漳州市和中山市儿童青少年胰岛素抵抗指数分布情况

目的了解福建省漳州市和广东省中山市儿童青少年中胰岛素抵抗指数(HOMA-IR)的分布情况。方法从福建省漳州市区和广东省中山市区分层随机抽取6~18周岁儿童青少年3102名[男孩1574名(50.74%),女孩1528名(49.26%)]进行横断面研究,分别测量其身高、体重、空腹血糖和空腹胰岛素并计算BMI和HOMA-IR。结果空腹血糖、空腹胰岛素水平在6~18周岁阶段随着年龄的增加逐渐增加,但性别差异无统计学意义;BMI随年龄增加而增加,12~15岁女孩的BMI高于同年龄段的男孩(P<0.05),16岁之后男孩的BMI高于女孩(P<0.05);HOMA-IR在6~12岁之间都随年龄的增加而增加,12岁之后,HOMA-IR指数处于高位,男女差异无统计学意义。结论空腹血糖、空腹胰岛素、HOMA-IR随年龄变化而变化,评价儿童胰岛素抵抗应基于不同年龄段该HOMA-IR的某一百分位数,而不是由单一切割值来确定。     

北京地区1359名非糖尿病人群心血管病危险因素与胰岛素抵抗的关系研究

目的 采用横断面研究的方法 分析北京地区非糖尿病人群各心血管病危险因素与胰岛素抵抗的关系.方法 采用分层随机抽样方法 在年龄25～64岁的北京市自然人群中选取1475人,利用该人群中未患糖尿病的1359人资料对各心血管疾病危险因素与胰岛素抵抗关联的密切程度进行分析.分析中采用稳态模式评估法(HOMA)获得的HOMA指数作为胰岛素抵抗程度的评价指标.结果 将HOMA指数取自然对数后进行分析,心血管病危险因素与HOMA指数均存在不同程度的关联(P＜0.001).按关联密切程度由高到低依次为血糖、体重指数(BMI)、甘油三酯(TG)、腰围(WC)、高密度脂蛋白胆固醇(HDL-C)、血清尿酸、DBP、SBP和总胆固醇(TC).在调整了性别和年龄后,血糖(r=0.49)、BMI(r=0.44)、TG(r=0.44)、WC(r=0.41)、HDL-C(r=-0.32)、尿酸(r=0.33)、SBP(r=0.20)、DBP(r=0.18)和TC(r=0.16)依然和HOMA指数存在关联(P＜0.001).将HOMA指数位于人群上四分之一分位者定义为有胰岛素抵抗,多因素logistic回归分析显示性别(OR=1.75)、低HDL-C(OR=1.80)、高尿酸血症(OR=2.11)、高TG(OR=2.14)和腹部肥胖(OR=2.68)与胰岛素抵抗独立相关.结论 心血管病危险因素均与胰岛素抵抗存在不同程度的关联,其中低HDL-C、高TG、腹部肥胖和高尿酸血症与胰岛素抵抗独立相关.     

Gvaves病患者的胰岛素抵抗的临床观察

目的：探讨Gvaves病患者的胰岛素敏感性的变化情况，方法：选择30例Gvaves病患者为试验组，30例正常健康人为对照组，分别测定其空腹血糖及空腹血浆胰岛素水平，以空腹血糖和空腹血浆胰岛素的乘积的倒数的自然对数表示胰岛素敏感指数（IAI）。结果：Grvaves病患者的IAI明显低于正常健康的人（P＜0．001），结论：Gvaves病患者存在明显的胰岛素抵抗。     

胰岛素抵抗与非胰岛素抵抗多囊卵巢综合征的临床治疗对比研究

目的:探讨胰岛素抵抗与非胰岛素抵抗多囊卵巢综合征的临床治疗对比。方法:共纳入100例多囊卵巢综合征患者,根据是否有胰岛素抵抗分为两组,A组为非胰岛素抵抗组给予常规治疗措施;B组为胰岛素抵抗组在给予常规治疗的基础上给予二甲双胍(0.5,bid,po)治疗。观察两组患者的体质指数(BMI)、血脂水平及性激素水平变化。结果:与A组(非胰岛素抵抗组)患者相比,B组(胰岛素抵抗组)患者的LH水平明显比较低,差异有统计学意义(P<0.05),而FSH及E2水平比较差异无统计学意义(P>0.05)。治疗后两组间血脂及体质指数比较结果显示:与A组(非胰岛素抵抗组)患者相比,B组(胰岛素抵抗组)患者的TG、HDL-C及BMI比较差异有统计学意义(P<0.05),而TC及LDL-C差异比较无统计学意义(P>0.05)。结论:两组PCOS患者性激素、血脂水平存在差异,非胰岛素抵抗患者LH水平升高明显,而胰岛素抵抗患者更容易出现血脂代谢的异常,因此临床上对有胰岛素抵抗的PCOS患者,需要积极改善胰岛素抵抗状态,减少相关并发症的发生。     

糖耐量异常高血压患者胰岛素抵抗指数的观察

[目的]探讨糖耐量异常高血压患者胰岛素抵抗指教的特点.[方法]糖耐量异常高血压患者中,排除了继发型高血压者和体重指数(BMI)≥28 kg/m2者以及体重指数(BMI)≤18.5 kg/m2者之后,调整年龄、性别、体重指数,将不同高血压分期的人群分为多级高血压组(59例,男34人,女25人)和一期高血压组(101例,男57人,女44人),并设正常对照组(273例,男156人,女117人),利用HOMA胰岛素抵抗指教(HOMA-IR)、HOMA β细胞功能指数(HBCI)等进行组间比较和分析.[结果]糖耐量异常高血压人群SBP、DBP、FPG、FINS和HOMA-IR均明显高于正常对照组,而HBCI明显低干正常对照组,差异均有统计学意义(P＜0.01);巴患高血压的糖耐量异常人群中发生心脑血管等器官损坏表现的人群SBP、DBP、FPG明显高于无器官损坏表现的一期高血压组(P＜0.01),而HBCI低于一期高血压组(P＜0.05).[结论]与正常对照组相比,糖耐量异常高血压人群存在胰岛素作用的减弱,表现为胰岛素抵抗.糖耐量异常高血压患者存在心脑血管等器官损坏表现的阶段胰岛β细胞功能已有明显减弱.     

AMPK在胰岛素抵抗和能量稳态中的作用

胰岛素抵抗在2型糖尿病、肥胖、原发性高血压和血脂异常等疾病的发生发展过程中起关键作用。腺苷酸激活蛋白激酶（AMPK）信号通路是调节细胞能量稳态的中心环节,被称为“细胞能量调节器”,在增加组织或细胞对葡萄糖的摄取、增加脂肪酸氧化以及调节基因转录等方面发挥重要作用。研究AMPK与胰岛素抵抗的关系,能够为AMPK作为防治2型糖尿病的新靶点提供可靠的理论基础和应用依据。     

肥胖患者血清真胰岛素及其胰岛素抵抗的关系研究

目的　观察单纯性肥胖患者血清真胰岛素和胰岛素抵抗的关系。　方法　单纯性肥胖者 70例 ,正常对照组3 0例 ,均检测身高、体重、腰围、臀围 ,同时测定血清真胰岛素 (TI)、空腹血糖 (FPG)、血甘油三脂 (TG)、胆固醇 (CHO) ,计算胰岛素敏感指数 (ISI) [ISI =1/(FPG×TI) ] ,并对ISI与各指标进行相关性分析。　结果　肥胖患者血清真胰岛素水平明显高于对照组 (P <0 0 1) ,ISI显著低于对照组 (P <0 .0 1) ,直线相关分析显示 ,ISI与BMI、体重、腰围、TG呈负相关 ,r依次为 -0 .678、-0 .5 40、-0 .5 68(P <0 .0 1) ,-0 .2 47,(P <0 .0 5 )。多元逐步回归分析显示影响肥胖患者ISI的最重要因素是BMI( -0 .5 14 )、TG( -0 .3 5 0 )、腰围 ( -0 .3 11) (R2 =0 .669,F =3 3 .814 ,P <0 .0 1)。去除BMI的影响因素后 ,ISI与TG明显负相关 (r =-0 .2 96,P <0 .0 5 )。　结论　肥胖患者有高真胰岛素血症和胰岛素抵抗 ,胰岛素抵抗与BMI、甘油三脂、腰围明显相关。     

肥胖患者血清胰岛素、真胰岛素的变化及其胰岛素抵抗的影响因素分析

目的　观察单纯性肥胖患者血清胰岛素、真胰岛素变化 ,并分析胰岛素抵抗的影响因素。方法　单纯性肥胖者 70例 ,正常对照组 3 0例 ,均检测身高、体重、腰围、臀围 ,同时测定血清真胰岛素 (TI)、免疫活性胰岛素 (IRI)、空腹血糖 (FPG)、血甘油三脂 (TG)、胆固醇 (CHO) ,计算胰岛素敏感指数 (ISI) [ISI1=1/(FPG×TI) ,ISI2 =1/(FPG×IRI) ] ,并对ISI1与各指标进行相关性分析。结果　肥胖患者血清胰岛素、真胰岛素水平明显高于对照组 (P <0 0 1) ,ISI1、ISI2 显著低于对照组 (P <0 0 1) ,但ISI1的降低要比ISI2 降低明显 ( P <0 0 1) ;直线相关分析显示 ,ISI1与BMI、体重、腰围、TG呈负相关 ,γ依次为 -0 678、-0 5 40、-0 5 68( P <0 0 1) ,-0 2 47,(P <0 0 5 )。多元步回归分析显示影响肥胖患者ISI1的最重要因素是BMI( -0 5 14 )、TG( -0 3 5 0 )、腰围 ( -0 3 11) ( χ2 =0 669,F =3 3 814 ,P <0 0 1)。去除BMI的影响因素后 ,ISI1与TG明显负相关 (γ =-0 2 96,P <0 0 5 )。结论　肥胖患者有高胰岛素血症和胰岛素抵抗 ,真胰岛素水平比免疫活性胰岛素水平更能反映胰岛素抵抗的程度 ,胰岛素抵抗与BMI、甘油三脂、腰围明显相关。     

肥胖大鼠胰岛素抵抗和leptin抵抗的关系研究

目的：探讨在肥胖形成的过程中Leptin抵抗和胰岛素抵抗何时出现及其因果关系。方法：选取雄性Wistar大鼠20按体重随机分为基础对照和肥胖2组,喂养5周,每周末称重,采尾血测定血糖、胰岛素和Leptin。结果：肥胖组体重、血糖、胰岛素和Leptin均高于基础对照组。在肥胖形成的过程中Leptin抵抗的发生先于胰岛素抵抗。肥胖组Leptin抵抗首先出现在第2周末而胰岛素抵抗出现在第3周末,推测Leptin抵抗是胰岛素抵抗的原因。结论：肥胖是糖尿病重要的危险因素。     

Laparoscopic Surgery Improves Blood Glucose Homeostasis and Insulin Resistance Following Distal Gastrectomy for Cancer

Background: Prevention of blood glucose elevation and insulin resistance could be more pronounced in patients undergoing laparoscopic rather than open gastrectomy. Methods: Fifty‐seven patients underwent distal gastrectomy by either laparoscopy (n = 36) or an open approach (n = 21). Blood glucose, serum insulin, and the daily insulin secretion rate (urinary C‐peptide) were measured. Insulin resistance was evaluated using an adapted homeostasis model assessment of insulin resistance (HOMA‐R). Results: Blood glucose levels were lower in the laparoscopy group than in the open group on the operative day and on postoperative days (POD) 1 and 3 (P< .001, P = .001, and P = .024, respectively). Serum insulin levels were lower in the laparoscopy group than in the open group on POD 1 and 3 (P = .045 and P = .027, respectively). HOMA‐R was lower in the laparoscopy group than in the open group on POD 1 and 3 (P = .024 and P = .009, respectively). Daily insulin secretion rates were lower in the laparoscopy group than in the open group on POD 1 (P = .023). Conclusions: Laparoscopic surgery prevents blood glucose elevation and improves insulin resistance compared with open surgery.     

胰岛素强化治疗在腹部手术患者肠外营养中的应用

目的:探讨腹部手术患者肠外营养(TPN)中使用胰岛素强化治疗(IIT)的效果及并发症。方法:选择2005年1月～2008年1月期间在我院行腹部手术后应用肠外营养患者52例,随机分成传统治疗组(对照组)和胰岛素强化治疗组(治疗组)。对照组28例,治疗组24例。两组间一般资料差异无统计学意义。对照组给予常规胰岛素治疗,控制血糖<11.0mmol/L。治疗组给予胰岛素强化治疗,血糖控制在4.4～6.1mmol/L。观察7天。比较两组病人死亡率、肺部感染、消化道出血、伤口感染及低血糖反应发生率。结果:治疗组发生低血糖1例(3.57%);对照组为1例(4.17%),低血糖发生率差异无统计学意义(P>0.05)。治疗组术后切口感染率、术口愈合障碍率、肺部感染、消化道出血及死亡率均低于对照组(P<0.05)。结论:腹部手术后肠外营养患者应用胰岛素强化治疗,与传统胰岛素治疗相比低血糖反应及死亡率并不增多,而且可以减少术后切口感染、切口愈合障碍、肺部感染、消化道出血等并发症,值得在临床中推广应用。     

胰岛素强化治疗在腹部手术患者肠外营养中的应用

目的：探讨腹部手术患者肠外营养（TPN）中使用胰岛素强化治疗（IIT）的效果及并发症。方法：选择2005年1月～2008年1月期间在我院行腹部手术后应用肠外营养患者52例,随机分成传统治疗组（对照组）和胰岛素强化治疗组（治疗组）。对照组28例,治疗组24例。两组间一般资料差异无统计学意义。对照组给予常规胰岛素治疗,控制血糖〈11．0mmol／L。治疗组给予胰岛素强化治疗,血糖控制在4．4-6．1mmol／L。观察7天。比较两组病人死亡率、肺部感染、消化道出血、伤口感染及低血糖反应发生率。结果：治疗组发生低血糖1例（3．57％）;对照组为1例（4．17％）,低血糖发生率差异无统计学意义（P〉0．05）。治疗组术后切口感染率、术口愈合障碍率、肺部感染、消化道出血及死亡率均低于对照组（P〈0．05）。结论：腹部手术后肠外营养患者应用胰岛素强化治疗,与传统胰岛素治疗相比低血糖反应及死亡率并不增多,而且可以减少术后切口感染、切口愈合障碍、肺部感染、消化道出血等并发症,值得在临床中推广应用。     

Lipid Mediators of Insulin Resistance

Lipid abnormalities such as obesity, increased circulating free fatty acid levels, and excess intramyocel-lular lipid accumulation are frequently associated with insulin resistance. These observations have prompted investigators to speculate that the accumulation of lipids in tissues not suited for fat storage (e.g., skeletal muscle and liver) is an underlying component of insulin resistance and the metabolic syndrome. We review the metabolic fates of lipids in insulin-responsive tissues and discuss the roles of specific lipid metabolites (e.g., ceramides, GM3 gan-glioside, and diacylglycerol) as antagonists of insulin signaling and action     

Dietary Plant Protein Intake Can Reduce Maternal Insulin Resistance during Pregnancy

Evidence suggests that the source of dietary protein may have an impact on insulin resistance, but no studies have explored it in pregnant populations. In this study, we combined a population study and an animal experiment to explore this effect. The population study was conducted with data from NHANES. Multiple linear regression was used to observe the association of protein intake with outcomes, including fasting glucose (GLU), insulin (INS), and HOMA-IR. In the animal experiment, 36 pregnant SD rats in three groups were orally administered 100% animal protein, 50% animal protein and 50% plant protein, or 100% plant protein, respectively. The intervention continued throughout the whole pregnancy. On day 19.5, maternal plasma was collected after overnight fasting, and metabolomics was performed using UPLC-MS. We found plant protein intake was negatively correlated with INS and HOMA-IR in the whole population. During the third trimester, a similar correlation was also observed. The animal experiment also presented the same result. In metabolomic analysis, changes in various metabolites and related pathways including FoxO and mTOR signaling pathways were observed. In conclusion, we found a negative association between dietary plant protein intake and maternal insulin resistance during pregnancy. Changes in some active substances and related metabolic pathways may play an important role.     

Vitamin D Deficiency Is Inversely Associated with Homeostatic Model Assessment of Insulin Resistance

The study was conducted to comprehensively assess the association of the concentration of vitamin D in the blood and insulin resistance in non-diabetic subjects. The objective was to pool the results from all observational studies from the beginning of 1980 to August 2021. PubMed, Medline and Embase were systematically searched for the observational studies. Filters were used for more focused results. A total of 2248 articles were found after raw search which were narrowed down to 32 articles by the systematic selection of related articles. Homeostatic Model Assessment of Insulin Resistance (HOMAIR) was used as the measure of insulin resistance and correlation coefficient was used as a measure of the relationship between vitamin D levels and the insulin resistance. Risk of bias tables and summary plots were built using Revman software version 5.3 while Comprehensive meta-analysis version 3 was used for the construction of forest plot. The results showed an inverse association between the status of vitamin D and insulin resistance (r = −0.217; 95% CI = −0.161 to −0.272; p = 0.000). A supplement of vitamin D can help reduce the risk of insulin resistance; however further studies, like randomized controlled trials are needed to confirm the results.     

Vitamin B12 in Obese Adolescents with Clinical Features of Insulin Resistance

Emerging evidence indicates an association between obesity, metformin use and reduced vitamin B12 status, which can have serious hematologic, neurologic and psychiatric consequences. This study aimed to examine B12 status in obese adolescents with pre-diabetes and/or clinical features of insulin resistance. Serum B12 was measured using chemiluminescence immunoassay in 103 (43 male, 60 female) obese (mean body mass index (BMI) z-score ± SD (2.36 ± 0.29)), adolescents aged 10 to 17 years, median (range) insulin sensitivity index of 1.27 (0.27 to 3.38) and 13.6% had pre-diabetes. Low B12 (<148 pmol/L) was identified in eight (7.8%) and borderline status (148 to 221 pmol/L) in an additional 25 (24.3%) adolescents. Adolescents with borderline B12 concentrations had higher BMI z-scores compared to those with normal concentrations (2.50 ± 0.22 vs. 2.32 ± 0.30, p = 0.008) or those with low B12 concentration (2.50 ± 0.22 vs. 2.27 ± 0.226, p = 0.041). In conclusion, nearly a third of obese adolescents with clinical insulin resistance had a low or borderline serum B12 status. Therefore, further investigations are warranted to explore the cause and the impact of low B12 status in obese pediatric populations.     

Effects of Coffee Consumption on Insulin Resistance and Sensitivity: A Meta-Analysis

Coffee is widely consumed worldwide and impacts glucose metabolism. After a previous meta-analysis that evaluated the effects of coffee consumption on insulin resistance and sensitivity, additional randomized controlled trials (RCTs) were conducted. This meta-analysis aimed to evaluate the effects of coffee consumption on insulin resistance or sensitivity. We selected RCTs that evaluated the effects of coffee consumption for seven days or more on insulin sensitivity or resistance using surrogate indices (homeostasis model assessment for insulin resistance (HOMA-IR) and Matsuda index). The fixed-effects or random-effects model was used according to heterogeneity. Four studies with 268 participants were analyzed in this meta-analysis. Coffee consumption significantly decreased HOMA-IR compared to control (mean difference (MD) = −0.13; 95% CI = −0.24–−0.03; p-value = 0.01). However, the significance was not maintained in the sensitivity analysis (MD = −0.04; 95% CI = −0.18–0.10; p-value = 0.55) after excluding data from the healthy, young, normal-weight group. Matsuda index was not significantly different between coffee and control groups (standardized mean difference (SMD) = −0.33; 95% CI = −0.70–0.03; p-value = 0.08). In conclusion, long-term coffee consumption has a nonsignificant effect on insulin resistance and sensitivity. More studies evaluating the effects of coffee consumption in the healthy, young, and normal-weight individuals are needed.     

原发性高血压患者胰岛素抵抗及血清脂联素的变化

目的研究原发性高血压患者胰岛素抵抗（IR）及血清脂联素（ADP）的变化,初步探讨其在发病机制中的作用及意义。方法随机选择具有不同高血压水平的患者90例作为研究对象,无高血压的健康查体者40例为对照组。受试者空腹抽肘静脉血,测定空腹胰岛素（FINS）、血清脂联素、空腹血糖（FBG）、甘油三酯（TG）、总胆固醇（TC）,计算胰岛素抵抗指数（IRI）。结果高血压1级组、高血压2级组、高血压3级组胰岛素抵抗水平明显高于对照组,且逐级增加（P〈0．01）,而血清脂联素水平高血压1级组、高血压2级组、高血压3级组较对照组明显降低,且逐级递减（P〈0．01）。研究组胰岛素抵抗与血清脂联素水平呈负相关。结论原发性高血压患者存在胰岛素抵抗和低脂联素血症,二者具有一定的相关性,为高血压的监测及治疗提供一个新的思路。