Investigation on Association between Obstructive Sleep Apnea Hypopnea and Metabolic Syndromes in Elderly Snorers

Objective:To investigate the associated pathognesis of higher clinical coexistence of obstructive sleep apnea hypopnea syndrome(OSAHS) and metabolic syndrome (MS) in elderly snorers.Methods:Through polysomnography examination, 69 elderly habitual snorers weredivided into simple snorers (control group) and OSAHS patients who were further divided into mild-to-moderate and severe OSAHS groups basedon their apnea hypopnea index (AHI) and the lowest pulse oxygen saturation (LSpO2) during sleep respectively. The incidences of MS werecompared among different groups. Correlation was analyzed among polysomnography parameters-AHI, LSpO2 and average pulse oxygensaturation (ASpO2),MS-associated parameters-fasting blood glucose (FBG),total cholesterol (TCH),triglyceride(TG),high-densitylipoprotein cholesterol (HDL),low-density lipoprotein cholesterol (LDL),insulin and proinsulin (PI),HOMA index and blood pressure(Bp),as well as some body indexes-body mass index (BMI),waist circumference (WC) and neck circumference (NC).Results:CoexistingMS was found in 28% of all the OSAHS patients. The incidences of MS in severe OSAHS groups were significantly higher than incontrol group(P＜0.05).Spearman correlation analysis indicated that HOMA index and PI were negatively correlated with nocturnalLSpO2 and ASpO2 significantly. There were no statistically significant correlation of HOMA index and PI with AHI. LSpO2 and ASpO2were negatively correlated with BMI, WC, NC and diastolic Bp but positively correlated with TCH and HDL significantly. UnivariateLogistic regression analysis suggested that the HOMA index and PI were risk factors of severe OSAHS and the odds ratio (OR) was1.907(1.312～2.796)(P＜0.01)and 1.703(1.162～2.497)(P＜0.01)respectively. Multivariate stepwise Logistic regression analysis suggestedthat HOMA index and severe OSAHS were independently correlated and the OR was 1.949(1.311～3.181)(P＜0.01).Conclusion:It wasconfumedfrom elderly snorers that there was a close association between OSAHS and MS, that IR might play an important role in thecoexistence of OSAHS and MS, and that the OSAHS patients with a lower SpO2 were more susceptible to IR

我国代谢综合征的流行现状和防治对策

代谢综合征(metabolic syndrome,MS)是以多种代谢性心血管病危险因素(肥胖、高血压、糖和脂代谢异常等)在个体聚集为特征的临床症候群.自1998年世界卫生组织(WHO)正式命名MS以来,国际上有关MS的定义已经超过10余种.尽管对MS的组分、诊断标准、本质和起因存在着争议和不同的学术观点,但对其危害人类健康的严重性(主要对心血管病和2型糖尿病的致病作用)医学界已取得共识,在国内外心血管病防治领域更受到广泛关注和重视.对MS组分共生、共存的病理生理基础的深入认识,以及针对其共同病理生理基础的早期干预,可以阻止或减少多重心血管病危险因素的形成,对心血管病防线的前移提供理论基础.正是基于对MS在心血管早期防治中价值的充分认识,我国"十一五"科技规划已经将MS人群干预研究列为心血管病防治领域的重点研究项目.

代谢综合征与中西医结合综合干预

中华医学会糖尿病学分会曾在"中国人代谢综合征和胰岛素抵抗特征"研讨会上报告了一个惊人的数字:中国城市人口中每8个成年人中至少有1人患有代谢综合征.而美国有报告每4个成年人中至少有1人患有代谢综合征,对这样一种全球性的疾病似尚未能引起我国广大医师的高度重视.本文旨在呼吁对代谢综合征应当提高认识,并从中西医结合角度探讨对防治这一被称为"死亡四重奏"的严重危害人类健康的高发疾病的防治.

Objective To explore the metabolic syndrome and its association with arterial compliance in Chinese children and adolescents. Methods 337 participants aged 6 to 18 years with males accounted for 55.8% were grouped according to their traits of metablic syndrome. Anthropometry, blood pressure, fasting plasma glucose, insulin and serum lipid profile were measured. Homeostasis model was assessed and insulin resistance (HOMA-IR) index was measured and calculated for estimating individual insulin resistance. Arterial compliance was also measured using digital pulse wave analyzing method (Micro medical, London), and stiffness index was calculated. Results The stiffness index in participants with metablic syndrome was significant higher than that in participants with no riskof metablic syndrome [(7.69±1.63) vs (6.25±0.86) m/s, P<0.01] and stiffness index and HOMA-IR were progressively increased with the increase of traits of metablic syndrom (P for linear trend <0.001). After gender, age, and pubertal development were adjusted, both traits of metablic syndrome and HOMA-IR were correlated positively with stiffness index (both P<0.05). Conclusion The clustering of metablic syndrome was closely associated with risk at increased arterial stiffness in Chinese children and adolescents. It was suggested that arterial compliance assessment of children and adolescents might be an important measure for prevention of cardiovascular diseases.

Objective Central obesity is considered to be a central component of metabolic syndrome. Waist circumference (WC) has been widely used as a simple indicator of central obesity. This study is aimed to evaluate the sensitivity of WC cut-off values for predicting metabolic risk factors in middle-aged Chinese.
Methods The study involved 923 subjects aged 40-65 years. The metabolic risk factors were defined according to the Chinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. WC cut-off 85-90 cm and≥90 cm were used as cut-off values of central pre-obesity and central obesity in males, respectively, while WC 80-85 cm and≥85 cm were used as cut-off values of central pre-obesity and central obesity in females.
Results First, WC values corresponding to body mass index (BMI) 24 kg/m2 and visceral fat area (VFA) 80 cm2 were 88.55 cm and 88.51 cm in males, and 81.46 cm and 82.51 cm in females respectively. Second, receiver operating characteristic curves showed that the optimal WC cut-off of value was 88.75 cm in males, higher than that in females (81.75 cm). Third, the subjects with higher WC values were more likely to have accumulating metabolic risk factors. The prevalence of metabolic risk factors increased linearly and significantly in relation to WC levels.
Conclusion WC cut-off values of central pre-/central obesity are optimal to predict multiple metabolic risk factors.

ObjectiveThis study exploredthe correlation of longitudinal changes in serumalanine aminotransferase (ALT) and aspartate aminotransferase (AST)levels with the incidence of metabolic syndrome (Mets)based on a dynamic health examination cohort.
MethodsA Mets-free dynamic cohortinvolving 4541 participants who underwent at leastthree health examinations from 2006 to 2011 was included in the study. Mets was defined according to the Chinese Medical Association Diabetes Branch definitionthat included hypertension, obesity, hyperlipidemia, and hyperglycemia. Generalized estimating equation (GEE) model was used to analyze multivariate relative risk (RR) of repeated observations ofALT and AST in quartiles for Mets or its components according to gender.
ResultsIn all, 826Mets cases were reported. Adjustmentof relevant parameters indicated that time-varyingchanges in ALT and ASTlevels were positively associated with the incidenceof Mets in a dose-response manner. Positive association between high ALT levels and fatty liver was much stronger than that between high AST levels and fatty liver, particularly in maleparticipants. These associations were consistently observed in the following subgroups: participants with ALT and ASTlevels of <40U/L, participants withof <25 kg/m2, and participants with non-fatty liver. Furthermore, participants with 2 Mets components at baseline showed lower multivariate adjusted RRs of ALT and AST for Mets than participants with 0-1 Mets component.
ConclusionThese results suggested that elevated serum ALT and AST levels wereearly biomarkers of Mets or its components.

Objective Waist circumference, as a brief indicator of visceral obesity, is associated with multi-metabolic disorders and cardiovascular diseases. The present study was aimed to find out the relationship between waist circumference and carotid intima media thickness (C-IMT), as well as the best waist circumference cutoff for identifying C-IMT elevation in Chinese male patients with newly-diagnosed diabetes.
Methods Five hundred and seventy-eight patients from Department of Endocrinology and Metabolism in Shanghai Sixth People’s Hospital affiliated to Shanghai Jiao Tong University were enrolled. Both physical examination (for measurement of waist circumference) and carotid ultrasonography (for measurement of C-IMT) were performed.
Results After grouping according to the quartiles of C-IMT, the waist circumference increased across all its quartiles. The waist circumference in 3rd and 4th quartiles (90.7±9.8 cm and 90.8±9.6 cm) was significant higher than in 1st and 2nd quartiles (P<0.05). When subjects were divided into 4 groups according to waist circumference, the C-IMT of subjects with waist circumference 90-95 cm was significant higher than that of subjects with waist circumference 85-90 cm and less than 85 cm respectively (P<0.05). Both spearman and partial correlation analysis showed that C-IMT was positively correlated with waist circumference (P<0.01). C-IMT was found significantly elevated with the increase of waist circumference. Multiple stepwise regression analysis showed that waist circumference was one of the independent risk factors of C-IMT. After an average of 2.23±0.85 years follow up, there was a significant elevation of C-IMT in the group with baseline waist circumference over 90 cm P<0.05), while no significant difference was detected in the group with baseline waist circumference less than 90 cm (P=0.27). Logistic regression showed that baseline waist circumference over 90 cm was associated with a relative risk to C-IMT elevation of 1.132 (95%CI 1.043-1.431, P<0.05).
Conclusion Among newly-diagnosed diabetic male patients, waist circumference over 90 cm not only reflects sub-clinical atherosclerosis in early stage, but also predicts the progression of atherosclerosis.

Objective To study the effectiveness of waist circumference cut-off values in predicting the prevalence of metabolic syndrome (MetS) and risk factors in adults in China.
Methods A cross-sectional survey was condcuted in 14 provinces (autonomous region, municipality) in China. A total of 47 325 adults aged ≥20 years were selected by multistage stratified sampling, and questionnaire survey and physical and clinical examination were conducted among them. MetS was defined according to the International Diabetes Federation (IDF) criteria and modified IDF criteria.
Results The age-standardized prevalence of MetS was 24.2%(22.1%in men and 25.8%in women) and 19.5% (22.1% in men and 18.0% in women) according to the IDF criteria and modified IDF criteria respectively. The age-standardized prevalence of pre-MetS was 8.1%(8.6%in men and 7.8%in women) according to the modified IDF criteria. The prevalence of MetS was higher in urban residents than rural residents and in northern China residents than in southern China residents. The prevalence of central obesity was about 30% in both men and women according to the ethnicity-specific cut-off values of waist circumference for central obesity (90 cm for men and 85 cm for women). Multivariate regression analysis revealed no significant difference in risk factors between the two MetS definitions.
Conclusion Using both the modified IDF criteria and ethnicity-specific cut-off values of waist circumference can provide more useful information about the prevalence of MetS in China.

Objective To study the optimal waist circumference (WC) cut-off values for identifying metabolic risk factors in middle-aged and elderly subjects in Shandong Province of China.
Methods A total of 2 873 men and 5 559 women were included in this cross-sectional study. Metabolic syndrome (MetS) was diagnosed according to the definition of Chinese Diabetes Society in 2004. The relation between WC and MetS was analyzed by multivariate logistic regression analysis. The optimal WC cut-off values were identified using the area under the ROC curve and the different diagnostic criteria for central obesity were compared.
Results The WC was the risk factor for MetS independent of BMI, blood glucose, blood lipid, and blood pressure. The optimal WC cut-off value was 83.8 cm and 91.1 cm for identifying MetS in women and men, respectively. Compared with 80 cm and 85 cm for women and men, 85 cm and 90 cm had a higher Youden index for identifying all metabolic risk factors and MetS in women and men.
Conclusion The appropriate WC cut-off value is 85 cm and 90 cm for identifying central obesity and MetS in women and men in Shandong Province of China.

代谢综合征与心血管疾病

众多研究证明,多种代谢紊乱和心血管危险因素呈聚集现象,并提示胰岛素水平与诸多致动脉粥样硬化危险因素有剂量相关.1988年,Reaven[1]将各危险因素归纳概括后,首先提出了"X综合征"这一概念,此外还有胰岛素抵抗综合征(insulin resistance)、死亡四重奏、代谢障碍综合征(dysmetabolic syndrome)和多代谢综合征(multiple metabolic syndrome)等,虽有诸多命名,但此综合征共同的病理基础是胰岛素抵抗(IR)引发的多代谢症候群.1999年,WHO正式将其命名为"代谢综合征"(metabolic syndrome,MS),并对其进行了定义.目前MS标准并不统一,普遍使用的还有美国的NCEP标准和欧洲的EGIR标准.现将代谢综合征的研究现状综述如下:

重视代谢综合征的防治

近年来代谢综合征(MS)因已确认是心血管疾病(CVD)的重要危险因子并涉及多个学科而倍受关注.多年来许多学者对MS给予了不同命名,20世纪20年代瑞典医生Eskil曾介绍一种兼有高血压、高血糖、高尿酸血症的疾病.1988年,Gerald等以及其他研究者详细介绍了现称之为"代谢综合征"或"X综合征"的特征.2002年发布的美国胆固醇教育计划成人治疗组第三次指南(NCEP-ATPIII)强调了将MS作为治疗目标的重要性.

心肾代谢综合征

心肾代谢综合征（ cardiorenal metabolic syndrome ）是指一组以肥胖、胰岛素抵抗、高血压、代谢性脂质紊乱（血清高密度脂蛋白水平降低，血清甘油三酯增高，小而密的低密度脂蛋白颗粒增多）、白蛋白尿或肾功能减退（肾小球滤过率＜60 ml／min ）为特征的临床症候群［1］，其中心环节是胰岛素抵抗，关键问题是代谢综合征（ metabolic syndrome ，MS）各组分（如肥胖、糖代谢紊乱、脂代谢异常及血压异常等）对心肾功能的影响。MS在欧美国家的发病率可达20％～40％，而在一些特殊的人群，如2型糖尿病患者中， MS发病率高达50％以上［2］。随着生活水平的提高，体力活动的明显下降， MS的发病率在我国青少年儿童和老年人中也迅速增多。我院曾报道，在中老年干部人群的体检中， MS检出率在2008年为22.34％，2009年迅速上升至40.69％，增加18.35％［3］。

补充肌醇或有助于绝经后妇女改善代谢综合征

目的 本研究旨在评估肌醇(Myo-inositol)通过增加胰岛素敏感性对伴有代谢综合征的绝经后妇女的益处.方法 进行为期6个月的前瞻性研究.共纳入80例伴代谢综合征的绝经后妇女,分为干预组(肌醇2g BID+饮食)和对照组(安慰剂+饮食).评估受试者基线和6个月后的胰岛素抵抗(用HOMA-IR来反映胰岛素敏感性),血脂和血压水平.结果 干预组比对照组在收缩压和舒张压、HOMA-lR、血清胆固醇和甘油三酯水平有更多改善,两组差异显著.就干预组而言,舒张压下降11%,HOMA指数降低75%,血清甘油三酯水平降低20%,HLD-C(高密度脂蛋白胆固醇)水平增加22%.结论对于伴有代谢综合征的绝经后妇女,补充肌醇可能是一个不错的选择.和单一的饮食干预相比,在饮食干预的基础上增加肌醇可能更好改善绝经后妇女代谢综合征的各个组分.

代谢综合征的干预治疗策略

代谢综合征(metabolic syndrome)也称胰岛素抵抗综合征(insulin resistance)、X综合征(syndrome X)、代谢障碍综合征(dysmetabolic syndrome)和多代谢综合征(multiple metabolic syndrome),虽有诸多命名,但此综合征的核心相同,共同的病理基础是胰岛素抵抗(IR)引发的多代谢症候群.

良性前列腺增生与代谢综合征关系的研究进展

良性前列腺增生(BPH)与代谢综合征(MS)常合并存在,BPH与MS之间可能通过共同的炎症介质、血管损伤、自主神经调节等机制而相互影响.

脂肪细胞分化不良:2型糖尿病与代谢综合征的关键病因

众所周知,肥胖可导致胰岛素抵抗与2型糖尿病,但是体质量正常甚至消瘦者也可出现胰岛素抵抗、2型糖尿病和代谢综合征,常常让人难以理解.

体外冲击波碎石并发髂股动脉血栓形成一例报告

ESWL主要的并发症有碎石后石街形成、输尿管穿孔、狭窄、肾功能损害等.ESWL后并发髂股动脉急性血栓形成,并由此继发取栓术后小腿骨筋膜室综合征(osteofascial compartment syndrome,OCS)及肌肾综合征(myonephropathic metabolic syndrome,MMS)者临床极为罕见.我院于2009年3月收治1例,报告如下.

肝移植术后代谢并发症

肝移植术后受者生存率已经得到了明显提高,受者远期并发症和生活质量越来越受到关注.肝移植术后代谢并发症(posttransplant metabolic syndrome,PTMS)包括肥胖、糖尿病、高血压、血脂异常等,是肝移植术后常见的并发症之一.PTMS大大增加发生心脑血管事件的危险性,而心脑血管疾病已经成为器官移植后患者死亡的重要原因[1]严重影响了肝移植受者的长期存活和生活质量,日益受到移植学界的重视,我们就PTMS国内外进展作一综述.一、PTMS的定义、发生率目前PTMS的定义普遍采用2002年Adult Treatment PanelⅢcriteria即肝移植术后1年,相关指标至少符合以下其中三项[1]:①腹部肥胖(男性腹围＞ 102 cm,女性腹围＞88 cm);②甘油三脂＞1.69 mmol/L;③高密度脂蛋白(HDL)男性＜1.04 mmol/L,女性＜1.29 mmol/L;④高血压(＞ 130/85 mm Hg);⑤空腹血糖＞6.1 mmol/L.也有相关研究采用BMI ＞28.8 kg/m2[2]或BMI＞ 30 kg/m2[3]代替“腹部肥胖”.

血滤在肌病肾病代谢综合征防治中作用的实验研究

肌病肾病代谢综合征(myonephropathic metabolic syndrome ,MNMS)是急性广泛、重度肢体缺血的常见、严重的并发症,是导致高病死率、高致残率的重要原因,已引起愈来愈高度的重视.本实验旨在探索急性广泛、重度缺血肢体代谢产物的早期变化趋势以及MNMS的有效防治方法,为血滤在临床上防治急性动脉闭塞后MNMS的有效性提供可靠的实验依据.