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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
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Objective:To find the relationship between insulin-resistance and Syndrome Differentiation type (SDT) in hypertensive patients.Methods: Two hundred and nine patients of early stage hypertention with no complications of heart, brain or kidney were selected and classified into 4 types according to SDT, the Liver-Fire exuberant type (A), the Phlegm-Dampness abundant type (B), the Yin-Deficiency and Yang-Excess type (C) and the Deficiency of both Yin and Yang type (D). Their insulin sensitivity was examined and compared with that of 40 healthy subjects.Results:(1) Compared with the healthy subjects, all hypertensive patients had apparent insulin resistance (P<0.05).If the insulin sensitivity of healthy subjects was defined as 1.00, that of patients of type A, B, C and D were 0.54, 0.58, 0.65 and 0.80 respectively. (2) The insulin sensitivity of patients in the 4 SDT groups were compared and no significant difference was found in comparison between group A, B and C, while significant difference was found when the other three groups were compared with group D (P<0.05), the insulin sensitivity of type D was close to that of the healthy subjects. (3) The fasting blood insulin of type D was obviously lower and the insulin sensitivity of type D was obviously higher than that of the other three types as a whole (P=0.0001). (4) Multivariate regression analysis demonstrated that insulin sensitivity was closely correlated with SDT (P=0.0001). Conclusion: Insulin resistance is one of the pathological basis for SDT in hypertension.
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To observe the relationship between TCM Syndrome-type and insulin resistance (ISR) in coronary heart disease (CHD). Methods: Fifty patients were divided into 3 groups according to the Syndrome Differentiation-typing in TCM, the Heart blood stasis (HBS) Syndrome group, the Phlegm-Turbid stagnation (PTS) Syndrome group and both Qi-Yin Deficiency (QYD) Syndrome group. The fasting blood glucose (FBG), fasting blood insulin (Ins), insulin antibody (IAA), islet cell antibody (ICA), glutamic acid decarboxylase antibody (GAD-Ab) and related blood lipid parameters in patients were determined and insulin sensitive index (ISI) was calculated simultaneously. Then the above-mentioned data were compared with those determined in 20 healthy control subjects. Results: The levels of FBG and Ins in CHD group were higher than those in the healthy control group significantly (P<0.05), but ISI level was obviously lower (P<0.01). Moreover, the positive percentage of IAA (40%) was higher in CHD group than that in the control group (5%) significantly (P<0.01). Comparison between the 3 TCM Syndrome-type groups and the control group showed that ISI level in HBS and PTS group was obviously lower than that in the control and the QYD (P<0.05) respectively, and the IAA positive percentage in the former 2 groups (50%, 47.37%) was higher than that in the latter two (5%,P<0.01 and 15.38%, P<0.05) markedly. While Ins level increased only in the HBS group (P<0.05). Besides, patients of HBS and PTS Syndrome were accompanied by lipid metabolic disturbance. Conclusion: ISR presents in part of CHD patients particularly in those with HBS and PTS Syndrome, which was partly due to the existence of serum IAA in patients.
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黄芪辅助治疗2型糖尿病对胰岛素抵抗的影响
胰岛素抵抗(IR)是2型糖尿病主要特征之一,寻找能使IR逆转的药物与方法已成为当代医学的迫切要求.我们于1999年4月-2002年6月,对应用黄芪注射液及黄芪水煎剂治疗的68例2型糖尿病患者进行观察,并与对照组进行比较,结果显示黄芪具有改善IR的作用.现将结果报告如下.
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糖尿病视网膜病变患者脂肪酸水平与胰岛素抵抗
近年的研究表明,胰岛素抵抗(insulin resistance, IR)和高胰岛素血症(IRS)对糖尿病及其微血管病变的发病具有重要的作用.脂肪酸不仅是机体代谢和细胞膜结构的重要成分,而且也是一种信使分子,它在IR和视网膜病变发病中的作用日益引起人们的重视[1].本文旨在探讨2型糖尿病患者血浆非酯化脂肪酸(NEFA)代谢紊乱与其IR和视网膜病变发生的关系.
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高脂和高果糖饲料喂养大鼠肌细胞内长链酯酰辅酶A的含量及其与胰岛素抵抗的关系
近年来研究表明,高果糖摄入可引起机体的胰岛素抵抗(IR),并与代谢综合征联系紧密[1],而骨骼肌中脂肪酸代谢异常及细胞内脂质含量增加可引起骨骼肌IR,继而全身IR,研究提示脂质中间代谢产物如长链酯酰辅酶A(LCACoA)和二酯酰甘油(DAG)等的堆积对胰岛素信号传导和葡萄糖利用有抑制作用.本研究通过高脂、高果糖饮食喂养诱导的动物模型探讨肌肉LCACoA与IR的关系.
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代谢综合征、胰岛素抵抗与结直肠癌
代谢综合征(metabolic syndrome),又称X综合征,是以糖尿病或糖耐量异常、高血压、血脂异常、肥胖为主要内涵,以胰岛素抵抗(insulin resistance)为共同病理生理基础,以多种代谢性疾病集结出现为临床特点的一组临床症候群[1].由于患者常伴有胰岛素抵抗和高胰岛素血症,也称胰岛素抵抗综合征[2].近年来,代谢综合征发病率逐年上升,已成为严重危害人类健康的常见病和多发病[1,3-6].肥胖是Ⅱ型糖尿病发生的一个重要危险因素,两者发病率平行增加[6,7].因此,代谢综合征近年受医学界的重视,但关注的焦点是心血管系统疾病以及糖尿病并发症,对其与肿瘤发生的关系研究较少.本文就代谢综合征与肿瘤,特别是与结直肠癌的关系作一综述,以期引起大家的关注和深入研究.
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心理性胰岛素抵抗的原因及护理对策
胰岛素是治疗1型糖尿病和大部分2型糖尿病的主要药物,但是多数患者甚至医生对选择胰岛素都十分勉强,这种尽量延迟开始胰岛素治疗时间的勉强性被定义为"心理性胰岛素抵抗"(Psychological insulin resistance,PIR)[1].PIR不仅影响开始使用胰岛素,也影响强化胰岛素治疗方案的执行.由于在一段时间内患者不情愿接受胰岛素治疗,使得血糖控制不理想,终长期会导致神经病变、微血管病变和大血管病变等并发症增加.
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扩展中的"代谢综合征"
迄今为止有关"代谢综合征"的定义有WHO,NCEP-ATPⅢ,American Association of Clincal Endocrinologists(AACE),International Diabetes Federation(IDF),European Group for the Study of Insulin Resistance(EGIR)和ICD-9-CM(国际疾病分类,第9版分类号227.7).近研究发现不少临床表现都有"代谢综合征"的成分.
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阻塞性睡眠呼吸暂停综合征与胰岛素抵抗
近年来越来越多的研究结果提示OSAHS与胰岛素抵抗(IR)、高胰岛素血症、2型糖尿病以及代谢综合征密切相关,其中IR是将OSAHS与这些代谢紊乱相联系的重要纽带[1-2].Ip等[3]报道在平衡了肥胖和其他重要的引起IR的因素后,OSAHS患者的呼吸暂停低通气指数(AHI)和低SaO2仍与空腹胰岛素水平和反映IR的体内稳态模式评估(OMA)指数明显相关,即AHI每增加一个单位,IR的程度增加0.5%,而且即使是在非肥胖患者中,OSAHS与IR仍相关联.
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B型胰岛素抵抗综合征合并重叠综合征一例
B 型胰岛素抵抗综合征(type B insulin resistance syndrome,TBIR)是由循环中存在特异性胰岛素受体抗体所致的一种罕见的特殊类型糖尿病。TBIR虽然发病率极低,但其病死率很高(>50%),且目前尚无标准化的治疗方案。本文报道1例应用环磷酰胺(CTX)和泼尼松联合治疗取得良好效果、合并重叠综合征的TBIR患者。
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妊娠期糖尿病患者肥胖抑制素水平及其与胰岛素抵抗的关系
肥胖抑制素是与编码胃促生长素的同一基因共同编码的含23个氨基酸的多肽,可通过与G蛋白耦联的孤儿受体39作用减少摄食,减轻体质量,减慢胃排空,抑制肠能动性[1].在胰腺组织中,胰岛素和肥胖抑制素浓度存在明显的相关性[2].
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减重手术治疗多囊卵巢综合征的研究进展
多囊卵巢综合征( polycystic ovary syndrome , PCOS)是育龄期妇女常见的一种内分泌代谢异常性疾病,以慢性无排卵、高雄激素血症和卵巢多囊样改变为主要特征。 PCOS 患病率为5%~10%[1]。PCOS存在胰岛素抵抗( homeostatic model assessment for insulin resistance,HOMA-IR)、高雄激素血症、高泌乳素血症、肥胖等代谢异常。虽然目前有针对不同情况的PCOS的内分泌药物治疗方法,但药物治疗对PCOS的肥胖效果不佳[2],且存在症状反复的可能性。同时肥胖的远期并发症也将严重威胁患者的健康,因此,减轻体重对PCOS患者的治疗十分重要。但实际上很多患者依靠运动、节食等方法减重效果十分有限,因此,探讨手术减重对PCOS具有十分重要的意义。本文对减重手术治疗PCOS的代谢效果及可能机制进行综述。
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Activity of tamarindus indica pulp water extract in high carbohydrate diet rats as a treatment for obesity and insulin resistance
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Objective To investigate the expression of phosphatase and tension homolog (PTEN) in adipose tissue of KKAy diabetic mice, a mouse model of type 2 diabetes.
Methods KKAy diabetic mice were fed with high fat diet for 4 weeks. After blood glucose met the criteria of diabetes (over 16.7 mmol/L), mice were randomly divided into 3 groups:a control group (without any treatment), a rosiglitazone group (treated with rosiglitazone 12.5 mg/kg·d once per day), and a metformin group (treated with metformin 3 g/kg·d twice daily). After 4 weeks, we then determined the expression of PTEN and phosphoserine 473-Akt (pS473-Akt) in the epididymal adipose tissue with Western blots. The mice in each group were further divided into the insulin (-) subgroup and insulin (+) subgroup, which were intraperitoneally injected with saline and insulin (5 mU/g body weight), respectively.
Results The expression of PTEN was elevated in the epididymal adipose tissue obtained from KKAy diabetic mice compared with that from the C57BL/6J mice (P<0.001). In accordance with the enhanced expression of PTEN, the level of pS473-Akt stimulated by insulin was decreased in the adipose tissue of KKAy mice compared to the C57BL/6J mice (P<0.001). Treatment with the insulin-sensitizing agents, rosiglitazone and metformin did not inhibit the elevated expression of PTEN in adipose tissue of KKAy diabetic mice.
Conclusion PTEN may play an important role in the development of insulin resistance in adipose tissue of type 2 diabetes mice model. -
胰岛素抵抗基础和临床研究
1.建立呈胰岛素抵抗的HepG2细胞模型:将HepG2细胞置于10-7mol/L胰岛素培液中24小时,使HepG2细胞胰岛素受体充分下调,检测并比较下调和未下调的HepG2细胞、糖、脂类代谢水平发现:下调HepG2细胞(DR-HepG2)胰岛素受体减少了56%,将DR-HepG2细胞置于不同浓度胰岛素培液中,胰岛素受体数仍明显减少,当培液中胰岛素的浓度为10-7mol/L时,DR-HepG2细胞胰岛素受体数减少到17%,其14C-葡萄糖、14C-醋酸盐掺合量明显低于未下调的HepG2细胞(NDR-HepG2).将DR-HepG2细胞置于不含胰岛素DMEM培液中48小时,再用不同浓度的胰岛素刺激24小时,DR-HepG2细胞14C-葡萄糖、14C-醋酸盐掺合量仍明显低于NDR-HepG2细胞.结果提示:将HepG2细胞置于10-7M胰岛素环境中24小时,该细胞对胰岛素的作用产生抵抗,且可维持48小时.
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护理干预对心理性胰岛素抵抗病人的影响
随着对2型糖尿病自然病程研究及治疗手段的不断更新,胰岛素治疗已成为控制2型糖尿病病人的病情、减少和预防并发症的有效手段.
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胰岛素抵抗与2型糖尿病
2型糖尿病(T2DM)发病机制多认为由胰岛素抵抗(IR)和B细胞功能缺陷引起,而IR又是T2DM发生的基础,并贯穿于T2DM发生发展的全过程.IR的发生机制十分复杂,不仅与遗传因素高度相关,而且与胰岛素信号传导缺陷、多种脂肪源性细胞因子表达异常、物质代谢异常、炎症介质和氧化应激等诸多因素有关.但目前已发现的多种基因突变和诸多因素尚不能完全解释IR现象,各种因素致IR的确切机制和产生IR的许多环节还不十分清楚,IR不仅存在于外周组织中,B细胞自身也存在IR,并与T2DM相关.
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2型糖尿病合并脑梗死与胰岛素抵抗的相关性研究
Background:Diabetes mellitus is associated with increased incidence of cerebrovascular diseases.As basical factor involved in pathogenesis of diabetes,insulin resistance is related to cerebral infarction attack.In this study, study on correlation between insulin resistance and cerebral infarction following diabetes mellitus was conducted.