脂联素瘦素比值在老年男性代谢综合征患者中的诊断价值

目的 研究血脂联素瘦素比值与老年男性代谢综合征的相关性. 方法 选择老年男性患者256例,分为代谢综合征组109例和非代谢综合征组(对照组)147例,代谢综合征的诊断采用2004年中国糖尿病学会制定的标准;采用LINCO放射免疫试剂盒测定空腹血脂联素、瘦素水平.结果 (1)老年男性代谢综合征组与对照组瘦素水平分别为(10.3±7.0)μg/L和(6.8±4.9)μg/L,脂联素分别为(7.8±5.6)g/L和(9.5±5.9)g/L,脂联素瘦素比值分别为0.94±0.78和2.15±2.13;(2)脂联素瘦素比值与体质指数、血三酰甘油、血尿酸水平均呈负相关,而与高密度脂蛋白水平显著正相关(P<0.001);(3)随着脂联素瘦素比值升高,代谢综合征发生的可能性减小,当比值在5以上,代谢综合征的患病率降至O(X2=34.891,P<0.001);(4)代谢异常组分数越多.脂联素瘦素比值越低(F=10.876,P<0.001). 结论 血脂联素瘦素比值可用于评价老年男性患者代谢紊乱程度,对老年男性代谢综合征的诊断有辅助作用.     

2型糖尿病脂联素、瘦素、脂联素与瘦素比值与代谢综合征组分关系的研究

目的观察脂联素、瘦素、脂联素与瘦素的此值（A／L）和代谢综合征的关系。方法初诊2型糖尿病患者260例,放免法检测Fins、脂联素、瘦素水平,计算胰岛素抵抗指数,并以脂联素、瘦素及其比值作为因变量进行多元回归分析。结果肥胖较非肥胖患者有较低的脂联素、A／L,较高的瘦素;胰岛素敏感的患者相对于胰岛素抵抗的患者,有较高的脂联素、A／L和较低的瘦素;A／L与代谢有关变量、胰岛素抵抗及相关变量都有明显的相关性。结论2型糖尿病患者脂联素、瘦素和A／L与肥胖、胰岛素抵抗及代谢综合征的表达有明显的相关性。据此推测脂联素、瘦素、A／L有可能成为进一步研究代谢综合征的发病机制及其诊断标准的指标。     

Leptin: Adiponectin ratio discriminated the risk of metabolic syndrome better than adiponectin and leptin in Southwest Nigeria

AimTo assess the ability of leptin, adiponectin and leptin: adiponectin ratio (LAR) to discriminate apparently healthy subjects with metabolic syndrome in Southwest Nigeria.MethodsOne hundred and twenty three subjects with metabolic syndrome (cases) were age matched with 123 subjects without metabolic syndrome. The serum adiponectin and leptin levels were measured using standard procedures. The ability of serum adiponectin, leptin and LAR to discriminate metabolic syndrome and its components were determined using the receiver operating curve and linear regression.ResultsThe median age of the cases (49 IQR 42, 56 years) was not significantly different from the controls (48 IQR 39, 56 years) p = 0.252. The adiponectin levels was reduced with increasing number of the components of metabolic syndrome from 11.6 (IQR 9.6, 13.5) among subjects without any component of metabolic syndrome to 6.5 (IQR 5.7, 7.7) in subjects with more than three components of metabolic syndrome. For leptin and LAR, the values increased with increasing components (p < 0.001). LAR (AUC 0.960) discriminated metabolic syndrome better than adiponectin (AUC 0.865) and leptin (AUC = 0.918) in males and females (LAR AUC = 0.966, adiponectin AUC = 0.888, leptin AUC = 0.929).ConclusionLAR had better ability to discriminate the risk of metabolic syndrome than adiponectin and leptin alone in males and females among apparently healthy subjects from Southwest Nigeria.     

腹部内脏脂肪沉积的老年非代谢综合征患者脂联素瘦素比值的变化

目的 观察体质指数正常、腹部内脏脂肪沉积的非代谢综合征老年男性患者血清脂联素、瘦素水平及脂联素瘦素比值的变化.方法 将入选的老年非代谢综合征男性患者109例分为2组,内脏无脂肪沉积组67例,内脏脂肪沉积组42例.采用CT方法测定内脏脂肪面积,当腹部内脏脂肪面积≥100cm2,为内脏脂肪沉积;采用LINCO公司提供的放射免疫试剂盒测定空腹血脂联素、瘦素水平;代谢综合征的诊断采用2004年中国糖尿病学会制定的标准.结果 (1)脂肪沉积组与无脂肪沉积组比较,体质指数、内脏脂肪面积均显著升高,体质指数分别为(22.94±1.35)kg/m2对(21.38±2.55)kg/m2(P＜O.001),内脏脂肪面积(135.6±31.7)cm2对(68.6±22.6)cm2(P＜O.001);脂联素瘦素比值降低.分别为2.17±1.77对4.54±7.00(P=0.031);而脂联素、瘦素水平在两者间差异无统计学意义;(2)脂联素瘦素比值与体质指数(r=-0.552,P＜0.001)、腰围(r=-0.390,P＜0.001)、腹部内脏脂肪面积(r=-0.311,P＜0.001)呈负相关.结论 体质指数正常有内脏脂肪沉积与无内脏脂肪沉积的老年男性比较.脂联素瘦素比值明显下降.并与腹部脂肪面积显著负相关.提示血清脂联素瘦素比值可能可用于筛选体质指数正常有腹部内脏脂肪肪沉积的患者.     

Association of circulating levels of leptin and adiponectin with metabolic syndrome and coronary heart disease in patients with various coronary risk factors

The aim of this study was to investigate the associations of adiponectin and leptin with metabolic syndrome (MetS) and coronary heart disease (CHD) in patients with various coronary risk factors. We determined serum adiponectin, leptin, and metabolic syndrome components in 104 patients (59 men and 45 women; aged 40-86 years) with various coronary risk factors at a cardiovascular out-patient clinic. Natural logarithmic transformed (ln) leptin was lower in men and smokers, and positively correlated with body mass index (BMI) (r = 0.59, P < 0.0001), waist circumference (r = 0.60, P < 0.0001), and homeostasis model assessment of insulin resistance (HOMA-IR) levels (r = 0.24, P < 0.02). Ln adiponectin was higher in women and nonsmokers, and was correlated with age and high-density lipoprotein cholesterol (HDL-C). Patients with MetS (n = 69) had significantly higher BMI, HOMA-IR, and ln leptin and lower ln adiponectin than those without Mets (Ln leptin, 2.14 ± 0.08 versus 1.30 ± 0.11; Ln adiponectin, 2.29 ± 0.06 versus 2.54 ± 0.09). In contrast, patients with coronary heart disease (CHD: n = 40) had significantly lower serum ln adiponectin concentrations than non-CHD patients (n = 64) (1.79 ± 0.12 versus 1.91 ± 0.10) as well as lower HDL-C and a higher smoking percentage. Consistent results were obtained by multivariate analyses. In conclusion, this study disclosed factors associated with the increase in serum leptin and adiponectin. Serum levels of leptin may be associated positively with MetS, whereas adiponectin levels are associated negatively with MetS and CHD, even in patients with various coronary risk factors.     

HDL2-cholesterol/HDL3-cholesterol ratio was associated with insulin resistance,high-molecular-weight adiponectin,and components for metabolic syndrome in Japanese

AimsRecent data have suggested a relationship between the high-density lipoprotein (HDL) subclass ratio and metabolic syndrome (MetS). However, limited information is available regarding the relationships between the HDL subclass ratio and insulin resistance, associated adipocytokine levels, and MetS components. The associations of the high-density lipoprotein 2 cholesterol (HDL₂-C) to high-density lipoprotein 3 cholesterol (HDL₃-C) ratio with the homeostasis model assessment of insulin resistance (HOMA-IR) index, high-molecular-weight adiponectin (HMW-Ad) levels, and MetS components were examined.MethodsThe study included 1155 Japanese subjects who met our inclusion criteria and underwent an annual health examination that included an HDL subclass analysis.ResultsThe HDL₂-C/HDL₃-C ratio and the HMW-Ad level gradually decreased as the number of MetS components increased. In contrast, HOMA-IR gradually increased as the number of MetS components increased. The HDL₂-C/HDL₃-C ratio correlated inversely with HOMA-IR and positively with the HMW-Ad level. A strong positive correlation was observed between the HDL₂-C/HDL₃-C ratio and the HDL-C level. The HDL₂-C/HDL₃-C ratio exhibited moderate negative correlations with the body mass index, waist circumference, and triglyceride level. Weak negative correlations were observed for the HDL₂-C/HDL₃-C ratio with the systolic and diastolic blood pressure and fasting plasma glucose levels.ConclusionsOur data indicated that the HDL₂-C/HDL₃-C ratio was associated with insulin resistance, the HMW-Ad level, and MetS components, and it was useful for evaluating MetS in Japanese individuals.     

The associations of leptin and adiponectin with the metabolic syndrome in an Indonesian and a Dutch population

Background and aimsAt the same BMI, Asian populations develop cardiometabolic complications earlier than Western populations. We hypothesized that a different secretion of the adipocyte-derived hormones leptin and adiponectin plays a role and investigated the associations of the two hormones with the metabolic syndrome (MetS) in an Indonesian and a Dutch population.Methods and resultsWe performed cross-sectional analyses of the Netherlands Epidemiology of Obesity Study (n = 6602) and the SUGAR Scientific Programme Indonesia–Netherlands Study (n = 1461). We examined sex-stratified associations of leptin and adiponectin with MetS, using multivariate logistic regression including adjustment for total body fat. The mean (SD) leptin (mcg/L) were 4.7 (6.0) in Indonesian men, 18.6 (12.0) in Indonesian women, 9.1 (7.7) in Dutch men, and 23.4 (17.4) in Dutch women. The mean (SD) adiponectin (mg/L) were 5.7 (5.4), 7.5 (7.1), 6.6 (3.3), and 11.3 (4.9), respectively. Within the same BMI category, leptin concentrations were similar in the two populations, whereas adiponectin was lower in the Indonesian population. Per SD of leptin, adjusted prevalence odds ratios (ORs, 95%CI) of MetS were 0.9 (0.6–1.2) in Indonesian men, 1.1 (0.9–1.4) in Indonesian women, 2.2 (1.6–2.8) in Dutch men, and 1.2 (1.0–1.5) in Dutch women. Per SD of adiponectin, the ORs were 0.9 (0.7–1.2), 0.8 (0.7–1.0), 0.6 (0.6–0.8), and 0.4 (0.4–0.5), respectively.ConclusionsDespite lower adiponectin levels, adiponectin was not related to the MetS in the Indonesian population and can not explain their increased cardiometabolic risk at the same BMI.     

肥胖儿童血清脂联素水平与代谢综合征、早期动脉粥样硬化的相关性研究

目的 研究脂联素在肥胖儿童极早期动脉粥样硬化形成过程中所起的保护性作用,评价血清脂联素水平对儿童代谢综合征的诊断价值.方法 选择176例肥胖和88名非肥胖年龄9～12岁的儿童,酶联免疫法(ELISA)检测血清脂联素水平,收集身高、体重、腰围、血压、胰岛素、超敏C反应蛋白(hsCRP)、血脂、血糖等临床资料,计算稳态模型评估的胰岛素抵抗指数(HOMA-IR).超声测量颈动脉内中膜层厚度(IMT)、颈动脉血管顺应性(CAC)、内皮依赖的血管舒张功能(FMD)和最大的腹膜前脂肪厚度(Pmax).结果 (1)脂联素与肥胖指标、血压、低密度脂蛋白胆固醇、空腹胰岛素、HOMA-IR、hsCRP、IMT呈显著负相关(P<0.05或P<0.01),与甘油三酯、空腹血糖、CAC、高密度脂蛋白胆固醇(HDL-C)、FMD无显著相关性(P>0.05).(2)以脂联素水平7.060 mg/L为切点,<7.060 mg/L的儿童发生代谢综合征的危险是>7.060 mg/L的4.43倍.(3)用血清脂联素水平判断代谢综合征诊断的敏感性,曲线下面积为0.769(95%CI0.714～0.816,P<0.01).(4)根据血清脂联素水平将肥胖儿童分为高、中、低3组,重度肥胖、内脏脂肪积聚、高血压、高胰岛素血症、低HDL-C、代谢综合征患病率3组间比较有显著性差异(P<0.05).结论 提高肥胖儿童血清脂联素水平有助于预防极早期动脉粥样硬化的发生.脂联素越低的儿童,患代谢综合征的可能性似越大.     

The leptin to adiponectin ratio is a good biomarker for the prevalence of metabolic syndrome, dependent on visceral fat accumulation and endurance fitness in obese patients with diabetes mellitus

Background: We investigated the contribution of adiponectin or leptin on the prevalence of metabolic syndrome (MS), while also taking cardiorespiratory fitness and visceral fat accumulation into account regarding diabetes patients. Methods: Japanese male patients (n = 77) with either impaired glucose tolerance (IGT) or type 2 diabetes mellitus were divided into three tertiles according to their adipocytokine levels. A logistic regression analysis was performed after adjusting for age to investigate the association between the adipocytokine levels and the prevalence of MS based on World Health Organization (WHO) criteria. Results: The visceral fat area (VFA) and maximal oxygen uptake ([Formula: see text] O(2)max) were found to be significantly different within the tertiles regarding the leptin and adiponectin levels and the adiponectin-to-leptin (A/L) ratio. The low tertile of leptin showed a significantly lower odds ratio (OR) for prevalence of MS than that in the high group. Both the low and the medium tertiles of adiponectin showed a significantly higher OR for prevalence of SM than that of the high group. Especially, the low tertile of A/L ratio had about an eight times higher prevalence of MS than the high tertile, and the difference was significant. However, when both the VFA and/or [Formula: see text] O(2)max were added to the logistic regression model as adjusting factors, all of these significant differences disappeared. Conclusion: The A/L ratio is suggested to be a good biomarker for the prevalence of MS in comparison to the adiponectin and leptin levels alone. However, these relationships are dependent on abdominal fat accumulation and/or cardiorespiratory fitness levels.     

脂联素与瘦素的比值和2型糖尿病胰岛素抵抗的相关性

在160例2型糖尿病患者分析脂联素与瘦素的比值(A/L)、稳态模型评估的胰岛素抵抗指数(HOMA-IR)和胰岛素抵抗参数的相关性.结果 显示,在两性患者中,A/L和体重指数、腰臀比、甘油三酯、高密度脂蛋白胆固醇均显著相关.当空腹血糖逐渐升高时,A/L与胰岛素抵抗参数仍然相关,而HOMA-IR不再相关,提示A/L相对于脂联素、瘦素、HOMA-IR是一个较好评估胰岛素抵抗的指标.     

ApoB/ApoA1比值与代谢综合征的相关性研究

目的 探讨载脂蛋白B(ApoB)/载脂蛋白A1(APOA1)比值与代谢综合征(MS)及其组分的关系. 方法 纳入709例重庆地区成年人,测定体重、身高、血压、腰围、空腹血浆葡萄糖(FPG)、空腹血清胰岛素(FIns)及血脂等,计算ApoB/ApoA1、BMI及胰岛素抵抗指数. 结果 IR或MS患者,其ApoB/ApoA1比值显著增高;与低ApoB/APOA1值人群相比,高ApoB/ApoA1值人群发生MS(OR=3.5)和IR(OR=2.3)的风险显著增加(P<0.001).随MS组分数增加,ApoB/ApoA1比值逐渐增加(P<0.001). 结论 ApoB/ApoA1比值与IR、MS及其组分密切相关,ApoB/ApoA1比值增高是MS发生的重要标志.     

2型糖尿病一级亲属血清脂联素、瘦素及其比值与胰岛素抵抗的相关性研究

目的 研究血清瘦素、脂联素与2型糖尿病(T2DM)一级亲属胰岛素抵抗(IR)相关性,探讨二者在T2DM发病中作用.方法 收集既往无糖耐量异常史的T2DM一级亲属, 分为糖耐量正常(NGT)组174例、空腹血糖受损(IFG)或糖耐量低减(IGT)组55例,及新发T2DM组71例;以其无糖尿病家族史的配偶或亲友中OGTT正常者114例作为正常对照组(NC).酶联免疫法测定上述人群的血清真胰岛素(TI)、瘦素和脂联素水平.用HOMA-IR评价胰岛素抵抗(IR)状态.结果 从NC至NGT、IGT/IFG到DM组,IR进行性加重(HOMA-IR分别为1.3±0.7、1.7±1.5、 2.2±1.4 和3.2±2.8,P＜0.01);血清瘦素水平进行性增高(P＜0.01),瘦素水平与HOMA-IR正相关(r=0.35, P＜0.01);血清脂联素水平进行性降低(分别为20±12、17±11、13±8和10±6mg/L,P＜0.01),与HOMA-IR负相关(r=-0.41,P＜0.01);脂联素/瘦素比值进性行降低,与HOMA-IR负相关(r=-0.53, P＜0.01). 结论 T2DM一级亲属在NGT时即存在瘦素水平升高和脂联素水平明显下降.脂联素/瘦素比值下降趋势与IR和糖调节受损的严重程度密切相关,推测该比值的变化可能是糖尿病一级亲属存在的固有遗传缺陷的一种表现,可能在IR和T2DM的发生发展中起重要作用,因而渴望作为预测T2DM发病的早期观察指标.     

血清脂联素水平与老年人代谢综合征的相关性

目的 通过横断面研究,评估血清脂联素水平与老年人代谢综合征的相关性.方法 检测61例代谢综合征患者和140例非代谢综合征老年人血清脂联素、C反应蛋白、血糖、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白等,通过Logistic回归分析评价血清脂联素水平与老年人代谢综合征的关系,并采用等级相关统计方法比较血清脂联素水平. 结果 代谢综合征患者血清脂联素为(7.2±3.6)g/L,低于非代谢综合征组(10.0±3.9)g/L,代谢综合征1级、2级、3级的患者分别为27例(44.3%)、21例(34.4%)和13例(21.3%),脂联素水平分别为(8.5±2.7)g/L、(7.0±2.5)g/L和(4.9±2.4)g/L,随着代谢综合征组分的增多,脂联素的含量呈下降趋势,两两比较呈等级相关(均为P＜0.01).Logistic回归分析显示,在校正了年龄、体质指数和性别比后,高水平脂联素使代谢综合征患病风险降低.脂联素四分法表示中,高脂联素水平组患代谢综合征的风险较其他较低组降低96.0%(OR=0.04,95%可信区间0.023～0.056,P＜0.01).结论 老年人中,高水平脂联素使代谢综合征患病风险降低.     

Correlation of the leptin:adiponectin ratio with measures of insulin resistance in non-diabetic individuals

Aims/hypothesis

Obesity is the dominant cause of insulin resistance. In adult humans it is characterised by a combination of adipocyte hypertrophy and, to a lesser extent, adipocyte hyperplasia. As hypertrophic adipocytes secrete more leptin and less adiponectin, the plasma leptin:adiponectin ratio (LAR) has been proposed as a potentially useful measure of insulin resistance and vascular risk. We sought to assess the usefulness of the LAR as a measure of insulin resistance in non-diabetic white adults.

Methods

Leptin and adiponectin levels were measured in 2,097 non-diabetic individuals from the Ely and European Group for the Study of Insulin Resistance (EGIR) Relationship between Insulin Sensitivity and Cardiovascular Risk (RISC) study cohorts. LAR was compared with fasting insulin and HOMA-derived insulin sensitivity (HOMA-S) in all individuals and with the insulin sensitivity index (M/I) from hyperinsulinaemic–euglycaemic clamp studies in 1,226 EGIR RISC participants.

Results

The LAR was highly correlated with HOMA-S in men (r?=??0.58, p?=?4.5?×?10^?33 and r?=??0.65, p?=?1.1?×?10^?66 within the Ely and EGIR RISC study cohorts, respectively) and in women (r?=??0.51, p?=?2.8?×?10^?36 and r?=??0.61, p?=?2.5?×?10^?73). The LAR was also strongly correlated with the clamp M/I value (r?=??0.52, p?=?4.5?×?10^?38 and r?=??0.47, p?=?6.6?×?10^?40 in men and women, respectively), similar to correlations between HOMA-S and the M/I value.

Conclusions/interpretation

The leptin:adiponectin ratio is a useful measure of insulin resistance in non-diabetic white adults. These data highlight the central role of adipocyte dysfunction in the pathogenesis of insulin resistance. Given that variations between fasting and postprandial leptin and adiponectin levels tend to be small, the leptin to adiponectin ratio might also have potential value in assessing insulin sensitivity in the non-fasted state.     

瘦素受体基因Gln223 Arg多态性与代谢综合征患者胰岛素抵抗的相关性

目的 研究瘦素受体基因Gln223Arg多态性与代谢综合征(MS)患者胰岛素抵抗的相关性.方法 代谢综合征组167例,对照组216名,以聚合酶链反应-限制性片段长度多态性(PCR-RFLP)法分析其瘦素受体基因型,并进行临床生化检测.结果 携带A等位基因者发生MS的风险是G等位基因的3.302倍(P<0.01).携带A等位基因的MS患者发生胰岛素抵抗的风险是G等位基因的3.446倍(P<0.01).结论 瘦素受体基因Gln223Arg多态性A等位基因携带者发生MS的风险增加,更容易发生胰岛素抵抗.     

血清瘦素肿瘤坏死因子-α与代谢综合征的相关性分析

目的 探讨血清瘦素、肿瘤坏死因子-α(TNF-α)与代谢综合征及其组分的关系.方法 2005年3月至5月对哈尔滨市2个社区按所在社区实际年龄别构成比进行分层抽样,对20～74岁455名常住居民检测腰围、血糖、血压、血脂、瘦素、TNF-α等指标.结果 中心性肥胖者瘦素升高,瘦素高者代谢综合征患病危险性是低水平的2.859倍,并受年龄的影响;血糖、血压异常者TNF-α降低,低,TNF-α者代谢综合征的患病危险性是高水平的1.859倍.结论 高瘦素是代谢综合征的危险因素;TNF-α与血糖、血压相关,是代谢综合征的保护性因素.     

脂联素水平及基因多态性与代谢综合征的关系

目的:探讨脂联素(APN)水平及其单核苷酸基因多态性(SNP) +45T/G和+276G/T两个位点与代谢综合征(MS)的关系.方法:238例研究对象分为对照组和MS组,采用实验-对照研究方法,应用酶联免疫吸附法(ELISA)及聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术,对血浆APN浓度及其2个位点基因多态性进行检测.结果:与对照组比较,MS组APN水平降低(P＜0.05);MS组SNP+276T等位基因分布明显升高,多因素逐步Logistic回归分析显示SNP+276基因多态性为MS危险因素.结论:MS患者APN水平下降,携带SNP+276T等位基因者患MS的风险增加.