多囊卵巢综合征女性一级亲属胰岛素抵抗及高雄激素血症的临床分析

目的检测多囊卵巢综合征（PCOS）一级亲属的胰岛素及雄激素水平,进一步分析其胰岛素抵抗或高雄激素血症的发病情况。方法选择50例PCOS一级亲属为实验组,50例无PCOS家族史的正常健康者作为对照组,检测两组胰岛素、血脂、血糖、瘦素以及生殖激素睾酮、雄烯二酮水平情况。结果与正常对照组相比,PCOS一级亲属血脂、血糖明显高于对照组,胰岛素敏感性指数降低,胰岛素抵抗指数显著升高（P〈0．05）;游离睾酮、雄烯二酮与对照组差异明显,明显高于正常水平（P〈0．05）,血清瘦素水平与正常组间无明显差异。结论PCOS女性一级亲属较正常健康者更易诱发胰岛素抵抗及高雄激素血症,更容易并发PCOS。     

多囊卵巢综合征妇女内源性胰岛素释放与睾酮反应的相关性研究

本研究以36例PCOS妇女和20例正常月经周期妇女为研究对象。通过测定激素基础水平,观察在糖耐量试验中胰岛素对糖负荷的反应和睾酮的变化以及分析体脂与胰岛素的关系。发现PCOS妇女有较高的空腹血糖水平、空腹血清胰岛素与空腹血清睾酮呈显著正相关(r=0.65,P<0.01)。在糖负荷期PCOS组血清胰岛素释放显著高于对照组(P<0.01),同时,总睾酮与总胰岛素呈正相关(r=0.69,P<0.01)。PCOS肥胖者总胰岛素对糖负荷的反应最大,对照非肥胖者反应最小(F=3.02,P<0.01)。PCOS妇女体脂百分率与空腹血清胰岛素呈正相关(r=0.523,P<0.05)。由此提示(1)PCOS妇女内源性胰岛素释放是PCOS雄激素增高的原因之一;(2)PCOS妇女体脂过多可能在PCOS的高胰岛素血症和胰岛素抵抗中起有部分作用。     

血清瘦素水平变化对围绝经期妇女脂类代谢的影响

探讨瘦素与围绝经期妇女肥胖及脂类代谢的关系.本文分别测量了110例围绝经期妇女(疾病组)血清瘦素(Leptin)、胰岛素(INS)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(apoA1)、载脂蛋白B(apoB)、垂体促性腺激素(LH、FSH)、雌二醇(E2)、睾酮(T)、孕酮(P)及体重和身高.与60名正常育龄妇女(对照组)进行比较分析.结果表明围绝经期肥胖组、非肥胖组血清Leptin、INS水平增高与对照组比较其差异有显著意义(P＜0.01).肥胖组LDL-C 5.01mmol/L、TG 2.21mmol/L、apoB 0.89g/L与非肥胖组及对照组相比,其差异有显著意义(P＜0.01).研究组内LH、FSH、E2和T值,差异无显著意义(P＞0.05),但与对照组比较,差异有显著意义(P＜0.01).相关分析显示:围绝经期妇女Leptin与BMI、INS、LDL-C、apoB高度相关(r=0.762,P=0.002;r=0.382,P=0.01,r=0.430,P=0.002;r=0.545,P=0.001; r=0.454,P=0.001),且LDL-C与apoB同步升高在明显相关(r=0.796,P=0.001).围绝经期瘦素水平与HDL-C、apoA1分析未见相关(r=-0.222～-0.190,P＞0.05).围绝经期Leptin水平与脂类代谢异常相关,肥胖、Leptin增高围绝经期妇女更应重视脂类代谢异常.     

瘦素与多囊卵巢综合征的相关分析

目的探讨血清中瘦素（Leptin）水平与多囊卵巢综合征（PCOS）的关系。方法采用免疫化学发光法检测68例PCOS患者和32例正常妇女血清中的廋素、性激素水平,同时进行糖耐量及胰岛素释放试验。结果 PCOS组血清瘦素水平明显高于对照组（P〈0.05）;PCOS组与对照组相比,除E2水平无显著性差异（P〈0.05）外,其余各项LH、T、PRL、FSH、A4差异显著（P〈0.05）;PCOS组中非肥胖与肥胖组间,除了T、A4差异显著（P〈0.05）外,其余指标差异均无统计学意义（P〈0.05）;PCOS组中瘦素与FINS（r=0.726,P〈0.01）、IR（r=0.631,P〈0.01）、AUC（r=0.518,P〈0.01）、ISI（r=0.663,P〈0.05）均呈正相关关系。结论瘦素可能参与PCOS的发生、发展,并与胰岛素抵抗、高胰岛素血症密切相关。     

瘦素、RAAS与高血压的关系

目的 探讨瘦素和肾素-血管紧张素-醛固酮系统（RAAS）与高血压的相互关系及病理生理机制.方法 采用放射免疫方法测定91例高血压患者及67名健康志愿者的血清瘦素、血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）和醛固酮（ALD））水平;同时测量身高、体重,计算体质指数（BMI）.结果 ①同组内女性瘦素水平均显著高于男性（P＜0.01）;高血压组女性瘦素水平显著高于正常组女性（P＜0.01）;高血压组男性瘦素水平也显著高于对照组男性（P＜0.05）.②高血压患者血清瘦素、PRA、收缩压（SBP）和舒张压（DBP）均显著高于对照组（P＜0.01）; AngⅡ水平也明显高于对照组（P＜0.05）,而BMI和ALD水平与对照组比较无明显变化.③直线相关统计分析显示,高血压组患者血清瘦素的升高与PRA、AngⅡ、BMI和SBP呈正相关（PRA：r =0.52,P＜0.01;AngⅡ：r=0.43,P＜0.01;BMI：r =0.55,P＜0.01;SBP：r=0.33,P＜0.05）,而与ALD和DBP无相关性;对照组瘦素仅与BMI呈高度正相关（r=0.54,P＜0.01）,其它指标均无相关性.结论 血清瘦素水平对血压的影响与性别有关,高血压患者存在瘦素抵抗,瘦素可通过影响RAAS的活性使血压升高,主要为收缩压（SBP）的增高.     

人瘦素放免分析法的建立及初步临床应用

瘦素是由肥胖基因编码, 由脂肪细胞合成和分泌的一种亲水性激素蛋白.本文用高纯的重组人瘦素抗原免疫家兔, 得到高效价的兔抗人瘦素多克隆抗体, 氯胺-T法制备125I-瘦素标记物, 建立人血清瘦素RIA.本方法特异性强, 灵敏度较高, 精密度较好, 其测定值与Linco公司的放免药盒有很好的一致性.用本法建立的正常参考值(BMI 18-25): 男性(34例)为2.15±1.46ng/mL,女性(36例)为7.86±3.60ng/mL.将112名健康者的检测结果分成男、女两组, 血清瘦素值与BMI之间有明显的正相关(r=0.72,P＜0.001).瘦素水平与年龄之间无明显相关性(P＞0.05).女性的促黄体激素、促卵泡激素、泌乳素、孕酮和雌二醇与瘦素无明显相关性(P＞0.05).而对于男性, 睾酮与瘦素水平成明显的负相关(r=0.792,P＜0.01).     

肥胖患者外周脂肪组织中瘦素受体水平的研究

通过对肥胖患者外周脂肪组织中瘦素(leptin)受体表达的研究,进一步探讨肥胖发生发展的机制.用放射配基竞争试验的方法,对71例受检者(其中肥胖32例,超重19例,正常人20名)外周脂肪组织leptin受体的密度进行检测.结果显示,随着体重指数(BMI)的增加,瘦素受体密度肥胖组和超重组与正常组比较差异十分显著(P＜0.01),肥胖组与超重组比较有显著性差异(P＜0.01);而受体与瘦素结合的能力没有显著性差异(P＞0.05).三组间的解离常数(Kd)值无差异,表明瘦素受体与配基结合的能力与BMI无关.从散点分布图可以看出,体重指数越大leptin受体的密度就越小,BMI与Bmax呈显著负相关(r=-0.76,P＜0.01).结论:肥胖患者外周脂肪组织中leptin受体的表达减少与BMI密切相关,这提示体内存在着leptin受体水平下调而造成leptin耐受,继而形成肥胖.     

多囊卵巢综合征患者血清抑制素B水平的分析

目的：探讨抑制素B（inhibin,INH-B）水平在多囊卵巢综合征（PCOS）患者血清中的变化及其与体重指数（BMI）的关系。方法：筛选PCOS患者40例,根据体重指数（BMI）分为肥胖组和非肥胖组并检测血清中的抑制素B（INH-B）、胰岛素生长因子-I（IGF-I）、空腹胰岛素（In）、瘦素（leptin）、黄体生成素（LH）、卵泡刺激素（FSH）、人体催乳素（PRL）、雌二醇（E2）和睾酮（T）,另取40例排卵正常、无怀孕妇女做对照分析。结果：PCOS患者肥胖组leptin、In、LH、T水平明显高于非肥胖组,INH-B、IGF水平则明显低于非肥胖组,差异有统计学意义（P〈0.05）;且肥胖组的LH与INH-B呈负相关（r=-0.735,P〈0.05）,非肥胖组的LH与INH-B无明显相关性。非肥胖组INH-B、IGF、LH、T水平明显高于对照组,差异有统计学意义（P〈0.05）。结论：INH-B与多囊卵巢综合征（PCOS）发生有关,且作为PCOS特征的肥胖又影响着INH-B的作用和水平。     

肥胖患者血清瘦素、C-肽和外周脂肪组织中瘦素受体水平的变化分析

目的 :通过对肥胖及伴有 2型糖尿病患者瘦素、C -肽及外周脂肪组织leptin受体表达的研究 ,进一步探讨肥胖及肥胖伴 2型糖尿病患者发生发展的机制。方法 :用放射免疫分析和放射配基结合实验的方法 ,对 91例受检者 (其中肥胖 38例 ,超重 2 3例 ,正常对照 30例 )外周脂肪组织leptin受体的密度及血清中的瘦素、C -肽水平进行检测。结果 :随着BMI的增加 ,瘦素受体密度肥胖组和超重组与正常组比较差异十分显著(p <0 0 1) ,肥胖组与超重组比较有显著性差异 (p <0 0 1) ;而受体与瘦素结合的能力 (Kd值 )没有显著性差异(p >0 0 5 )。三组间的Kd值无差异。从散点分布图可以看出体重指数越大其leptin受体的密度就越小 ,BMI与Bmax相关性 (r=- 0 70 ,p<0 0 1) ;在超重和肥胖伴有 2型糖尿病患者 ,血清中的瘦素和C -肽水平肥胖组比超重组明显升高 ,二者的比值有明显差异 (p <0 0 1) ;血清C -肽增高幅度比瘦素明显 ;血清C -肽水平与体重指数呈正相关。结论 :单纯性肥胖及肥胖伴 2型糖尿病患者血清瘦素、C -肽水平及外周脂肪组织中leptin受体的密度的变化与BMI密切相关 ,肥胖病人所并发的 2型糖尿病与瘦素抵抗和胰岛素抵抗密切相关     

瘦素和脂联素在儿童肥胖相关性高血压发病中的作用

目的探讨瘦素和脂联素在儿童肥胖相关性高血压发病中的作用。方法基于北京市儿童青少年代谢综合征研究项目的现况调查结果,非随机选择3502名6-18岁学龄儿童（其中男1784名,女1718名）为研究对象,按照超重（包括肥胖）和高血压状态将研究对象分为4组,正常体重正常血压组（对照组,1497名）、正常体重高血压组（HBP组,125名）、超重但血压正常组（OB组,1349名）和超重合并高血压组（OB＋HBP组,531名）。通过比较4组人群血清瘦素和脂联素水平,以及瘦素和脂联素与血压之间的相关回归分析,探讨其与肥胖和血压之间的关系。结果超重肥胖人群BMI、血压、胰岛素和瘦素水平显著升高,脂联素水平降低。HBP组与对照组BMI、瘦素、脂联素水平差异无统计学意义。OB组和OB＋HBP组与对照组比较,BMI、SBP、DBP、胰岛素和瘦素水平升高,脂联素水平降低,与HBP组比较仍可见BMI、胰岛素和瘦素水平升高,脂联素水平降低。与OB组比较,OB＋HBP组BMI和胰岛素水平及男性的瘦素水平明显升高。血压与年龄、BMI、胰岛素、瘦素均呈显著正相关（r=0.260-0.643,P〈0.01）,与脂联素呈显著负相关（r=-0.171--0.332,P〈0.01）。但在调整胰岛素或BMI后,瘦素、脂联素与血压的相关性减弱或消失。结论超重人群血压、胰岛素及瘦素水平均高于对照人群,脂联素水平低于对照人群。瘦素、脂联素可能通过肥胖或胰岛素抵抗与血压相关。     

Serum leptin correlates with serum uric acid but not serum testosterone in non-obese male adolescents

To identify the serum factors that affect circulating leptin levels, we measured the serum concentrations of leptin, testosterone (T), estradiol (E), serum alanine aminotransferase, total cholesterol and uric acid (UA) in healthy male adolescents (age, 18.3 +/- 0.1 years, n=96). We also measured body mass index (BMI), percent body fat and thickness of skin fold to assess the effect of body constitution on serum leptin level. Since serum concentration of leptin significantly correlated with BMI (r=0.820, p<0.001), we analyzed the relation-ship between leptin/BMI ratio (L/BMI) and serum parameters. Analysis of data of subjects with normal serum T level showed a significant inverse correlation between L/BMI and serum T levels (n=96, r=-0.294, p<0.005), but no such correlation was present among non-obese subjects (n=70) with BMI of +/-20% of normal (22 kg/m2). There was no correlation between L/BMI and serum E level. Serum UA level significantly correlated with L/BMI in both the test group (n=96, r=0.520, p<0.001) and non-obese subjects (r=0.369, p<0.005). Stepwise multiple regression analysis showed that UA independently and significantly influenced serum leptin levels in both the test and control groups. Our results demonstrate that T weakly influences serum leptin concentration, and that UA concentrations strongly influences serum leptin in healthy male adolescents independent of their obesity level.     

肥胖儿童血清高敏C反应蛋白、瘦素、可溶性瘦素受体和胰岛素的水平及意义

目的探讨肥胖儿童血清高敏C反应蛋白、瘦素、可溶性瘦素受体及胰岛素的水平变化及临床意义。方法对64例12岁肥胖儿童进行血清高敏C反应蛋白（high-sensitivity C-reactive pro-tein,hs-CRP）、瘦素（leptin,Lp）、可溶性瘦素受体（soluble leptin receptor,sLR）及胰岛素（Insulin,INS）的水平测定,与48例健康体检儿童进行对照比较。其中,血清Lp、INS采用放射免疫分析法（RIA）测定,sLR采用酶联免疫吸附试验法检测,hs-CRP采用电化学发光免疫法测定。结果肥胖儿童组血清hs-CRP、Lp、INS水平及BMI均显著高于对照组（均P〈0.01）,sLR水平低于对照组（P〈0.05）;相关性分析显示肥胖儿童血清hs-CRP水平与Lp、INS、BMI之间均呈显著性正相关性（r=0.575,P〈0.01;r=0.504,P〈0.01;r=0.685,P〈0.01）,与sLR呈显著性负相关性（r=-0.339,P〈0.01）;Lp与INS、BMI之间呈显著性正相关性（r=0.352,P〈0.01;r=0.503,P〈0.01）,与sLR呈显著性负相关性（r=-0.467,P〈0.01）,sLR与BMI呈显著性负相关性（r=-0.398,P〈0.01）。结论肥胖儿童已存在炎症状态的改变及瘦素、胰岛素抵抗,且三方面密切相关。对这些血清学指标的检测,有助于儿童肥胖状态的监控和治疗。     

Is there a role for leptin in the endocrine and metabolic aberrations of polycystic ovary syndrome?

Immunoreactive serum leptin was analysed in 49 women with polycystic ovary syndrome (PCOS) distributed on a wide range of body mass index (BMI; kg/m2) and in 32 normally menstruating women with comparable age, BMI, physical activity and dietary habits. All women with PCOS had increased androgen concentrations and obese women with PCOS (BMI > or = 25, n=24) also showed decreased insulin sensitivity and a preferential accumulation of truncal-abdominal body fat. Anthropometric and hormonal variables, insulin sensitivity, and pancreatic beta-cell activity were investigated in all women. Percentage body fat was calculated using gender-specific regression equations based on skinfold measurements. Serum leptin concentrations were higher in obese than in non-obese women (P < 0.001), but did not differ between the women with PCOS and controls, nor did they differ between glucose intolerant and glucose tolerant, or hirsute and non-hirsute women with PCOS. Both groups showed strong correlations between serum leptin concentrations and percentage body fat, BMI, body fat distribution, fasting plasma insulin and C-peptide, early insulin secretion, the free androgen index (FAI), and the degree of insulin resistance. After correcting for percentage body fat, only the FAI in the women with PCOS remained significant (P < 0.05). However, in a multiple regression analysis with both percentage body fat and the FAI as independent variables, the FAI increased only minimally (2%) the explained variation in leptin concentrations. Thus, serum leptin concentrations are almost exclusively determined by the total amount of body fat, independent of its location, and do not confirm the hypothesis that leptin is involved in the development of the hormonal and metabolic abnormalities in the PCOS.      

Serum Leptin and Skeletal Differences between Obese and Non-Obese Patients with Chronic Obstructive Pulmonary Disease

ObjectiveChronic obstructive pulmonary disease (COPD) affects body composition, adipokine secretion, and skeletal integrity. The aim was to determine the association between leptin, body mass (BM) and body composition parameters - fat mass (FM) and fat mass index (FMI), lean tissue mass (LTM), lean tissue mass index (LTMI) and bone mineral density (BMD) in 67 male COPD patients.MethodsBM, body composition and biochemical indicators were measured or calculated using standard methods. Data were analyzed according to groups: non-obese (N = 48, BMI 21.0-29.9 kg/m²) and obese (N = 19, BMI ≥ 30.0 kg/m²).ResultsIn the non-obese group statistically significant correlations were observed: negative ones of age with most BMD T scores, positive ones of BMI with all T scores, FM, FMI, LTMI and leptin, of FMI with leptin and all T scores, and of LTMI with most T scores. In the obese group also statistically significant correlations were found: positive ones of BMI with FMI, LTM, leptin and T scores (trochanter, total hip); of FMI with leptin; and of leptin with total hip T score.ConclusionA positive relationship between FMI and BMD was found only in non-obese but not in obese COPD patients. Leptin concentration was associated positively with the total hip T score only in obese COPD patients, suggesting its protective role on the skeleton of obese COPD patients.Key Words: Body mass, Body mass index, Fat mass, Fat mass index, Lean tissue mass, Lean tissue mass index, 25-OH vitamin D, Leptin, Bone mineral density     

多囊卵巢综合征不孕妇女抗精子抗体的评价

目的:探讨多囊卵巢综合征(PCOS)不孕妇女抗精子抗体(ASA)的水平,阐明ASA是否介导了PCOS不孕妇女的生育力下降。方法:选择26~35岁的PCOS不孕妇女127例,按体质量指数(BMI)分为肥胖型PCOS不孕组(obese组,42例)和非肥胖型PCOS不孕组(non-obese组,85例),选择门诊同期24~36岁体重正常的非PCOS不孕患者90例作为对照(control组)。采用间接免疫珠试验检测3组患者血清标本中ASA-Ig G和ASAIg A水平,以黏附免疫珠的活动精子数50%为阳性,另设20%~49%为弱阳性,20%为阴性。结果:Obese和non-obese组没有检出ASA-Ig G阳性,control组检出2例ASA-Ig G阳性,阳性率为2.2%。Obese、non-obese和control组分别检出1、2和2例ASA-Ig G弱阳性,弱阳性率分别为2.4%、2.4%和2.2%,3组弱阳性率无显著差异。3组均未检出ASA-Ig A阳性。结论:ASA没有参与介导PCOS不孕妇女的生育力下降,临床仍需重视不孕妇女ASA的筛查。     

Adipokines, insulin resistance and hyperandrogenemia in obese patients with polycystic ovary syndrome: cross-sectional correlations and the effects of weight loss

Objective: To assess the effects of weight loss on serum adipokine levels in polycystic ovary syndrome (PCOS). Methods: We determined serum leptin, adiponectin, resistin, and visfatin levels in 60 overweight/obese women with PCOS and 48 BMI-matched female volunteers. Measurements were repeated after 24 weeks of treatment with orlistat 120 mg 3 times per day along with an energy-restricted diet. Results: At baseline, serum visfatin concentration was higher in patients with PCOS than in controls (p = 0.036); serum levels of leptin, adiponectin, and resistin did not differ between the two groups. After 24 weeks, a significant reduction in BMI and waist circumference was observed in both patients with PCOS and controls (p < 0.001 vs. baseline in both groups). Also serum leptin levels decreased in both patients with PCOS and controls (p < 0.001 vs. baseline in both groups). The reduction in serum leptin levels did not differ between groups. Serum adiponectin, resistin, and visfatin levels did not change in either group. Conclusions: Leptin, adiponectin, and resistin do not appear to play major pathogenetic roles in overweight/obese patients with PCOS. In contrast, visfatin emerges as a potentially important mediator of the endocrine abnormalities of these patients. However, serum visfatin levels are not substantially affected by weight loss. Copyright ? 2012 S. Karger GmbH, Freiburg.     

Comparison of leptin protein levels in Prader-Willi syndrome and control individuals

Prader-Willi syndrome (PWS) is characterized by early childhood obesity, mental deficiency, hypogonadism, hypotonia, hypopigmentation, short stature, small hands and feet, and a characteristic face. It is the most common genetic cause of obesity and obesity is the most significant health problem for PWS patients. Ob protein (leptin), which is produced by adipose tissue, is thought to play a significant role in obesity; thus, unusually low plasma leptin levels, or relative loss of sensitivity to leptin in PWS subjects, could be an important factor in their obesity. We measured plasma leptin levels in 19 obese and 14 non-obese PWS patients [mean body mass index (BMI) 37.2 and 22.0, respectively] and compared these levels to those of 28 obese controls (mean BMI 35.5) and 16 non-obese control individuals (mean BMI 21.6). The mean plasma leptin concentration (ng/ml) for obese PWS subjects was 33.4 and 23.6 for non-obese PWS subjects. Obese control leptin was 36.2 ng/ml and non-obese control was 9.9. Among the control groups, leptin levels in females were significantly higher than those in males; the obese males and females had significantly higher leptin than their respective non-obese counterparts. These differences did not hold true for the PWS subjects. Leptin levels in obese PWS males and females were similar, and the same was true of the non-obese PWS males and females. The differences between obese and non-obese PWS subjects of both sexes were small and not significant. Comparing control groups with their PWS counterparts revealed no significant differences, with one exception: circulating plasma leptin levels in non-obese PWS males were nearly five times higher than in non-obese control males with similar BMI. This difference may reflect a more female pattern of fat distribution and hypogonadism, which are characteristic of PWS males. Leptin levels in PWS patients were not obviously correlated with the chromosome 15 finding seen in the patients. Am. J. Med. Genet. 75:7–12, 1998. © 1998 Wiley-Liss, Inc.     

多囊卵巢综合征患者血清瘦素和胰岛素检测的临床意义

目的:检测多囊卵巢综合征(polycystic ovary syndrome, PCOS)患者血清瘦素(leptin)及胰岛素(insulin)含量,以探讨leptin与PCOS的关系.方法:采用放射免疫分析检测34例PCOS患者及30例健康对照组血清中的leptin和insulin浓度.结果:PCOS患者血清中的leptin及insulin含量均高于健康对照组,且有高度显著性差异(P＜0.01);同时,PCOS患者中的肥胖组与非肥胖组相比二者也有高度显著性差异(P＜0.01),肥胖组高于非肥胖组.结论:血清leptin和insulin与PCOS可能有较好的相关性,提示血清leptin含量可作为PCOS患者的一项辅助诊断指标.