Reaven‘s综合征

近年研究发现高胰岛素血症不仅只简单的是机体对胰岛素(In)抵抗的代偿、是Ⅱ型糖尿病进一步发展因素之一,并且提出胰岛素抵抗/高胰岛素血症在高血压、各种脂蛋白代谢异常以及冠心病的发生发展上起着十分重要的有害的作用。不容忽视的事实是:高血压、糖、脂代谢异常与冠心病常在同一患者身上群集存在。因而研究这些异常之间的相互关系即成了重要课题。 1 Reaven’s综合征的含义为1988年Reaven氏提出,称之为X综合征。其异常变化包括:对胰岛素刺激的葡萄糖摄取的抵抗,高胰岛素血症,葡萄糖耐量     

胰岛素受体抗体致自身免疫综合征

别名自身免疫低血糖症;B型胰岛素抵抗综合征(TBIR);胰岛素抵抗性糖尿病B型Kahn等~[1]于1976年首先报导了6例伴有黑棘皮病的高胰岛素血症患者,存在明显的胰岛素抵抗,后查证体内存在胰岛素受体抗体,后Kahn将伴免疫性疾病、血中存在胰岛素受体抗体的病人命名为胰岛素抵抗性糖尿病B型。2002年Arioglu等~[13]总结了24例B型胰岛素抵抗综合     

高浓度胰岛素在心血管系统的非代谢效应

胰岛素抵抗、高胰岛素血症与冠心病、高血压等重要心血管系统疾病有着密切的联系〔１，２〕。胰岛素是一种重要的物质代谢激素，高胰岛素血症伴发的物质代谢紊乱〔３〕是导致这些疾病发生的原因之一。近年来随着研究的深入，高浓度胰岛素在心血管系统的广泛的非代谢作用逐渐引起学者的重视。人们开始认识到：高胰岛素血症不仅仅是心血管系统疾病高危的标志，它本身即是促使这些疾病发生、发展的重要因素。本文就高浓度胰岛素在心血管系统的非代谢作用及其可能的临床意义作一综述。一、高浓度胰岛素的心血管系统保护效应血管内皮细胞（ＶＥＣ…     

高胰岛素血症与冠心病关系的研究

对40例冠心病患者及30例正常人进行糖耐量、胰岛素及C肽释放试验,并计算胰岛素敏感指数。发现冠心病患者血糖面积、空腹胰岛素水平及胰岛素面积、空腹C肽水平及C肽面积均高于正常人,而胰岛素敏感指数低于正常。提示冠心病患者存在高胰岛素血症及胰岛素抵抗。     

代谢综合征

代谢综合征指一组由多种代谢相关疾病如糖耐量减低、糖尿病、冠心病、高血压、脂代谢紊乱等中的两种或两种以上的组合，胰岛素抵抗、高胰岛素血症在其病因及发病机制中起关键作用，但并非此单一因素所致，遗传和环境因素也共同参与其中。胰岛素抵抗、高胰岛素血症、瘦素、脂肪细胞因子、肾素．血管紧张素系统、神经内分泌异常等互相作用，促使动脉粥样硬化的发生及发展。代谢综合征的治疗包括健康教育、改变生活方式、加强锻炼、减肥、应用胰岛素增敏剂，以及控制高血压、高血脂、高血糖、高血凝、高血粘度、低高密度脂蛋白一胆固醇水平，并使这些治疗达标。     

冠心病与血胰岛素水平及胰岛素敏感性的关系

目的 :探讨冠心病与血胰岛素 (INS)水平及胰岛素敏感性之间的关系。方法 :对 133例冠心病和 77例健康对照者进行血糖 (BG)、血 INS及胰岛素敏感性 (1/ BG× INS)测定。结果 :冠心病组与对照组比较 ,血糖水平无显著性差异 (P >0 .0 5 ) ,而血 INS明显增高 (P <0 .0 5 ) ,胰岛素敏感性明显下降 (P <0 .0 5 )。冠心病组内 ,单纯冠心病组及冠心病并发原发性高血压组相比较 ,两组间血糖、血 INS及胰岛素敏感性均无显著性差异 (P >0 .0 5 )。结论 :冠心病患者存在着高胰岛素血症及胰岛素敏感性下降     

儿童高胰岛素血症发生的相关因素及危害

儿童高胰岛素血症的发生与肥胖、低出生体重、青春期、遗传及种族等多种因素有关。高胰岛素血症对儿童机体可能造成多种损害 ,如黑棘皮病 ,日后亦可能发展成为 2型糖尿病 ;高胰岛素血症还是心血管疾病发生的危险因子等。针对儿童高胰岛素血症 ,可通过改善胎儿营养状态 ,控制体重或口服药物进行治疗 ,以期能控制和减少儿童高胰岛素血症造成的危害。     

代谢综合征

代谢综合征指一组由多种代谢相关疾病如糖耐量减低、糖尿病、冠心病、高血压、脂代谢紊乱等中的两种或两种以上的组合,胰岛素抵抗、高胰岛素血症在其病因及发病机制中起关键作用,但并非此单一因素所致,遗传和环境因素也共同参与其中。胰岛素抵抗、高胰岛素血症、瘦素、脂肪细胞因子、肾素-血管紧张素系统、神经内分泌异常等互相作用,促使动脉粥样硬化的发生及发展。代谢综合征的治疗包括健康教育、改变生活方式、加强锻炼、减肥、应用胰岛素增敏剂,以及控制高血压、高血脂、高血糖、高血凝、高血粘度、低高密度脂蛋白-胆固醇水平,并使这些治疗达标。     

39例气虚血瘀型冠心病病人胰岛素抵抗的临床观察

近年来 ,越来越多的研究表明胰岛素抵抗 (IR )与冠心病(CHD)的发生、发展有密切关系 ,冠心病病人常伴有胰岛素抵抗及代偿性高胰岛素血症 ,IR可能是一种独立的心血管危险因素 ,在CHD发生、发展过程中具有重要的作用[1] 。笔者以胰岛素敏感指数为主要指标 ,观察 3 9例气虚血瘀型冠心病病人和2 8例非冠心病病人的空腹血糖 (FPG )、空腹胰岛素 (FINS)、胰岛素敏感指数 ,意在了解气虚血瘀型冠心病病人胰岛素抵抗的程度 ,为中医辨证气虚血瘀型冠心病的治疗提供客观的科学依据。1　资料与方法1.1　一般资料　选择 2 0 0 1年 10月— 2 0 0 3…     

非胰岛素依赖型糖尿病及高血压患者胰岛素抵抗现象的相关研究

非胰岛素依赖型糖尿病及高血压患者胰岛素抵抗现象的相关研究刘德敏，张纬，张慧，汤新之，姜茂，王家驰近年来，国外许多研究证明高血压人群中糖耐量异常和高胰岛素血症比正常血压人群中更为多见，并注意到高胰岛素血症是冠心病的危险因子之一［１］。本文对４８例非胰岛...     

积雪草对2型糖尿病大鼠胰岛素抵抗影响的研究

目的：观察积雪草提取液对2型糖尿病大鼠胰岛素抵抗（IR）的影响。方法：尾静脉注射链脲佐菌素（STZ）并高糖高脂饲料喂养诱导2型糖尿病大鼠模型。随机分为积雪草低剂量组、积雪草高剂量组、二甲双胍组、模型组与正常组。观察体重、口服糖耐量试验（OGTT）、血甘油三酯（TG）、总胆固醇（TC）、空腹血清胰岛素（FINS）、胰岛素抵抗指数（IRI）（IRI=FINS×FPG/22.5）的改变。结果：①模型组大鼠体重明显增加（P〈0.01）,OGTT、TG、TC水平较正常对照组明显增高（P〈0.01）;②药物治疗后,积雪草组及二甲双胍组体重、血糖、血脂、IRI均明显降低（P〈0.01）;③积雪草高剂量组在降低血糖、血脂水平方面与二甲双胍组之间无明显的统计学差异（P〉0.05）,在降低IRI方面与二甲双胍组之间有明显的统计学差异（P〈0.01）。结论：2型糖尿病大鼠存在糖脂代谢紊乱及IR,积雪草可明显降低其血糖水平、减轻体重、降低血脂及IRI,其降低血糖、血脂水平的作用与二甲双胍相当,其降低IRI水平的作用优于二甲双胍。     

PAX6基因突变的无虹膜症患者中糖代谢异常的病理生理学特征

目的探讨PAX6基因突变的无虹膜症患者是否存在糖代谢异常,并阐明其病理生理学特征。方法一个PAX6基因突变所致的无虹膜症家系包括19名健在的患者和4名无突变的正常成员。16名无虹膜症患者参与本研究,4名无突变的家系成员和12名健康成人作为正常对照（NC）组,8名无PAX6基因突变的新诊断2型糖尿病（T2DM）患者作为另一个对照组。通过OGTT,分析血糖、总胰岛素及胰岛素原水平的变化,采用胰岛素耐量试验（ITT）检测胰岛素敏感性。结果在16例PAX6基因突变的无虹膜症患者中,FPG与NC组无显著差别,OGTT 120min血糖显著高于NC组,其中糖耐量受损（IGT）5例和DM4例。PAX6基因突变患者的BMI均〈23,胰岛素敏感性未见明显降低,OGTT 30min总胰岛素水平显著降低,但胰岛素原／总胰岛素比值显著高于NC组和T2DM组,并且在糖耐量正常时即可见到这种变化。结论PAX6基因突变患者存在糖代谢异常,大多表现为负荷后高血糖,其病理生理学基础主要是胰岛素原向胰岛素转化过程存在缺陷。     

胰岛素抵抗对不稳定性心绞痛患者的作用及临床意义

目的探讨在冠心病患者中胰岛素抵抗（IR）对血脂和凝血纤溶系统的影响及其与不稳定性心绞痛（UA）发生的关系。方法接世界卫生组织制定的冠心病诊断标准，选UA患者29例，稳定性心绞痛（SA）患者32例，健康对照者28例，做口服葡萄糖耐量和胰岛素释放试验；采集空腹静脉血，检测血糖，总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL－c）、纤维蛋白原（FG）含量，组织纤溶酶原激活剂（t－PA）和纤溶酶原激活剂抑制物（PAI－1）活性；按通用公式计算胰岛素敏感指数（ISI）和低密度脂蛋白胆固醇（LDL－c）。结果UA组及SA组血糖和胰岛素曲线下的面积明显高于正常对照组；冠心病患者的ISI明显降低，与血TC、IDC－c、FG含量和PAI－1活性呈显著负相关，UA患者的表现尤其突出；在非IR及IR者中，SA组与UA组的TG、TC和LDL－c无显著差异，UA组的FG含量和PAI活性显著高于SA组；ISI降低的发生率在UA组显著高于其余两组。结论IR及高胰岛素血症对血脂代谢和凝血纤溶系统的影响与冠心病临床表现的严重程度有一定相关性；IR可通过多种机制加速冠心病的进程，并影响和促使UA的发生。     

Evaluation of glycaemic status in young people with clinical insulin resistance; fasting glucose,fasting insulin or an oral glucose tolerance test?

Objective It is important to identify young people with prediabetes for early intervention. However, it is unclear how to best screen overweight and obese young people for prediabetes. The objective of this study was to compare fasting indices with an oral glucose tolerance test (OGTT) in diagnosing prediabetes. Design Retrospective review. Patients A total of 224 young people, aged 12·0 years (range: 3·2–17·3 years), with clinical features of insulin resistance, who had an OGTT between 2000 and 2007 at a tertiary children’s hospital, Sydney, Australia. Measurements Oral glucose tolerance test. Results A total of 168 (75%) participants had normal glucose tolerance, 45 (20%) had prediabetes and 11 (5%) had type 2 diabetes; 29 of those with prediabetes and 10 with type 2 diabetes were identified by fasting glucose criteria alone. Young people with normal fasting glucose and fasting insulin ≤180 pmol/l had lower insulin resistance (homeostasis model assessment median 1·9 vs. 4·2, P < 0·001), higher insulin sensitivity index (2·4 vs. 1·0, P < 0·001) and a lower early insulin response (insulinogenic index 2·5 vs. 4·1, P < 0·001) compared to those with normal fasting glucose and higher fasting insulin levels. If a fasting insulin cut point (≤180 pmol/l) was used in addition to fasting glucose to determine the need for an OGTT, 114 (68%) young people with normal glucose tolerance would have avoided the test. By contrast, the diagnosis of impaired glucose tolerance, identified by an OGTT, would have been missed in three children. Conclusion Fasting glucose and insulin levels should be measured in young people with insulin resistance before undertaking a time‐ and resource‐intensive OGTT.     

Patterns of insulin resistance in the general population of southeast Spain

The aim of this study was to evaluate patterns of insulin resistance in the general population. The study was cross sectional. Clinical, anthropometric, and lipid measurements were made in 1226 persons aged 18-65 years. An oral glucose tolerance test (OGTT) was performed in 1020 subjects, with insulin levels determined at baseline and after 2 h. The homeostasis model assessment insulin resistance index (HOMA IR) and HOMA beta-cell function were calculated. Compared with subjects with normal glucose tolerance, the groups with abnormal OGTT had different baseline insulinemia, 2 h post OGTT insulinemia, HOMA IR and HOMA beta-cell indices. Serum insulin levels at baseline and 2 h after OGTT showed a characteristic pattern for each category of glucose tolerance, resulting from the different insulin responses. In the subjects with normal glucose tolerance, the pattern of the relationships between both types of serum insulin levels was exactly the same, so that it was possible to determine risk groups according to the ratio of baseline serum insulin/2 h insulin. HOMA IR and HOMA beta-cell were significantly associated with the risk of impaired fasting glucose, previously unknown diabetes mellitus, and known diabetes mellitus. These results support the rationale for introducing preventive measures against insulin resistance in the general population.     

Glucose tolerance, plasma insulin, HDL cholesterol and obesity: 12-year follow-up and development of coronary heart disease in Edinburgh men.

The insulin response to a standard oral glucose tolerance test (OGTT) and other anthropometric and biochemical risk factors for coronary heart disease (CHD) were measured in a random sample of 107 Edinburgh men, who were initially studied in 1976 when they were 40 and who were reexamined in 1988-89. Fasting glucose and glucose response to OGTT were higher in 1988-89 than in 1976. In contrast, insulin levels did not differ between the initial and follow-up study either before or after the glucose load. Body mass indices increased, except triceps skinfold. Changing patterns in both fasting and OGTT insulin or glucose levels in individuals were related to changes in bodyweight or in subscapular skinfolds. Modifications in serum total and HDL cholesterol were related to changes in fasting insulin and insulin area, respectively, but not to glucose data. Eleven men developed clinical CHD. Neither glucose nor insulin measures obtained in 1976 differed between those with and without CHD. Weight-height index and abdominal skin-folds were higher in those with CHD. HDL cholesterol was significantly lower (P less than 0.05). Abdominal skin-fold but not body mass index remained significant when adjusted for HDL cholesterol. This small study confirms the importance of central obesity and low HDL cholesterol but failed to identify insulin as a risk factor for CHD in this Scottish population.     

Oral glucose tolerance test and insulin sensitivity in low insulin responders

Oral and iv glucose tolerance, insulin response to iv and oral glucose load as well as insulin sensitivity were evaluated in 58 'low insulin responders'. They were selected from a group of 226 healthy subjects with normal fasting blood glucose and normal iv glucose tolerance test on the basis of a low insulin response during a standardized glucose infusion test (GIT). The insulin response to GIT was analysed by parameter identification in a mathematical model (parameter KI). Insulin sensitivity was also measured by computer analysis of GIT (parameter KG) and, in a limited group of subjects, by a somatostatin infusion test. Thirty-three low insulin responders had normal OGTT, whereas 5 demonstrated borderline-1, 16 borderline-2, and 4 decreased OGTT. The first group of subjects demonstrated normal or enhanced insulin sensitivity. Borderline and decreased OGTT, in most instances, was accompanied by decreased insulin sensitivity, implying that a subgroup of low insulin responders exhibited signs of both impaired insulin response to glucose and insulin resistance. Since these defects characterize manifest type-2 diabetes, these subjects possibly may run a high risk to develop this type of diabetes. On the other hand, low insulin response in combination with increased insulin sensitivity may reflect adaptation of the secretory capacity of B-cells to the need of insulin.     

Loss of the First Phase Insulin Response to Intravenous Glucose in Subjects with Persistent Impaired Glucose Tolerance

Loss of the first phase insulin response to intravenous glucose is one of the earliest detectable defects of beta cell dysfunction in Type 2 diabetes mellitus. Impaired glucose tolerance (IGT) is considered a prediabetic condition, therefore loss of first phase insulin secretion in subjects with IGT would suggest beta cell dysfunction as an early lesion in the development of Type 2 diabetes. Three groups of subjects were studied, 7 subjects with persistent IGT (classified as having IGT at two 75 g oral glucose tolerance tests (OGTT) done 6 months apart), 6 subjects with transient IGT (IGT at the first OGTT, but normal glucose tolerance at a repeat OGTT 6 months later), and 7 normal controls. First phase insulin secretion was studied using an intravenous glucose tolerance test with arterialized blood sampling. Fasting, 3, 4 and 5 min samples were assayed for glucose and insulin (specific two-site immunoradiometric assay). The fasting insulin was similar in all three groups, however the 3 min insulin response was significantly lower in those with persistent impaired glucose tolerance (p < 0.02). Thus subjects with persistent impaired glucose tolerance demonstrated loss of the first phase insulin response as an early indicator of beta cell dysfunction while subjects with transient IGT had a normal insulin response to intravenous glucose. During the OGTT, the 30 min glucose was not significantly different (p = 0.1) but the 30 min insulin to glucose ratio was significantly lower in subjects with persistent IGT (p < 0.03). In the whole group the 30 min insulin to glucose ratio during the OGTT showed a significant correlation with the peak insulin response during the IVGTT (r = 0.76, p < 0.001). This study suggests that beta cell dysfunction with impaired early insulin release is present before the development of Type 2 diabetes.     

Changes in visfatin levels after oral glucose tolerance test in women with gestational diabetes mellitus

Visfatin levels increased following an oral glucose tolerance test (OGTT) in normal pregnancy, and this increase correlated with metabolic indexes such as blood glucose, blood fat, and insulin resistance. Conversely, visfatin levels in women with gestational diabetes mellitus (GDM) increased to lesser extent than in normal pregnancy, which suggests a disorder in the relationship between visfatin, blood glucose and insulin.     

Suppressive effects of diacylglycerol oil on postprandial hyperlipidemia in insulin resistance and glucose intolerance

The diacylglycerol (DAG), a commonly used as a cooking oil in Japan, results in a lower elevation of serum triglyceride (TG) after ingestion compared to triacylglycerol (TAG). Postprandial hyperlipidemia (PPHL) and an increase in remnant lipoproteins (RLP) levels are risk factors for CAD, and a close relationship between PPHL and type 2 diabetes and/or insulin resistance has been reported. To evaluate the effect of DAG on PPHL in insulin resistance and glucose intolerance, 11 subjects with a normal glucose tolerance (NGT) and 14 subjects with IGT received oral fat tolerance test (OFTT) twice. They ingested emulsified test oils prepared with either DAG or TAG. In the IGT subjects, after the DAG and TAG load, the serum concentrations of TG, RLP-TG, and RLP-cholesterol increased throughout the 4-h study. The responses of these variables above baseline after the DAG load were significantly smaller than those after the TAG load (p<0.05). In contrast, in the NGT subjects, changes in these parameters were much smaller than those observed for IGT subjects. The difference in the integrated responses for serum RLP-cholesterol concentration during OFTT between DAG and TAG in all subjects can be easily explained by the integrated response of insulin rather than glucose during oral glucose tolerance test (r=0.7, p<0.01). DAG was more effective in insulin resistant and hyperinsulinemic participants regardless of glucose intolerance, and may be beneficial in reducing the extent of CAD risk in such individuals.