血清 C-反应蛋白（CRP）、内脂素、脂联素在 2 型糖尿病肾病不同时期的变 化

目的研究血清C-反应蛋白（CrtP）、内脂素、脂联素在2型糖尿病肾病不同时期的具体变化情况。方法从2010年3月-2013年3月该院接受2型糖尿病肾病治疗的患者中随机选择194例作为研究组进行分析,根据患者具体的尿清蛋白排泄率分为3组,其中正常蛋白尿组70例,微量蛋白尿组60例,大量蛋白尿组64例;并选择70例经体检健康状况良好的正常者作为对照组。采用酶联免疫吸附法检测所有受检者体内的内脂素、脂联素具体水平,并采用免疫比浊法测定血清C-反应蛋白（CRP）。另外对所有受检者的空腹血糖值,高、低密度脂蛋白胆固醇含量等先关指标进行具体检测,并比较研究组和对照组之间的差异。结果研究组患者体内的血清内脂素和血清C-反应蛋白（cRP）水平明显高于对照组,差异有统计学意义（P〈0．05）。正常蛋白尿组的具体血清脂联素含量低于对照组,微量蛋白尿组和大量蛋白尿组患者的血清脂联素高于对照组,差异有统计学意义（P〈0．05）。结论血清内脂素、脂联素和血清C-反应蛋白（CRP）极有可能参与到了2型糖尿病肾病发生、发展的整个过程．联合对参者的具体水平进行检测和分析可能会对评估早期糖尿病肾病有重要的帮助作用。     

慢性心力衰竭患者血浆内脏脂肪素水平及其影响因素的研究

目的观察慢性左心衰竭患者的血浆内脏脂肪素水平,探讨其与糖脂代谢参数和高敏C反应蛋白（hs—CRP）的关系。方法将50例慢性左心功能不全患者（心力衰竭组）根据超声心动图左心室射血分数（LVEF）分成两亚组：轻度心功能不全亚组（35％〈LVEF≤45％）25例,重度心功能不全亚组（LVEF≤35％）25例;对照组（LVEF〉50％）24例,检测并比较各组hs—CRP、内脏脂肪素、血脂、血糖等指标。结果心力衰竭组内脏脂肪素较对照组降低（5．84-221ng／mlVS8．5±2．4ng／ml,P〈0．01）;轻度、重度心功能不全亚组及对照组比较．内脏脂肪素、hs—CRP、血糖、HOMAIR、HDL—C差异均有统计学意义（P〈0．05或0．01）;内脏脂肪素与LVEF呈正相关（r=0．49,P〈001）,与hs—CRP呈负相关（r=-0．30,P〈0．01）。结论心力衰竭患者的血清内脏脂肪素显著降低,此结果独立于年龄、性别、BMI和代谢参数。     

Role of adipocytokines and its correlation with endocrine pancreatic function in patients with pancreatic cancer

IntroductionSome authors suggest that adipocytokines contribute to the induction of pancreatic carcinogenesis as well as the development of endocrine insufficiency.AimsWe evaluate the circulating concentrations of leptin, resistin and visfatin in patients with newly diagnosed pancreatic cancer (PC) and relationship between serum adipocytokines level and clinicopathological features of PC. Moreover the usefulness of those adipocytokines as possible biomarkers of endocrine pancreatic function in PC has been assessed.MethodsThe pilot study group consisted of 45 individuals (mean age 65.6 ± 11.5 years, BMI 21.8 ± 3.4 kg/m²) with newly diagnosed PC (within last 1–3 months) and 13 healthy individuals with age, gender and BMI matched to the study group. Among PC patients 18 (40%) had recently diagnosed diabetes. Fasting plasma leptin, resistin, visfatin concentrations were determined with ELISA (R&D Systems, Phoenix Pharmaceuticals) and insulin by RIA (DakoCytomation).ResultsPatients with PC as compared to controls had significantly lower plasma leptin (40.6 ± 21.3 vs 63.2 ± 16.3 pg/mL; p < 0,0008). In contrast PC patients showed more than six fold higher level of resistin (126.2 ± 143.2 vs 18.9 ± 7.2 ng/mL; p < 0.009) than controls. The median plasma visfatin was 2.8 ± 1.8 ng/mL, which was not significantly different from the controls (3.8 ± 1.1 ng/mL). When PC patients with and without diabetes were considered separately, plasma leptin concentrations among nondiabetic patients were slightly, but not significantly higher (44.6 ± 21.0) as compared to diabetics (34.5 ± 20.7). Moreover there was no difference between visfatin and resistin level in PC, among patients with and without diabetes. No significant differences between serum level of leptin, visfatin and resistin and age, gender, BMI, smoking status, tumor localization, distant metastases and pain has been found.ConclusionThe results of this study confirm previous findings that patients with newly diagnosed pancreatic cancer are characterized with lower level of leptin. This pilot study showed significantly higher resistin concentrations in patients with PC in comparison to healthy controls, which may be helpful in PC early diagnosis. Changes in leptin and resistin level in PC are not likely related to endocrine disorders.     

Association of genetic variability in selected regions in visfatin (NAMPT) gene with anthropometric parameters and dietary composition in obese and non-obese Central-European population

AimsVisfatin (NAMPT/PBEF) is a recently identified adipocytokine which harbors strong insulin-mimetic activity and was reported to be associated with obesity. However, nothing is known about whether visfatin is related to specific nutritional behavior which may result in obesity development. This is the first study focusing on genetic variability of the visfatin gene and its association with circulating visfatin, anthropometric parameters and dietary composition.Materials and MethodsWe analyzed a total of 11 exons and adjacent non-coding regions of the NAMPT gene in 20 extremely obese Czech individuals (mean BMI 52.2 ± 5.0 SD) using direct sequencing and a frequency of rs2302559 was established in the validation cohort of another 605 individuals with completed 7-day food records and complex anthropometric measurements. Serum levels of visfatin, leptin and leptin-receptor were measured in all sequenced individuals and in part of the validation cohort.ResultsThree common polymorphisms were identified, two in non-coding regions (rs78411774 A/C, rs71564769 A/C) and one synonymous SNP in exon 7 (rs2302559 A/G). The rs2302559 showed significant correlation with visfatin serum level throughout the entire study cohort (p < 0.001); there was a significant tendency toward higher visfatin levels in G allele carriers with GG homozygotes having the highest visfatin serum levels. Furthermore, a negative correlation was observed between visfatin and leptin serum level (p = 0.01). No association between investigated SNPs and anthropometric parameters or native dietary composition was observed.ConclusionThis is the first study to demonstrate that the rs2302559 polymorphism in the PBEF gene is related to circulating levels of visfatin. As the SNP is synonymous, we hypothesize it might be linked to another SNP in the PBEF gene which controls visfatin serum levels.     

妊娠期糖尿病孕妇血清视黄醇结合蛋白4、内脂素水平的变化及其临床意义

目的探讨妊娠期糖尿病(GDM)患者血清视黄醇结合蛋白4(RBP4)、内脂素水平变化的意义,研究视黄醇结合蛋白4和内脂素与胰岛素抵抗(IR)的相关性。方法采用稳态模型评估法评估正常糖耐量孕妇(NGT)、糖耐量减低孕妇(GIGT)和妊娠期糖尿病孕妇(GDM)的胰岛素抵抗指数,采用酶联免疫吸附法检测所有受试者的空腹血糖(FPG)、空腹胰岛素(FINS)、RBP4和内脂素水平。结果 GDM组和GIGT组血清RBP4、内脂素和胰岛素抵抗指数(HO-MA-IR)均显著高于NGT组(P<0.01)。血清RBP4、内脂素与HOMA-IR均呈显著正相关。结论妊娠期糖尿病患者存在胰岛素抵抗,RBP4、内脂素可影响妊娠期糖尿病患者IR的程度。     

吡格列酮与二甲双胍对初诊肥胖2型糖尿病患者血清内脏脂肪素影响的研究

目的观察吡格列酮与二甲双胍对初诊肥胖T2DM患者血清内脏脂肪素（visfatin）水平的影响,探讨visfatin与T2DM发病的关系和药物的治疗机制。方法100例初诊肥胖T2DM患者随机分为吡格列酮组50例,每日口服盐酸吡格列酮片30mg,二甲双胍组50例,每日早晚口服二甲双胍缓释片500mg,疗程24周。结果吡格列酮组空腹血清visfatin、IR、TG较用药前明显降低,B细胞功能有改善（P〈0．05或P〈0．01）。二甲双胍组血清visfatin、TG无统计学改变。两组治疗后比较,吡格列酮组的visfatin、IR、TG降低明显,差异有统计学意义（P〈0．05或〈0．01）,但二甲双胍组的BMI较吡格列酮组下降更明显（P〈0．05）。结论对初诊肥胖T2DM患者吡格列酮与二甲双胍均能较好地控制血糖,吡格列酮还能明显降低血清visfatin的水平,提示吡格列酮通过下调visfatin水平发挥抗炎作用。     

冠心病患者血清内脏素浓度与血脂的相关性研究

目的：探讨冠心病患者血清内脏素浓度与血脂的关系。方法：选取冠心病患者82例,另选健康对照组100例,常规测量身高、体重,所有实验对象空腹采血离心取血清测定内脏素（visfa—tin．）、甘油三脂（TG）、胆固醇（Ch01）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—c）。结果：①冠心病组血清内脏素浓度均高于对照组（P〈0．05）;②冠心病患者内脏素量与TG、HDL—C、VLDL—C呈正相关（P均〈0．05）;结论：冠心病患者血清内脏素量可能与冠心病发生及血脂代谢相关。     

血清内脂素水平与2型糖尿病患者动脉粥样硬化关系探讨

目的 探讨2型糖尿病患者血清内脂素水平与动脉粥样硬化的关系.方法 69例2型糖尿病患者依据有无颈动脉粥样硬化斑块分为无动脉硬化斑块组（A组）20例、动脉硬化斑块组49例,后者再根据是否伴急性脑梗死分为不伴急性脑梗死组（B组）30例和伴急性脑梗死组（C组）19例,比较各组血清内脂素水平.结果 B组、C组血清内脂素水平均高于A组（P＜0.05或P＜0.01）.结论 内脂素可能与2型糖尿病患者动脉粥样硬化及脑梗死的发生、发展相关.     

妊娠期糖尿病患者血清内脂素水平的变化

目的    探讨妊娠期糖尿病（GDM）患者血清内脂素（visfatin）的变化及其与年龄、孕周、体质量指数(BMI)、血糖、胰岛素抵抗（HOMA IR）、胰岛B细胞功能（HOMA B）、血脂等的关系。方法    2009年7月至2009年12月在重庆医科大学附属第一医院门诊常规产前检查就诊者80名,按ADA2009年GDM诊断标准分为GDM组35例和非GDM组45例,ELISA法测定空腹血清visfatin水平,葡萄糖氧化酶法分别测定空腹血糖（FPG）及口服75g葡萄糖后0.5、1、2h血糖(0.5hPG、1hPG、2hPG),电化学发光法测定空腹胰岛素（FINS）,酶法测定血脂等。结果    ① GDM患者空腹血清visfatin明显高于非GDM组(P<0.05);②Spearman相关分析显示,visfatin与2hPG（r=0.506、P<0.01）、FINS (r=0.321、P<0.01)、 HOMA-IR (r=0.364、P<0.01)呈显著正相关;③多元线性逐步回归分析表明,2hPG是影响血清visfatin的独立相关因素。结论    GDM患者血清visfatin显著升高,可能是机体针对体内血糖增高、胰岛素抵抗所发生的一种代偿效应。     

血浆内脂素在代谢综合征各组分的表达及相关因素分析

目的观察代谢综合征(MS)患者与健康人群血浆内脂素水平的变化。方法采用病例—对照研究,共入选118例。健康对照组48例为健康体检者;病例组70例根据MS定义中组分的累加评分(1个组分为1分,以此类推,计为1～4分)分为:1分组(10例)、2分组(18例)、3分组(24例)、4分组(18例),其中符合MS诊断者(即3分组和4分组之和)为MS组(42例)。用酶联免疫吸附方法(ELISA)测定空腹血浆内脂素浓度,化学发光法测定空腹血清胰岛素浓度(FINS),同时常规测量身高、体质量、腰围(WC)、臀围、BP,计算BMI、WHR、WHtR,检测空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(Apo-A)、载脂蛋白B(Apo-B)、血尿酸(UA)等指标,并用稳态模型法计算胰岛素抵抗指数(HOMA-IR)。比较各组血浆内脂素水平,并将内脂素与其他指标进行直线相关分析及多元线性回归分析,观察血浆内脂素与各检测指标间的关系。观察随着MS组分的聚集,血浆内脂素水平的变化。结果 (1)MS组的血浆内脂素水平(547±67)μg/L明显高于健康对照组(498±46)μg/L,差异有统计学意义(P<0.01)。(2)MS患者1～4分组血浆内脂素水平分别为(469±59)μg/L、(530±54)μg/L、(538±70)μg/L、(559±66)μg/L。内脂素水平随着MS组分的增加呈升高趋势,其中3、4分组血浆内脂素水平高于1分组,差异均有统计学意义(P<0.05)。(3)直线相关分析显示血浆内脂素水平与BMI、WC、WHR、WHtR、TC、TG、HDL-C、Apo-B、FBG、HOMA-IR呈正相关(r值依次为0.473、0.366、0.327、0.415、0.460、0.325、0.465、0.331、0.327、0.344,P均<0.05)。多元线性回归分析显示WC、WHtR为影响血浆内脂素水平的最显著因素。结论 (1)MS患者血浆内脂素水平明显高于健康人群。随着MS组分的聚集,血浆内脂素水平逐渐升高。(2)WC、WHtR是影响血浆内脂素的独立相关因素。内脂素可能在MS以及相关疾病的发病过程中起一定作用。