Markers of insulin resistance in Polycystic ovary syndrome women: An update

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting 5%-10% of women of reproductive age. The importance of this syndrome lies in the magnitude of associated comorbidities: infertility, metabolic dysfunction, cardiovascular disease (CVD), plus psychological and oncological complications. Insulin resistance (IR) is a prominent feature of PCOS with a prevalence of 35%-80%. Without adequate management, IR with compensatory hyperinsulinemia contributes directly to reproductive dysfunction in women with PCOS. Furthermore, epidemiological data shows compelling evidence that PCOS is associated with an increased risk of impaired glucose tolerance, gestational diabetes mellitus and type 2 diabetes. In addition, metabolic dysfunction leads to a risk for CVD that increases with aging in women with PCOS. Indeed, the severity of IR in women with PCOS is associated with the amount of abdominal obesity, even in lean women with PCOS. Given these drastic implications, it is important to diagnose and treat insulin resistance as early as possible. Many markers have been proposed. However, quantitative assessment of IR in clinical practice remains a major challenge. The gold standard method for assessing insulin sensitivity is the hyperinsulinemic euglycemic glucose clamp. However, it is not used routinely because of the complexity of its procedure. Consequently, there has been an urgent need for surrogate markers of IR that are more applicable in large population-based epidemiological investigations. Despite this, many of them are either difficult to apply in routine clinical practice or useless for women with PCOS. Considering this difficulty, there is still a need for an accurate marker for easy, early detection and assessment of IR in women with PCOS. This review highlights markers of IR already used in women with PCOS, including new markers recently reported in literature, and it establishes a new classification for these markers.     

糖调节受损与糖尿病风险预测

糖调节受损(impaired glucose regulation,IGR)者是最重要的糖尿病高危人群,近年来大量研究证实糖调节受损可作为一个未来糖尿病的较好预报因子。而根据有关糖尿病高危因素(年龄、肥胖、高血压、高甘油三酯、糖尿病家族史、不良生活方式等)设计的非侵入性的预测方法,如危险因素分类树法、芬兰糖尿病风险评分、腰臀比或腰围指标法,对在普通人群及糖尿病高危人群中进行普查以预测糖尿病及IGR人群,有着极其重要的价值。     

糖耐量异常的急性前循环脑梗死患者左室舒张功能的改变及其对预后的影响

目的探讨急性前循环脑梗死合并糖耐量异常患者的左室舒张功能的改变及其对卒中预后的影响。方法急性脑梗死患者106例,均于脑梗死2周后行75 g口服葡萄糖耐量试验(oral glucose tolerancetest,OGTT)。按OGTT结果分为糖耐量正常组(normal glucose tolerance,NGT)33例、糖耐量异常组(impaired glucose tolerance,IGT),35例和糖尿病组(diabetes mellitus,DM)38例。于入院后次日早晨空腹查糖化血红蛋白、心肌酶谱、血脂、肝功、肾功等生化指标。发病两周后行心脏超声心动图检查,测量左室射血分数(left ventricular ejection fraction,LVEF)、E峰、A峰等心功能指标。于发病90 d进行改良的Rankin评分(modified gankin Scale,mRS)作为评估预后的指标。结果 (1)E/A1在NGT、IGT和DM组所占的比率分别是63.6%、85.7%、84.2%。IGT及DM组E/A1的比率与NGT组比较有统计学意义(χ~2=4.42,P=0.036;χ~2=3.95,P=0.047)。(2)卒中后90 d mRS与E/A (r=-0.452,P=0.000)、每博输出量(stroke volume,SV)(r=-0.228,P=0.020)、左室射血分数(left ventricular ejectmn franction,LVEF)(r=-0.328,P=0.001)、左室短轴缩短率(franctional shorting,Fs)(r=-0.301,P=0.002)、E峰(r=-0.321,P=0.001)呈负相关。结论急性脑梗死患者左室舒张功能的异常与血糖水平密切相关,伴有IGT的急性脑梗死患者出现了左室舒张功能的下降,左室舒张功能的下降影响了伴IGT的急性脑梗无患者的预后。     

Keeping us on track: a national program to reduce impaired driving in the United States

In January 1995, a bold new national goal was established to reduce alcohol-related traffic fatalities in the United States of America to no more than 11 000 by the year 2005. It is well known that a combination of effective laws, highly publicized enforcement, public information and education, and practical alternatives to drinking and driving are the keys to substantially reducing the impaired driving problem in the US. If we are really serious about achieving the goal by the year 2005, there are existing laws that can be implemented in every state, enforcement program strategies that will deter people from drinking and driving in the first place, public information campaigns that will raise the public consciousness of the problem, and transportation alternatives that will make it easier for certain segments of society to change their behavior. Many of these strategies have already helped reduce alcohol-related traffic fatalities in the US from an estimated 25 165 in 1982 to 22 084 in 1990 to 16 653 in 2000. What will it take? It will take the political will of the US Congress, the new administration, federal, state and local officials, and the general public to make it happen. While there are arguments against some of these measures, they are cost-effective and the majority of American people favor them.     

Presence of the Metabolic Syndrome in Obese Adolescents Predicts Impaired Glucose Tolerance and Nonalcoholic Fatty Liver Disease

PURPOSE: To evaluate whether the presence of metabolic syndrome (MS) in obese adolescents is associated with other comorbidities of obesity METHODS: A total of 85 obese teens (70% female and 30% male) with fasting insulin >25 microU/ml and family history of type 2 diabetes mellitus and/or acanthosis nigricans were studied. Mean age was 15.8 +/- 1.7 years and body mass index (BMI) was 39.3 +/- 6.6 kg/m(2). Of the subjects, 54% were Hispanic and 35% black, 5% white, 5% American Indian, and 1% Asian. Laboratory analysis included fasting lipids, glucose, gamma-glutamyl transpeptidase (GGT), and oral glucose tolerance testing. Additional liver transaminase levels were determined and liver ultrasound (US) was performed to evaluate the presence and severity of fatty liver. RESULTS: All subjects met MS criteria for children for waist circumference, 49% for blood pressure, 54% for high-density lipoprotein, 54% for triglycerides, and 20% for impaired fasting glucose (IFG) or impaired glucose tolerance [IGT]). In all, 47 subjects had three or more MS criteria. BMI was no different between groups with and without MS. Subjects with three or more MS criteria were more likely to have IGT (p = .004), elevated alanine aminotransferase (p = .039), elevated GGT (p = .036), fatty liver on US (p < .001), and more severe fatty liver (p = .001). CONCLUSIONS: Abnormal glucose regulation and evidence of nonalcoholic fatty liver disease (NAFLD) were more common in subjects meeting three criteria for MS than in those meeting fewer criteria. The identification of MS provides value to the primary care provider. Those patients meeting criteria for MS should be evaluated for glucose intolerance and NAFLD.     

Generalised glucosephosphate isomerase (GPI) deficiency causing haemolytic anaemia,neuromuscular symptoms and impairment of granulocytic function: a new syndrome due to a new stable GPI variant with diminished specific activity (GPI Homburg)

A new glucosephosphate isomerase (GPI) variant is described which is characterised by very low specific activity in erythrocytes, granulocytes and muscle tissue, nearly normal stability, normal kinetic properties and a decreased electrophoretic mobility. The propositus suffers from a complex syndrome involving erythrocytes (congenital haemolytic anaemia), granulocytes (decreased production of superoxide anion and reduced bactericidal activity in vitro) and the neuromuscular system (myopathy, mental retardation). It is suggested that the clinical syndrome results from generalised GPI deficiency due to a decreased specific activity of the variant enzyme, which cannot be compensated by an increase of de-novo synthesis of GPI protein even in cells exhibiting active protein synthesis such as granulocytes and muscle cells.Abbreviation GPI glucosephosphate isomerase     

机关工作人员高血压、糖尿病及高脂血症患病情况分析

目的了解机关工作人员高血压、糖尿病和高脂血症现患情况。方法对1462名体检人员的一般资料及血压、血糖和血脂等资料进行分析。结果①高血压现患率为21.8%,新诊断者占31.6%,过去确诊的高血压患者63.4%血压控制不达标;②糖尿病现患率为9.4%,空腹血糖受损和/或糖耐量减低现患率为12.5%,48.9%的糖尿病患者为首次确诊,过去确诊的糖尿病患者78.6%血糖控制不满意;③高脂血症现患率为41.5%,单纯高甘油三酯血症和单纯高胆固醇血症分别是16.6%和12.9%。高血压、糖尿病和高脂血症现患率基本上呈随龄递增趋势;体重指数(BMI)愈大,高血压、糖尿病和高脂血症患病率愈高。结论高血压、糖尿病和高脂血症是影响本组人群健康的常见病,年龄增大和体重增加是高血压、糖尿病和高脂血症的重要危险因素。     

糖耐量减低患者尿微量白蛋白排泄的探讨

目的探讨糖耐量减低(IGT)时尿微量蛋白(mALB)排泄与血压、血糖的关系。方法对83例IGT和64例NGT行空腹血糖(FBG)、餐后2h血糖(2hBG)和尿mALB检测,并依血压高低分组比较。结果各组间FBG、2hBG、尿mALB水平均有显著性差异,均P<0.01,IGT血压升高组分别依次显著高于IGT血压正常组、NGT血压升高组和NGT血压正常组。结论IGT患者已存在早期微血管病变所致的肾损害,预防糖尿病及并发症,干预应从IGT开始。     

老年糖调节受损患者合并心脑血管疾病的危险因素分析

目的探讨老年糖调节受损(IGR)患者心脑血管病变的特点及相关危险因素。方法通过回顾性分析,将114例老年IGR患者分为心脑血管病变组(病变组)61例和无血管病变组(无病变组)53例。病变组包括缺血性心脏病(IHD)患者35例、脑血管病变(CVD)患者26例。对2组患者的临床数据进行比较及回归分析。结果病变组的年龄、高血压患病率、病程、C反应蛋白水平比无病变组明显增高(P<0.05);各亚组与无病变组的比较也有相似的趋势。回归分析显示,年龄、高血压是老年IGR患者心脑血管病变的独立危险因素,同时也是IHD和CVD的独立危险因素。另外高三酰甘油血症与心脑血管病变及IHD分别独立相关。结论对于老年IGR患者,除了年龄、高血压外,高三酰甘油血症是心脑血管病变的独立危险因子。