【摘要】 目的 探讨血浆内脏脂肪素(visfatin)与2型糖尿病的关系。方法 2007年7月—9月选取2型糖尿病患者和正常对照组各40例。根据体重指数再分为超重肥胖组和非超重肥胖组。检测visfatin水平、空腹血糖、空腹胰岛素、血脂、血压等,计算腰臀比、体重指数、稳态模型胰岛素抵抗指数homeostasis model assessment of insulin resistance,HOMAIR)及胰岛素分泌功能(HOMAβ)。结果 2型糖尿病组血浆visfatin水平显著低于正常对照组(Plt;0.05)。多元逐步相关分析表明,在肥胖的2型糖尿病个体中visfatin与高密度脂蛋白胆固醇、空腹血糖、体重指数呈负相关。二分类Logstic回归分析显示血浆visfatin及胰岛素抵抗指数与2型糖尿病的发生显著相关,回归方程式为Y=7.681+2.417 ln HOMAIR-2.549 visfatin。结论 visfatin的变化可能对2型糖尿病的发生、发展具有一定作用。
ObjectiveTo systematically evaluate the changes in placental protein expressions in gestational diabetes mellitus (GDM) and their correlations with maternal insulin resistance (IR). Methods PubMed, Cochrane Library, Scopus, Web of Science, Embase, China National Knowledge Infrastructure, VIP database, Wanfang Database and CBMdisc were searched for case-control studies published from January 2009 to November 2021, which reported the placental protein expressions in GDM and their correlations with IR. Two researchers independently reviewed the literature, extracted data and evaluated the literature quality. RevMan 5.4 software was used for meta-analysis, and descriptive analysis was performed on data that cannot be combined. ResultsA total of 19 studies were included, comprising 2 012 patients. The results of meta-analysis showed that: the expression level of retinol binding protein 4 (RBP4) [standard mean difference=2.11, 95% confidence interval (CI) (1.64, 2.58), P<0.000 01] and the positive rate of protein tyrosine phosphatase-1B (PTP1B) [relative risk (RR)=1.56, 95%CI (1.29, 1.88), P<0.000 01] were up-regulated, and the positive rate of insulin receptor substrate 1 (IRS-1) [RR=0.69, 95%CI (0.60, 0.78), P<0.000 01] was down-regulated. The protein expression levels of RBP4 (P<0.000 01) and PTP1B (P<0.000 01) were positively correlated with homeostasis model assessment of insulin resistance (HOMA-IR), while the protein expression levels of IRS-1 (P<0.000 01) and APN (P=0.002) were negatively correlated with HOMA-IR, and glucose transporter 4 (GLUT 4) was not correlated with HOMA-IR (P=0.79). Descriptive analysis found that the expression levels or positive rates of adipocytokines (leptin, resistin), oxidative stress markers (xanthione oxidase, malondialdehyde, 8-isoprostaglandin),inflammatory factors (tumor necrosis factor α, Toll-like receptor 4, Galectin-3, Galectin-2, migration inhibitory factor),fetuin-A, forkhead box transcription factor 1, forkhead box transcription factor 3a and estrogen receptor α in GDM placenta were up-regulated and all were positively correlated with HOMA-IR. The expression levels or positive rates of insulin signaling pathway proteins [phosphoinositide 3-kinase (PI3K), protein kinases B (AKT), phospho-protein kinases B (p-AKT), GLUT 4] were down-regulated, PI3K and AKT were negatively correlatedwith HOMA-IR, while p-Akt had no correlation with HOMA-IR. ConclusionsThe dysregulation of placental protein expressions may mediate maternal IR exacerbation, thus promote the occurrence and development of GDM and other pregnancy complications. The causal relationship and regulatory mechanism are still unclear, which need to be further studied.
目的:探讨老年2型糖尿病患者体重指数(BMI)与胰岛β功能状态及胰岛素抵抗(RI)的关系。方法:调查对象为2006年4月~2008年7月入我接受健康体检的成都地区离退休干部。采用1999年WHO糖尿病诊断标准,以129例已确诊T2DM患者为观察对象,根据体重指数(BMI)分为两组:肥胖组(含超重)(BMI≥25)66例,均为男性;非肥胖组(BMIlt;25)63例,其中3例为女性(无统计学意义),并与19例正常对照组进行对比研究。以氧化酶法测定空腹血葡萄糖(FBG),酶联免疫法测胰岛素(INS)及C肽(CP)水平等参数。用HOMA公式计算胰岛素抵抗(IR)和β细胞功能指数(BCI)。采用SPSS软件进行方差分析(ANOVA),分析3组间各指标的差异显著性x-±S表示。结果:三组经HOMA 公式计算的IR值为对照组(3.0±1.3)、非肥胖组(4.6±4.0)、肥胖组(5.2±6.2)依次递增,但各组间无显著性差异。HOMAβ细胞功能指数为非肥胖组(82.06±84.1)、肥胖组(138.4±179.6)、对照组(226.5±236.8)依次递增,各组间均有显著性差异(Plt;0.01～0.05)。 结论:老年2型糖尿病患者普遍存在β细胞功能减退,尤其是非肥胖组;同时也具有胰岛素抵抗,主要是肥胖组。表明BMI对老年糖尿病患者胰岛β细胞功能有影响,肥胖患者β细胞分泌能力加强,负担加重,功能受损,胰岛素抵抗明显。
Objective To investigate the relationship between adipocyte fatty acid binding protein ( A-FABP) and obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 120 patients were recruited and underwent polysomnography. The groups were allocated according severity of OSAHS and obesity. Plasma A-FABP ( ng/mL) levels were measured by ELISA. The associations between A-FABP and AHI, BMI, LSaO2 , MSaO2 , neck collar, waist /hip ratio, insulin resistance index were analyzed. Results Plasma A-FAPB levels were significantly higher in the OSAHS group than in the non-OSAHS group of same weight, independent of age and gender. In the non-OSAHS group and the severe OSAHS group, plasma A-FABP levels of obesity persons were significantly higher than those without obesity, independent of age and gender. Plasma A-FAPB level was positively correlated with AHI, BMI, insulin resistance index, neck collar, SLT90% , and waist/hip ratio, but negatevely correlated with LSaO2 and MSaO2 in the OSAHS group. In the non-OSAHS group, plasma A-FAPB level was positively correlated with BMI and insulin resistance index. Conclusions Plasma A-FABP level is higher in patients with severe OSAHS. Plasma A-FABP level is positively correlated with BMI and insulin resistance index both in OSAHS and non-OSAHS patients.
【摘要】 目的 探讨2型糖尿病（T2DM）胰岛素抵抗导致糖尿病性心功能不全的临床表现特点及相关激素的改变。 方法 2008年1-4月对T2DM患者35例（胰岛素抵抗指数HOMA-IRlt;2.69者19例为A1组，HOMA-IR≥2.69者16例为A2组）及健康体检者20人B组测体重指数（BMI）、空腹血糖（FPG）、胰岛素、心钠素（ANP）、脑钠素（BNP）水平；心脏彩色多普勒超声分别测E/A、e/a、S/D、LVEF、DT期。 结果 A2组BMI较A1、B组均明显增加（Plt;0.05），A1、B组间差异无统计学意义（Pgt;0.05）。ANP、BNP及DT值在A1、A2组均较B组增高（Plt;0.05），BNP在A2组高于A1组（Plt;0.05），ANP、DT值在A1、A2组间差异均无统计学意义（Pgt;0.05）。E/A、e/a和S/D在A1、A2组均较B组降低（Plt;0.05），A1、A2组间差异均无统计学意义（Pgt;0.05）。A2组患者LVEF较A1、B组均明显降低（Plt;0.05），A1、B组间差异无统计学意义（Pgt;0.05）。 结论 随着胰岛素抵抗加重，心肌舒张顺应性较差和收缩力下降，伴随相关激素（心脏利钠肽）分泌增加，最终产生心功能不全的临床表现、体征及多普勒超声心动图表现。【Abstract】 Objective To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency leaded by insulin resistance in type 2 diabetes mellitus (T2DM). Methods From January to April 2008, 35 patients with T2DM (group A1: HOMA-IRlt;2.69, n=19; group A2: HOMA-IR≥ 2.69, n=16) and 20 subjects without T2DM (group B) were enrolled. The body mass index (BMI), fasting plasma glucose (FPG), insulin (FINS), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and E/A, e/a, S/D, LVEF and DT stage of all subjects were detected. Results The BMI in group A2 was higher than those in group A1 and group B (Plt;0.05), while the difference between the later two groups was not statistically significant (Pgt;0.05). The ANP, BNP and DT stage were all higher than those in group B (Plt;0.05), the BNP was higher in group A2 than in group A1 (Plt;0.05), while the difference of neither ANP nor DT stage between the later two groups was statistically significant (Pgt;0.05). The values of E/A, e/a and S/D in group A1 and A2 were all lower than those in group B (Plt;0.05), while there were no statistically significant diferences between group A1 and A2 (Pgt;0.05). The values of LVEF of group A1 and A2 were both significantly reduced than that in group B (Plt;0.05), and the values in group A2 were the lowest (Plt;0.05). Conclusion With the aggravating of insulin resistance, myocardial contractility and diastolic function will decline, meanwhile the ANP and BNP secretion will increase, and then the clinical and echocardiographic manifestation will appear.
摘要:目的: 观察格列美脲对2型糖尿病患者心血管的保护作用并探讨其可能的机制。 方法 :112例T2DM患者随机分为格列美脲组(格列美脲+二甲双胍)和对照组(格列本脲+二甲双胍),观察治疗前后两者空腹及餐后两小时血糖(FBG,2hPBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、HOMA模型胰岛素抵抗指数(HOMAIR)、甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、同型半胱氨酸(HCY)、血浆脂联素的变化。 结果 :两组患者的TC、LDLC、TG、FBG、2hPBG都较治疗前降低,连续服用6个月以上格列美脲的T2DM患者其血浆HCY、HOMAIR、血糖水平明显下降,血浆脂联素水平明显升高,与对照组相比差异有统计学意义(〖WTBX〗P lt;005)。 结论 :格列美脲能降低多项心血管危险因子水平,对血脂、HCY和动脉粥样硬化都有良性调节作用,其作用基础可能与改善胰岛素抵抗,增加血浆脂联素相关。Abstract: Objective: To observe the protective effects and to explore mechanisms of glimepiride on cardiovascular system of Type 2 Diabetes Mellitus. Methods : 112 patients with type 2 diabetes mellitus were randomly divided into treatment group (glimepiride combined with metformin) and control group (glibenclamide combined with metformin). The fasting blood glucose (FBG), 2hPBG, hemoglobin A1c (HbA1c), FINS, HOMAIR, blood lipid (TC, TG, LDLC and HDLC), HCY (homocysteine) and adiponectin were detected before and after treatment. Results : In all cases, the level of TC、LDLC、TG、FBG、2hPBG were decreased after treated with glimepiride or glibenclamide combined with metformin for 6 monthes. Moreover, the level of HCY, HOMAIR and blood glucose were decreased and the level of adiponectin was increased significantly than that of in control group (Plt;005). Conclusion : Glimepiride showed the effective on decreasing the risk factor of cardiovascular system disease with regulation of blood lipid, HCY, and improve the atherosclerosis. The effective of glimepiride on cardiovascular system was relation to improved the insulin resistance and increase the adiponectin.
Objective To investigate the risk factors for insulin resistance (IR) after selective operation in the department of general surgery. Methods Two hundred and sixty-three patients including 122 males and 141 females after selective operation between March 2009 and October 2009 in The First Affiliated Hospital of Xi’an Jiaotong University were studied. Sex, age, histories of smoking and drinking, hypertensive disease, history of operation, height, weight, waist circumference, anesthesia method, operation duration, operation method, and volumes of transfusion and liquid injection during operation were recorded. The fasting blood glucose (BG) and fasting plasma insulin (INS) were tested for selectively operative patients on day 1 before and after surgery. Insulin resistance index (HOMA-IR) and the index of insulin secretion (HOMA-β) were calculated with homeostasis model assessment (HOMA). Logarithms of HOMA-IR (lnHOMA-IR) was taken because that HOMA-IR was not normal distribution. Results The levels of fasting BG, fasting plasma INS, and lnHOMA-IR on day 1 after operation were higher than those on day 1 before operation (Plt;0.001). IR was correlated with patients’ sex (P=0.002), the history of smoking (P=0.033), waist circumference (P=0.000), operation method (P=0.007), and the volume of liquid injection during operation (P=0.001). A significant elevation of the change of lnHOMA-IR level was found between abdominal and nonabdominal surgery (Plt;0.001). Conclusions IR occurs in selectively operative patients in the department of general surgery. It is helpful for depressing IR to control the intensity of surgery.
Objective We investigated the effect of supplementation with alanyl-glutamine dipeptide on insulin resistance and outcome in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods A prospective, randomized, open and controlled trial was conducted. Patients with COPD and respiratory failure were recruited between Jan 2005 to Feb 2006 and randomly assigned to a trial group (n=14) with glutamine dipeptide supplmented parenteral nutrition and a control group (n=16) with isocaloric, isonitrogenic parenteral nutrition. On the third day and fifth day of nutrition treatment, blood glucose was clamped at level of 4.4 to 6.1 mmol/L by intravenously bumped insulin. Blood gas, blood glucose level, insulin dosage were recorded everyday. The outcomes were mortality, length of stay (LOS) in hospital and in ICU, mechanical ventilation times and the costs of ICU and hospital.Results Thirty patients successfully completed the trial. There was no difference in blood gas between two groups, but PaO2 increased gradually. Compared with control group, blood glucose level had trend to decrease in trial group. The average insul in consumption decreased significantly in trial group on the fifth day. There was no statistical difference between two groups in mortality, length of stay in hospital and the costs of hospital. But compared with control group, length of stay in ICU and mechanical ventilation days had trend to decrease in trial group. Conclusion Alanyl-glutamine dipeptide do not improve pulmonary function of patients with COPD and respiratory failure. However, alanyl-glutamine dipeptide attenuated insul in resistance and stabilized blood glucose. This trial does not confirm alanyl-glutamine di peptide can improve outcome in critically ill patients with COPD and respiratory failure between two groups in mortality at the end of 30 days, length of stay in hospital and the costs of hospital. But the length of stay in ICU and the duration of mechanical ventilation does decrease, but not significantly, in the trial group.
ObjectiveTo investigate role and mechanism of protein tyrosine phosphatase 1B (PTP1B) in jejunoileal bypass to treating rats with type 2 diabetes mellitus (T2DM). MethodsTwenty-four T2DM SD rats and 24 normal SD rats were selected randomly by using random number table, then the SD rats with T2DM were randomly divided into jejunoileal bypass operation (DJBO, n=12) group and sham operation (DSO, n=12) group, the SD rats with normal food diet were randomly divided into jejunoileal bypass operation (NJBO, n=12) group and sham operation (NSO, n=12) group. Subsequently, fasting body weight (FBW), fasting plasma glucose (FPG), fasting insulin (FINS), and homeostasis model-insulin resistant (HOMA-IR) index of rats in each group were tested at different time points (before operation, on week 4 and 8 after operation). In addition, expression of PTP1B protein in skeletal muscle was determined by immunohistochemical staining and Western blot method respectively. Results① The FBW before making T2DM model had no significant difference between the rats with high-fat diet and with normal diet (P > 0.05), which on week 4 or 8 after making T2DM model in the rats with high-fat diet was significantly heavier than that in the rats with normal diet (P < 0.05). ② Before jejunoileal bypass operation, the FBW, FPG, FINS, and HOMA-IR index in the DJBO group and the DSO group were significantly higher than those in the NJBO group and the NSO group (P < 0.05), respectively, which had no significant differences between the DJBO group and the DSO group (P > 0.05) and between the NJBO group and the NSO group (P > 0.05). ③ Compared with the values before jejunoileal bypass operation, the FBW, FPG, FINS, and HOMA-IR index on week 4 or 8 after jejunoileal bypass operation were significantly decreased in the DJBO group (P < 0.05); the FBW was significantly increased on week 4 or 8 after jejunoileal bypass operation in the DSO group and the NSO group (P < 0.05), and on week 8 after jejunoileal bypass operation in the NJBO group (P < 0.05). The other indexes had no significant differences between before and after jejunoileal bypass operation in the DSO group, the NSO group, or the NJBO group (P > 0.05). ④ On week 8 after jejunoileal bypass operation, the expression of PTP1B protein in the DSO group was significantly higher than that in the DJBO group, the NSO group or the NJBO group (P < 0.05), which in the DJBO group was significantly higher than that in the NSO group (P < 0.05) or the NJBO group (P < 0.05), which had no significant difference between the NJBO group and the NSO group (P > 0.05). ConclusionJejunoileal bypass could effectively improve insulin resistance and decrease FPG level and FBW of T2DM rats through inhibiting expression of PTP1B protein in skeletal muscle of rat with T2DM.