于病情评估,这些发现为预测慢性肾脏病的发生发展提供了依据,并且有利于提高患者生命质量,减少不良事件发生。     

健脾祛痰法治疗血脂异常研究概况

血脂异常在我国普遍存在,中医药干预血脂异常越来越得到人们的重视。中医学认为脾主运化水谷精微,脂质亦需要脾的运化功能布散周身。脾气虚则脾失健运,清气不升,浊阴独留,生湿生痰;痰湿进一步阻碍气机,影响脾胃运化,使脾虚更甚,加重脂浊,浸润血脉。近年来健脾祛痰法被越来越多地应用于血脂异常的防治中,且在临床中收到不错的疗效。     

Relationships between Smoking Status,Cardiovascular Risk Factors,and Lipoproteins in a Large Japanese Population

Aims: Smoking is a major risk factor for cardiovascular disease (CVD), a leading cause of death and disability. Other CVD risk factors include age, gender, hypertension, diabetes, increased low-density lipoprotein cholesterol (LDL-C) and decreased high-density lipoprotein cholesterol (HDL-C). Our goal was to assess relationships between smoking status and CVD risk factors, with a focus on direct LDL-C, HDL-C, triglycerides (TG) and small dense LDL-C (sdLDL-C). Methods: A total of 34,497 Japanese men and women, mean age 51 years, had their CVD risk factors including fasting serum total cholesterol, TG, HDL-C, sdLDL-C, and direct LDL-C assessed. One-way ANOVA and multiple linear regression analyses were carried to assess the interrelationships of these parameters with smoking. Results: In both men and women, current smokers had significantly ( p ＜0.001) higher median TG (+19.6%, +16.9%) and sdLDL-C levels (+12.7%, +4.2%) levels, and significantly ( p ＜0.001) lower HDL-C levels (-7.3%, -4.3%) than non-smokers. They were also significantly ( p ＜0.05) more likely to have TG values ＞150 mg/dL (+56.8%, +116.3%), sdLDL-C ＞40.1 mg/dL (+28.8%, +44.9%), and HDL-C ＜40 mg/dL (+89.8%, +114.3%). Ex-smokers generally had lipid values that were intermediate between non-smokers and current smokers. Multivariate analysis confirmed the significance of these relationships. Conclusion: Our data indicate that current cigarette smoking is associated with increased TG and sdLDL-C levels, as well as decreased HDL-C levels. Furthermore, smoking effect on lipid profiles remain after cessation. These data provide further justification for smoking cessation.     

600例血脂异常中医症状规律性的研究

通过对600例血脂异常中医症状的分析,得出如下结论：①具有中医病名诊断意义的特异性症状较少;②症状统计支持血脂异常的辨证从虚论治,特别是支持以补肾为先治疗原则的确定;③中医辨证所依据的症状很少由单纯的血脂异常所导致,而大多是由MS及其各组分等因素共同作用于机体所引起;④中医症状的分布与代谢综合征及其各组分无相关性规律,与血脂异常的临床分型诊断也无相关规律性发现。总之,既总结出了一些对临床治疗有指导意义的结论,同时也对目前血脂异常研究中的一些所谓＂共识＂提出了疑义,期望能对血脂异常的症状学研究有所启示。