糖耐量减低患者胰岛素抵抗与颈动脉粥样斑块的相关性分析

目的　探讨胰岛素抵抗 (IR)在糖耐量减低 (IGT)大血管并发症中的作用。方法　测定 1 2 0名IGT患者和 96名糖耐量正常(NGT)对照者的空腹血糖 (FBG)、胆固醇 (TC)、甘油三酯 (TG)、胰岛素 (FINS)及餐后 2h血糖 (PBG) ,并测量身高、体重、腰围、臀围 ,计算相对胰岛素敏感指数 (RISI)、体重指数 (BMI)、腰臀比 (WHR) ,结合其颈动脉多普勒超声检测结果进行对比分析。结果　IGT组及NGT组颈动脉粥样斑块发生率有显著性差异 (P <0 .0 0 1 ) ,斑块面积与RISI呈负相关 (r =- 0 .45 ,P <0 .0 1 ) ,与餐后 2h血糖 (r =0 .39,P <0 .0 1 )、BMI(r=0 .48,P <0 .0 1 )及WHR(r=0 .41 ,P <0 .0 1 )正相关 ,而与TG、FBG、TC、FINS无相关性 (P >0 .0 5)。IGT组患者有斑块和无斑块者之间RISI、WHR、BMI、餐后 2h血糖、TG之间也存在显著性差异 (P <0 .0 1 )。结论　胰岛素抵抗与颈动脉粥样硬化的发生密切相关 ,是IGT患者发生大血管并发症的重要原因。     

肥胖青少年代谢紊乱特点的研究

目的：探讨青少年肥胖代谢紊乱的特点。方法：将41例正常体重者和88例单纯性肥胖者，分成青少年组与成人组，观察血瘦素(leptin)、空腹血糖(FBS)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA—IR)、血三酰甘油(TG)、总胆同醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白AI(apoAI)和载脂蛋白B(apoB)等指标的变化。结果：肥胖青少年和肥胖成人的Leptin、FINS、HOMA—IR、TC、TG、LDL、apoB等均显著地升高，而HDL、apoAI均显著性降低。与肥胖成人组相比．肥胖青少年组的FINS、HOMA—IR升高更明显，而脂代谢紊乱却较轻。肥胖青少年组的leptin水平与FINS、HOMA—IR、体重指数和腰嗣正相关，与HDL负相关。肥胖成人女性组Leptin水平显著高于男性，肥胖青少年男女组间Leptin未见明显差异。结论：肥胖青少年代谢紊乱的特点为：存在明显的胰岛素抵抗和瘦素抵抗；脂代谢紊乱情况相对较轻；瘦素水平与FINS、HOMA—IR、HDL、体重指数和腰围相关；性别对瘦素的影响不明显。     

Effect of age and caloric restriction on insulin receptor binding and glucose transporter levels in aging rats

We report on the effect of age and chronic caloric restriction (CR) on insulin binding and glucose transporter content in both diaphragm and heart muscle membrane of young (11 months), mid-age (17 months), and old (29 month) ad libitum fed and CR Brown-Norway rats. The control animals received rat chow ad lib and CR animals were allowed 60% of ad libitum food. The CR regimen was initiated at four months of age and the animals were maintained on their respective diets until necropsy. There was no effect of age on insulin binding for either ad libitum or CR animals at each age evaluated. Caloric restriction significantly lowered insulin levels at each age studied when compared to the ad libitum-fed rats. However, CR animals were noted to have increased insulin binding (p < 0.001) compared to ad libitum-fed animals at each age for diaphragm muscle. For the heart, there appeared to be a decreased binding, particularly at higher insulin concentrations, in CR-fed animals. There was no net change in Glut-1 or Glut-4 levels for heart muscle membrane, or Glut-4 levels for diaphragm muscle membrane between ad libitum or CR animals. This data indicates that caloric restriction may have tissue-specific effects for insulin receptor binding, and that the improved insulin sensitivity in CR states is not a result of altered glucose transporter protein content.     

一种胰岛素抵抗的糖尿病特殊类型报告

报告５例对胰岛素抵抗的糖尿病特殊类型病例，其均具有胰岛素应用指征，但使用胰岛素后血糖却反而上升，逐渐增加胰岛素用量，则血糖值亦呈上升趋势。对该类病人的治疗，首先停用胰岛素，改用自制中药制剂及优降糖、降糖灵治疗，取得了良好效果。     

Hereditary Hypertriglyceridemic Rat: A New Animal Model of Metabolic Alterations in Hypertension

Hereditary hypertriglyceridemic rats (hHTg) were developed as a new genetic model for the study of relationships between blood pressure (BP) and metabolic abnormalities. This strain has been produced by selective inbreeding from Wistar rats according to the rise of plasma triglycerides induced by a high-sucrose diet. Though hHTg rats display hypertriglyceridemia, impaired glucose tolerrance, hyperinsulinemia, insulin resistance and increased BP even without nutritional stimuli, high sucrose feeding further aggravates these symptoms. High plasma triglycerides levels in hHTg rats seem to be a consequence of their hyperproduction. Impaired insulin action is responsible for the defective glucoregulation in this strain. The loss of insulin responsiveness might be due to a reduction in the number of glucose transporters. Highly significant relationships among plasma triglycerides, ouabain-resistant Na⁺ transport and BP were demonstrated in the hHTg rats. Segregating populations (F2 hybrids) should be used for genetic analysis of the primary role of lipid and/or ion transport abnormalities in the pathogenesis of this form of genetic hypertension.     

肝硬化患者胰岛素释放试验的临床意义

本文报道46例肝硬化患者口服葡萄糖胰岛素释放试验的结果,并与18名正常人和18名原发性糖尿病患者比较。肝硬化患者糖耐量减低者28例(60.9％),其中29例(43.5％)呈糖尿病型耐量曲线。胰岛素释放高峰值在服糖后2h;释放过多和分泌延迟者32例(69.6％),降低者4例(8.7％)。20例肝源性糖尿病患者的胰岛素释放指数明显高于原发性糖尿患者。笔者认为血浆胰岛素和胰岛素释放指数测定对鉴别这两种类型的糖尿病有很大价值。     

Insulinoma: Selective arterial calcium injection performed to confirm localization and complete resection

A case of insulinoma is reported in a patient in whom selective arterial calcium injection (SACI) tests were performed both to confirm tumor localization before surgery and to confirm complete tumor removal during surgery. An 18-year-old woman with hypoglycemic episodes was diagnosed with an insulinoma in the pancreatic body demonstrated by celiac arteriography. In a preoperative SACI test, calcium was injected into the splenic artery (SpA), gastroduodenal artery (GDA), and superior mesenteric artery (SMA). Serum immunoreactive insulin (IRI) and proinsulin levels were measured in hepatic venous samples. IRI was markedly increased after the injection of calcium into the GDA and SMA, while there was no response in IRI levels when calcium was injected into the SpA. Therefore, no occult insulinoma was revealed in the distal area fed by the SpA, although the presence of insulinoma was uncertain in the proximal pancreas. In the intraoperative SACI test, calcium was injected into the celiac artery. Insulin (determined by enzyme immunoassay) and proinsulin levels were measured in portal venous samples before and after resection of the tumor. After resection, these levels decreased in response to the calcium stimuli, confirming complete removal of the insulinoma. The SACI test was helpful to localize the insulinoma and was useful to confirm the complete removal of the tumor.     

胰岛素对大鼠血管平滑肌细胞表型转化的影响

目的:探讨胰岛素对体外培养的血管平滑肌细胞(vascular smooth muscle cell,VSMC)表型转化的影响.方法:用酶消化法分离大鼠VSMC,采用免疫组织化学法检测胰岛素作用后VSMC肌动蛋白(α-SM actin),RT-PCR 检测胰岛素作用后VSMC中bFGF、TGF-β、PDGF、matrix Gla和OPN各目的基因mRNA相对表达水平.结果:胰岛素组VSMC的3H-TdR掺入值比对照组升高47％(P<0.01), VSMC α- SM actin免疫组化结果显示对照组的α-SM actin比胰岛素组染色深.而matrix Gla和OPN在培养的VSMC中mRNA的表达量,胰岛素组明显高于对照组(P<0.05),同时bFGF、TGF-β、PDGF的表达胰岛素组也明显高于对照组(P<0.05).并可明显见到细胞骨架F-actin、G-actin重新分布.结论:在合成表型的matrix Gla和OPN表达量明显高于收缩表型,而合成表型的α- SM actin表达量明显低于收缩表型.提示胰岛素对VSMC的表型转化起了一定作用.胰岛素在促进了VSMC增殖的同时,伴有VSMC由收缩型转变为合成型及细胞骨架F-actin、G-actin重新分布.     

电化学发光免疫分析法测定血清胰岛素效果评价

①目的　探讨电化学发光免疫分析 (ECLIA)法测定血清胰岛素的效果及临床应用价值。②方法采用ECLIA法和放射免疫分析 (RIA)法分别测定糖尿病病人的血清胰岛素含量 ,并用酶联免疫法 (ELISA)测定C 肽含量 ,并对测定结果进行分析比较。③结果　ECLIA法测定胰岛素的批内与批间变异系数分别为 1.97% ,2 .5 6 % ,平均回收率是 99.5 % ;RIA法的批内与批间变异系数分别为 10 .18% ,13.2 1% ,平均回收率是 93.4 % ;E CLIA及RIA法所测胰岛素含量与ELISA法所测C 肽含量均呈正相关 (r =0 .94 ,0 .91,P均 <0 .0 1)。④结论ECLIA法测胰岛素的各技术参数优于RIA法 ,该方法能较好评价胰岛B细胞功能 ,且操作简便 ,检测速度快 ,具有重要临床应用价值。