8～10岁超重肥胖儿童HOMA-IR指数分布及与人体成分的相关性研究

目的：探讨8～10岁超重肥胖儿童稳态胰岛素评估模型胰岛素抵抗（HOMA IR）指数的分布及与人体成分等测量指标的关系。方法：以2018年北京市某小学8～10岁超重肥胖儿童为研究对象,采集人体测量指标（体质量、身高、体质量指数、腰臀比）、人体成分指标（肌肉量、去脂体重量、体脂肪、体脂百分比、内脏脂肪面积、基础代谢率）,检测血液空腹血糖、胰岛素水平,采用HOMA IR指数评估胰岛素抵抗。结果：共收集149名儿童,其中超重57名、肥胖92名;肥胖者体质量指数、腰臀比、体脂肪、体脂百分比、空腹胰岛素、内脏脂肪面积、HOMA IR指数均显著高于超重者,两者空腹血糖比较无显著差异（P=0.108）。男生（109例）在肌肉量、去脂体重、基础代谢率方面大于女生（40例）（P＜0.05）。48例（32.2%）儿童存在胰岛素抵抗状态（IR＞4）,且各检测指标均显著升高（P＜0.001）。体质量指数、腰臀比、体脂肪、体脂百分比、内脏脂肪面积均与HOMA IR指数呈显著正相关（P＜0.001）,其中腰臀比相关性最大（r=0.472）。结论：超重肥胖儿童HOMA IR指数普遍偏高。HOMA IR指数大于4时,体重、BMI、体脂肪、体脂百分比、内脏脂肪面积等显著增加。人体成分分析可用于超重肥胖儿童体格评估。     

PEMT基因V175M多态性与非酒精性脂肪肝易感性的关系

目的:探讨磷脂酰乙醇胺N-甲基转移酶(phosphatidylethanolamine N-methyltransferase,PEMT)基因V175M多态性与非酒精性脂肪肝(NAFLD)易感性的关系。方法:抽取NAFLD患者外周血基因组DNA,PCR扩增获得其V175M基因,测序后分析PEMT基因V175M多态位点的基因分型。收集患者身高、体重、腰围、空腹血糖、低密度脂蛋白、空腹胰岛素等临床资料,计算体重指数和HOMA胰岛素抵抗指数(HOMA-IR),同时选取年龄、性别相匹配的非NAFLD79人为对照。结果:NAFLD组和对照组在年龄、性别方面相匹配,但NAFLD组的肥胖者显著增多。NAFLD组和对照组M等位基因的频率分别为20.1%和12.0%,差异有统计学意义(P<0.05),NAFLD组和对照组VM MM基因型的频率分别为26.6%和22.8%(P=0.05)。以BMI≥25作为肥胖的标准,将研究对象分为肥胖和非肥胖者,在肥胖的对照和NAFLD组中,V175M等位基因和基因型频率差异均无统计学意义(P>0.05);在非肥胖的NAFLD和对照组中,M等位基因的频率分别为21.9%和9.6%,VM基因型的频率则分别为43.8%及19.3 %,差异均有统计学意义(P<0.05)。通过引入其他已知的非肥胖型NAFLD易感因素(腰围,LDL和HOMA-IR),再进行Logistic回归分析,V175M基因型未能进入回归方程,P=0.323。结论:广州汉族人中存在PEMT V175M多态性,且以V等位基因为主,PEMT V175M并非NAFLD的独立易感因素。     

绝经后女性高尿酸血症患者性激素结合球蛋白与血尿酸的相关研究

目的：研究绝经后女性高尿酸血症患者血浆中性激素结合球蛋白（sexhormonebindingglobulin,SHBG）水平与血尿酸水平的相关性。方法：选取绝经后女性404例,其中高尿酸血症组204例,正常对照组200例,测量所有研究对象体重、身高、腰围、臀围、收缩压（SBP）、舒张压（DBP）,并计算体重指数（BMI）和腰臀比（WHR）,检测血尿酸（UA）、空腹血糖（FBG）、总胆固醇（TG）、甘油三酯（TC）低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、雌激素（E2）、雄激素（T）、空腹胰岛素（INS）及SHBG,并计算胰岛素抵抗指数（Homa-IR）。结果：与绝经后女性尿酸正常者相比,高尿酸血症的患者UA,WHR,TC,FBG,INS,Homa-IR明显升高（P〈0．01）,DBP,WAIST和LDL升高（P〈0．05）,SHBG水平明显下降（P〈0．01）;SHBG与INs、uA、TG呈显著负相关（P〈0．05）,SHBG与E2呈显著正相关P〈0．01）。结论：绝经后女性中高尿酸血症患者的低血浆SHBG水平与高血尿酸水平显著相关,血浆SHBG水平下降与胰岛素抵抗可能高度相关,低sHBG可能作为绝经后女性患高尿酸血症的高危因素。     

大学生运动员体型与胰岛素敏感度相关性研究

为了了解大学生运动员体型与胰岛素敏感度的相关性,我们招募了320名大学生运动员与300名非运动员为受试对象,测量了其身高、体重、BIA体脂肪率,计算身体质量指数(body mass index,BMI),并检测理论空腹血糖、血清胰岛素、稳态模型评估(homeostasis model assessment,HOMA)值、糖化血红蛋白以及胆固醇数值。我们比较了大学生运动员和非运动员胰岛素敏感度与代谢指标,并推测了其关联性。研究发现,运动员的体重、身体质量指数与BIA脂肪率均显著的高于非运动员;运动员的空腹胰岛素以及HOMA都显著的高于非运动员。另以皮尔逊积差相关以及偏相关探讨与胰岛素相关的因子,发现无论有没有经过性别与年龄的校正,运动员或非运动员的肥胖指标(体重,身体质量指数与脂肪率)都与胰岛素敏感度指标(胰岛素,HOMA)呈显著正相关,说明大学生运动员具有较低的胰岛素敏感度,并且胰岛素敏感度随着肥胖指标的升高而下降。本研究结果为揭示运动员体型与胰岛素敏感度的相关性提供了一定的帮助。     

基于主成分分析法探讨人体测量学参数与青少年血糖关系的研究

目的:调查分析人体测量学参数包括体重指数(BMI)、腰围(WC)、臀围(HC)、腰围/臀围比(WHR)及腰围/身高比(WHtR)对南昌地区青少年空腹血糖的影响。方法:在南昌地区进行随机抽样检查731例12-18岁之间的青少年,测量身高、体重、BMI、WC、HC、WHR、WHtR和空腹血糖,用SAS软件进行统计分析。结果:男女性的五项人体测量学指标和空腹血糖间均呈显著正相关,相关系数为0.14-0.38;通过主成分分析得到四个主成分,多重回归分析结果表明联合四个主成分比单独使用其中任何一个更能解释空腹血糖的变异。结论:BMI、WC、HC、WHR、WHtR与男性和女性空腹血糖都有一定相关性,并且联合这五项测量学指标比单独使用其中任何一个能更精确预测空腹血糖。     

达格列净对2型糖尿病合并非酒精性脂肪性肝病患者血清FGF-21水平的影响

摘要 目的：分析血清成纤维细胞生长因子-21（FGF-21）与2型糖尿病（T2DM）合并非酒精性脂肪性肝病（NAFLD）患者常见指标及NAFLD纤维化评分（NFS）的相关性,进一步探讨达格列净对T2DM合并NAFLD患者血清FGF-21水平的影响。方法：选取2022年1月至2022年6月徐州医科大学附属徐州市立医院收治的80例T2DM合并NAFLD患者为研究对象（T2DM合并NAFLD组）,选择同期80例T2DM不合并NAFLD患者为T2DM组。收集腰围（WC）、身高、体重数据,计算体重指数（BMI）。测定空腹血糖（FPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-c）,低密度脂蛋白胆固醇（LDL-c）、肌酐（Cr）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST ）、白蛋白（Alb）、血小板计数（PLT）等指标,计算胰岛素抵抗指数（HOMA-IR）、NFS。采用酶联免疫吸附（ELISA）法测定FGF-21水平。比较T2DM组和T2DM合并NAFLD组各项指标的差异,探讨血清FGF-21水平与T2DM合并NAFLD患者其他指标的相关性,Logistic回归分析T2DM合并NAFLD的影响因素,受试者工作特征曲线（ROC）分析各影响因素对T2DM合并NAFLD的诊断价值。将80例T2DM合并NAFLD患者按随机数字表法随机分为二甲双胍组和达格列净组各40例,治疗前后观测各项指标变化,并密切监测不良反应。结果：T2DM合并NAFLD组患者WC、BMI、FINS、HbA1c、TG、AST、ALT、HOMA-IR、NFS及FGF-21均高于 T2DM组（P＜0.05）。相关性分析显示,FGF-21水平与T2DM合并NAFLD组患者WC、BMI、HbA1c、TG、HOMA-IR、NFS均存在正相关（P<0.05）。Logistic回归分析显示,BMI、HbA1c、FGF-21、HOMA-IR为影响T2DM患者合并NAFLD的危险因素。ROC曲线分析显示,BMI、HbA1c、FGF-21、HOMA-IR对T2DM合并NAFLD均具有一定预测价值,其中以FGF-21的预测效能最佳。治疗后,达格列净组TG、AST、ALT、NFS、FGF-21水平较二甲双胍组降低更为明显（P＜0.05）。结论：血清FGF-21水平为T2DM合并NAFLD的危险因素,参与了T2DM合并NAFLD发病及进展,且对T2DM合并NAFLD有较好的预测效能。相较于二甲双胍,达格列净可明显降低T2DM合并NAFLD患者血清FGF-21水平并改善NFS,具有一定程度的肝脏保护作用。     

冠心病患者胰岛素抵抗程度的影响因素分析

目的:分析冠心病患者胰岛素抵抗程度的影响因素。方法:选择我院收治的冠心病住院患者166例,根据胰岛素抵抗指数(HOMA-IR)水平将其分成四组。A组:HOMA-IR≤1.53(n=36);B组:1.53HOMA-IR≤3.46(n=30);C组:3.46HOMA-IR≤5.13(n=36);D组:HOMA-IR≥5.14(n=64)。检测和比较各组一般临床资料和相关生化指标的差异,并进一步分析影响冠心病患者胰岛素抵抗程度的危险因素。结果:C、D组腰围、空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、低密度脂蛋白胆固醇(LDL-C)均高于A、B组;D组空腹胰岛素(INS)均高于A、B组,B、C组INS、LDL-C均高于A组;D组体质量、TC高于A组。上述差异均有统计学意义(P0.05)。多因素分析结果显示BMI、腰臀比(WHR)、FBG、INS、TC、HDL-C均是HOMA-IR的影响因素(P0.05)。结论:体重、腰围、FBG、2h PBG、INS、TC、HDL-C的上升均为加重冠心病患者胰岛素抵抗程度的危险因素。     

肥胖儿童血浆脂联素的变化及临床意义

目的:检测儿童血浆脂联素(ADPN)的变化及其与肥胖的关系,探讨ADPN在儿童肥胖症发病的意义.方法:265名儿童随机分为肥胖组和正常对照组,分别测定腰围(WC),臀围,腰臀比(WHR),体脂百分比(%BF),甘油三酯(TG),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),空腹血糖(FBG),空腹胰岛素(FINS)及ADPN,计算稳态模型胰岛素抵抗指数(HOMA-IR),并分析ADPN与体质量指标、糖脂代谢指标的关系.结果:肥胖组儿童ADPN水平低于正常组儿童(P＜0.05),且与BMI、WHR、HOMA-IR、%BF、FINS、TG呈显著负相关(P均＜0.05);多元逐步回归分析显示%BF、BMI、HOMA-IR、FINS是影响ADPN的主要因素.结论:肥胖儿童ADPN水平显著下降,且与体脂含量及胰岛素抵抗密切相关.     

军事飞行人员非酒精性脂肪肝病患者白细胞计数、C反应蛋白、尿酸与糖脂代谢、胰岛素抵抗和肝纤维化指标的相关性研究

摘要 目的：研究军事飞行人员非酒精性脂肪肝病（NAFLD）患者白细胞计数（WBC）、C反应蛋白（CRP）、尿酸（UA）与糖脂代谢、胰岛素抵抗和肝纤维化指标的相关性。方法：选择2018年7月至2021年12月期间海军青岛特勤疗养中心收治的100例NAFLD军事飞行人员作为NAFLD组,另取同期健康体检者90例作为对照组。检测并对比两组的WBC、CRP、UA、糖脂代谢、胰岛素抵抗以及肝纤维化相关指标,采用Pearson相关系数分析WBC、CRP、UA与糖脂代谢、胰岛素抵抗和肝纤维化指标的相关性。结果：NAFLD组的WBC、CRP、UA水平均明显高于对照组（P<0.05）。NAFLD组的空腹血糖（FBG）、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹胰岛素（FINS）、稳态模型胰岛素抵抗指数（HOMA-IR）水平均高于对照组,高密度脂蛋白胆固醇（HDL-C）水平低于对照组（P<0.05）。NAFLD组的Ⅲ型前胶原肽（PC-Ⅲ）、层粘连蛋白（LN）、透明质酸（HA）、Ⅳ型胶原（Col-Ⅳ）水平均明显高于对照组（P<0.05）。Pearson相关性分析结果显示, WBC、CRP、UA与TC、TG、LDL-C、HOMA-IR、PC-Ⅲ、LN、HA、Col-Ⅳ均呈正相关,而与HDL-C呈负相关（P<0.05）; WBC、CRP、UA与FBG、FINS无显著相关性（P>0.05）。结论：军事飞行人员NAFLD患者体内WBC、CRP、UA明显升高,且与糖脂代谢紊乱、胰岛素抵抗和肝纤维化有关。     

长沙市肥胖小学生血清瘦素水平的变化及其影响因素分析

目的:探讨长沙市肥胖小学生血清瘦素(leptin)水平的变化及其影响因素.方法:长沙市5所小学7～12周岁学龄儿童中随机抽取单纯性肥胖儿童119名和正常体重儿童103名,分别测定腰围(WC),臀围,腰臀比(WHR),双能X线骨密度仪(DEXA)测量体脂百分比(%BF),并检测血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)和空腹胰岛素(FINS),计算稳态模型胰岛素抵抗指数(HOMA-IR),ELISA法测血清瘦素(Leptin).结果:肥胖小学生血清瘦素水平显著高于正常儿童(P<0.01),肥胖小学生瘦素水平与BMI、WC、WHR、%BF、TG、LDL-C呈明显正相关,与HDL-C呈明显负相关,多元逐步回归分析表明FINS、HOMA-IR、BMI、TG、LDL-C及%BF是肥胖儿童血清瘦素水平的主要相关因素.结论:长沙市肥胖小学生血清瘦素水平升高且与体脂、胰岛素抵抗和血脂明显相关.     

Homeostatic model assessment (HOMA) index cut-off values to identify the metabolic syndrome in children

The aim of the study was to establish the best cut-off value for the homeostatic model assessment (HOMA) index in identifying children and adolescents with the metabolic syndrome. The study included 72 non-obese and 68 obese children aged 7 to 16 years. Obesity is defined using the criteria proposed by Cole et al., being included as metabolic syndrome variables waist circumference, systolic blood pressure, diastolic blood pressure and seric values of glucose, uric acid, fasting insulin, leptin, triglycerides and HDL-cholesterol. Children were considered as having the metabolic syndrome when four or more characteristics showed abnormal values. The HOMA index was calculated as the product of the fasting plasma insulin level (microU/mL) and the fasting plasma glucose level (mmol/L), divided by 22.5. HOMA index cut-offs from the 5th to the 95th percentile were used. A receiver operating characteristic (ROC) curve was generated using the different HOMA cut-offs for the screening of the metabolic syndrome. The areas under the ROC curve, 95% confidence intervals, and the point to the ROC curve closest to 1, were calculated. The area under the ROC curve was 0.863 (95% C.I.: 0.797, 0.930). The point closest to 1 corresponds to the 60th percentile of the HOMA index distribution in our sample. HOMA index value at the 60th percentile was 2.28. Cut-off values corresponding to a range of HOMA index from the 50 to the 75 percentile, showed similar distances to 1. HOMA index values for percentiles 50 to 75 ranged from 2.07 to 2.83. In conclusion, HOMA index could be a useful tool to detect children and adolescents with the metabolic syndrome. HOMA cut-off values need to be defined in the paediatric population; however, values near to 3 seem to be adequate.     

Frequency of non-alcoholic fatty liver disease in overweight/obese children and adults: Clinical,sonographic picture and biochemical assessment

Non-alcoholic fatty liver disease (NAFLD) is a condition defined by significant lipid accumulation (5–10%) in hepatic tissue in the absence of significant chronic alcohol consumption. We aim to detect frequency of fatty liver among overweight/obese adults and children and associated clinical; anthropological measures; biochemical; genetic and imaging studies. Eighty three consecutive adults and 72 children included in the study. All patients underwent clinical measurements of height, body weight, body mass index (BMI), waist and hip circumference. Biochemical investigations were done to all subjects including liver function tests; lipid profile; fasting blood glucose; insulin resistance (IR); high sensitivity C reactive protein (hs-CRP); adiponectin and genotyping of adiponectin genes. Abdominal ultrasonography was done to search for fatty liver; to measure subcutaneous fat thickness (SFT) and visceral fat thickness (VFT). Fatty liver was detected in 47 (65.3%) children and in 52 (62.7%) adults. Correlation analysis in both groups revealed that enlarged liver was highly positively correlated to age; BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP); waist circumference; hip circumference, subcutaneous fat thickness (SFT) and Visceral fat thickness (VFT), alanine aminotransferase (ALT), aspartate aminotransferase/alanine aminotransferase (AST/ALT). In addition in adults to fasting blood glucose, cholesterol, triglycerides (TG), low density lipoprotein (LDL), IR and hs-CRP. Homozygous T adiponectin genotype at position +276 was significantly increased among children with enlarged liver size and hs-CRP. NAFLD affects a substantial portion of adults and children; it is associated with the metabolic syndrome.     

Selected anthropometric variables and aerobic fitness as predictors of cardiovascular disease risk in children

The aim of this study was to assess the suitability of body mass index, waist circumference, waist-to-height ratio and aerobic fitness as predictors of cardiovascular risk factor clustering in children. A cross-sectional study was conducted with 290 school boys and girls from 6 to 10 years old, randomly selected. Blood was collected after a 12-hour fasting period. Blood pressure, waist circumference (WC), height and weight were evaluated according to international standards. Aerobic fitness (AF) was assessed by the 20-metre shuttle-run test. Clustering was considered when three of these factors were present: high systolic or diastolic blood pressure, high low-density lipoprotein (LDL) cholesterol, high triglycerides, high plasma glucose, high insulin concentrations and low high-density lipoprotein (HDL) cholesterol. A ROC curve identified the cut-off points of body mass index (BMI), WC, waist-to-height ratio (WHtR) and AF as predictors of risk factor clustering. BMI, WC and WHR resulted in significant areas under the ROC curves, which was not observed for AF. The anthropometric variables were good predictors of cardiovascular risk factor clustering in both sexes, whereas aerobic fitness should not be used to identify cardiovascular risk factor clustering in these children.     

Effect of Family History of Type 2 Diabetes on White Blood Cell Count in Adult Women

Objective: To evaluate the effect of a first‐degree family history of type 2 diabetes on white blood cell (WBC) count, a risk factor for atherosclerotic vascular disease, in glucose‐tolerant adult women Research Methods and Procedures: WBC count was measured in 174 normal weight, overweight, and obese female offspring of type 2 diabetic patients (FH⁺) and 174 age‐ and BMI‐matched female controls with no family history of type 2 diabetes (FH^?). Other measurements included fat mass (FM), measured by body impedance analysis; central fat accumulation, evaluated by waist circumference; insulin resistance, estimated by homeostatic model assessment for insulin resistance (HOMA_IR); systolic and diastolic blood pressure; and fasting concentrations of glucose, insulin, and lipids. Results: WBC count, waist circumference, systolic blood pressure, and fasting levels of glucose, insulin, and triglycerides were significantly higher in FH⁺ than in FH^? subjects. In FH⁺ individuals, WBC count was positively associated with BMI, FM, waist circumference, HOMA_IR, and triglyceride and insulin concentrations, and negatively correlated with age and high‐density lipoprotein‐cholesterol. In FH^? subjects, WBC count was directly associated with BMI, FM, waist circumference, and triglyceride and insulin concentrations, and inversely correlated with age and high‐density lipoprotein‐cholesterol. After multivariate analyses, WBC count maintained a significant association with age, systolic blood pressure, and HOMA_IR in FH⁺ subjects and with age, BMI, FM, and triglycerides in FH^? individuals. Discussion: This study indicates that WBC count is increased in adult women with genetic predisposition to type 2 diabetes, and its main correlates are insulin resistance in FH⁺ and adiposity in FH^? individuals.     

Body adiposity index and other indexes of body composition in the SAPHIR study: Association with cardiovascular risk factors

Objective:

The accuracy of anthropometric surrogate markers such as the body adiposity index (BAI) and other common indexes like the body mass index (BMI), waist‐to‐hip ratio (WHR) and waist‐to‐height ratio (WHtR) to predict metabolic sequelae is essential for its use in clinical practice.

Design and Methods:

Thus, we evaluated the strength of BAI and other indexes to relate with anthropometric parameters, adipocytokines, blood lipids, parameters of glucose‐homeostasis and blood pressure in 1,770 patients from the Salzburg Atherosclerosis Prevention Program in Subjects at High Individual Risk (SAPHIR) study in a crosssectional design. Measurements were BAI, BMI, WHR, WHtR, abdominal subcutaneous and visceral adipose tissue (aSAT and VAT), total body adipose tissue mass, body weight, waist‐ and hip circumference (WC and HC), leptin, adiponectin, high‐density lipoprotein‐cholesterol (HDL‐C), low‐density lipoprotein‐cholesterol (LDL‐C), triglycerides (TG), fasting plasma glucose, fasting plasma insulin, the homeostasis model assessment of insulin resistance (HOMAIR), systolic and diastolic blood pressure.

Results and Conclusions:

BAI was significantly associated with leptin and HC. We conclude that BAI was the best calculator for leptin. BAI was inferior to BMI to predict anthropometric parameters other than HC, adiponectin, blood lipids, parameters of glucose homeostasis, and blood pressure in this cross‐sectional study.     

Fetal and infant growth and cardiovascular risk factors in women.

OBJECTIVE--To examine whether cardiovascular risk factors in women are related to fetal and infant growth. DESIGN--Follow up study of women born 1923-30 whose birth weights and weights at one year were recorded. SETTING--Hertfordshire. SUBJECTS--297 women born and still living in East Hertfordshire. MAIN OUTCOME MEASURES--Plasma glucose and insulin concentrations during a standard oral glucose tolerance test; fasting plasma proinsulin and 32-33 split proinsulin concentrations; blood pressure; fasting serum total, low density lipoprotein and high density lipoprotein cholesterol, triglyceride, and apolipoprotein A I and B concentrations; and plasma fibrinogen and factor VII concentrations. RESULTS--Fasting plasma concentrations of glucose, insulin, and 32-33 split proinsulin fell with increasing birth weight (P = 0.04, P = 0.002, and P = 0.0002 respectively, when current body mass index was allowed for). Glucose and insulin concentrations 120 minutes after an oral glucose load showed similar trends (P = 0.03 and P = 0.02). Systolic blood pressure, waist:hip ratio, and serum triglyceride concentrations also fell with increasing birth weight (P = 0.08, P = 0.07, and P = 0.07 respectively), while serum high density lipoprotein cholesterol concentrations rose (P = 0.04). At each birth weight women who currently had a higher body mass index had higher levels of risk factors. CONCLUSION--In women, as in men, reduced fetal growth leads to insulin resistance and the associated disorders: raised blood pressure and high serum triglyceride and low serum high density lipoprotein cholesterol concentrations. The highest values of these coronary risk factors occur in people who were small at birth and became obese. In contrast with men, low rates of infant growth did not predict levels of risk factors in women.     

多囊卵巢综合征患者体重指数、内分泌、代谢指标的相关性分析

目的:探讨多囊卵巢综合征患者的体重指数、内分泌及代谢指标的相互关系。方法:选取2016年10月至2017年7月的收治多囊卵巢综合征患者53例作为研究对象,分别根据BMI、HOMA-IR和睾酮水平进行分组,检测和比较体重指数(BMI)、血生化、胰岛素、C肽及性激素等内分泌和代谢指标。结果:根据BMI水平进行分组,空腹胰岛素、60分钟胰岛素、120分钟胰岛素、空腹C肽、60分钟C肽、120分钟C肽、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白差异有统计学意义(P0.05);根据HOMA-IR指数进行分组,空腹血糖、60分钟血糖、120分钟血糖、空腹胰岛素、60分钟胰岛素、120分钟胰岛素、空腹C肽、60分钟C肽、120分钟C肽、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、黄体生成素、黄体生成素/卵泡刺激素、睾酮和雌二醇差异有统计学意义(P0.05);根据睾酮水平进行分组,BMI、空腹胰岛素、60分钟胰岛素、120分钟胰岛素、HOMA指数、黄体生成素、黄体生成素/卵泡刺激素、睾酮、雌二醇差异有统计学意义(P0.05)。结论:多囊卵巢综合征表现复杂多变,应根据不同的体质指数、内分泌和代谢特点进行对症对因治疗,以提高患者治愈水平和生存质量。     

Analysis of Obesity and Hyperinsulinemia in the Development of Metabolic Syndrome: San Antonio Heart Study

Objective: To use standardized cut‐offs of body mass index (BMI), waist circumference, waist‐to‐hip ratio, and fasting insulin levels to predict the development of metabolic disorders and metabolic syndrome. Research Methods and Procedures: We performed an 8‐year follow‐up study of 628 non‐Hispanic whites and 1340 Mexican Americans, ages 25 to 64 years, from the second cohort of the San Antonio Heart Study. We defined metabolic disorders as dyslipidemia (triglycerides ≥2.26 mM or high‐density lipoprotein <0.91 mM in men and <1.17 mM in women), hypertension (blood pressure ≥140/≥90 mm Hg, or receiving antihypertensive medications), and type 2 diabetes (fasting glucose ≥7.0 mM, 2‐hour test glucose ≥11.1 mM, or receiving anti‐diabetic medications). People with at least two metabolic disorders were defined as having metabolic syndrome. Results: High waist‐to‐hip ratio and fasting insulin levels were significant predictors of developing metabolic syndrome. High anthropometric indices remained significant predictors of metabolic syndrome after adjusting for fasting insulin. Waist circumference, BMI, and insulin had similar areas under the receiver operating characteristic curves (0.74 to 0.76). Further multivariate analyses combining these indices showed minimal increase in prediction. Of subjects who had a combination of high BMI (≥30 kg/m²) and high waist circumference (above “Action Level 2”), 32% developed metabolic syndrome, compared with 10% of subjects with both low BMI and low waist circumference. Discussion: These findings support the National Institutes of Health recommendations for reducing the risk of metabolic syndrome. Adjustment for baseline fasting insulin levels had only a small effect on the ability of anthropometric indices to predict the metabolic syndrome.     

低能量平衡膳食联合有氧运动对单纯性肥胖儿童体脂代谢、胰岛素抵抗及氧化应激反应的影响

摘要 目的：观察单纯性肥胖儿童经有氧运动、低能量平衡膳食联合干预后,机体体脂代谢、胰岛素抵抗及氧化应激反应的变化。方法：选择2019年8月~2021年7月期间新疆医科大学第一附属医院接收的单纯性肥胖儿童93例,将纳入的患儿根据随机数字表法分为对照组和研究组,各为46例和47例。对照组患儿接受低能量平衡膳食干预,研究组患儿接受低能量平衡膳食联合有氧运动干预。对比两组体脂代谢、胰岛素抵抗、血脂及氧化应激反应相关指标变化情况。结果：研究组干预12周后体质量指数（BMI）、甘油三酯（TG）、体脂含量、总胆固醇（TC）、体脂率、腰臀比、空腹胰岛素（FINS）、低密度脂蛋白（LDL-C）、空腹血糖（FPG）、蛋白质羰基（PC）、C肽、胰岛素抵抗指数（HONA-IR）、丙二醛（MDA）低于对照组（P<0.05）。研究组干预12周后高密度脂蛋白（HDL-C）、超氧化物歧化酶（SOD）高于对照组（P<0.05）。结论：低能量平衡膳食联合有氧运动可促进单纯性肥胖儿童体脂代谢改善,减轻胰岛素抵抗及氧化应激反应,效果确切。     

Serum leptin concentration,obesity, and insulin resistance in Western Samoans: cross sectional study.

OBJECTIVE: To measure serum leptin concentrations in the Polynesian population of Western Samoa and to examine epidemiological associations of leptin with anthropometric, demographic, behavioural, and metabolic factors in this population with a high prevalence of obesity and non-insulin dependent diabetes mellitus. DESIGN: Cross sectional study, leptin concentration being measured in a subgroup of a population based sample. SUBJECTS: 240 Polynesian men and women aged 28-74 years were selected to cover the full range of age, body mass index, and glucose tolerance. MAIN OUTCOME MEASUREMENTS: Serum leptin, insulin, and glucose concentrations; anthropometric measures; physical activity; and area of residence. RESULTS: Leptin concentrations were correlated with body mass index (r = 0.80 in men, 0.79 in women) and waist circumference (r = 0.82 in men, 0.78 in women) but less so with waist to hip ratio. At any body mass index, leptin concentration was higher in women than men (geometric mean adjusted for body mass index 15.3 v 3.6 pg/l, P < 0.001). Leptin concentration also correlated with fasting insulin concentration (r = 0.63 in men, 0.64 in women) and insulin concentration 2 hours after a glucose load (r = 0.58 in men, 0.52 in women). These associations remained significant after controlling for body mass index; effects of physical activity and of rural or urban living on leptin concentration were eliminated after adjusting for obesity, except values remained high in urban men. 78% of variance in leptin was explained by a model including fasting insulin concentration, sex, body mass index, and a body mass index by sex interaction term. Similar results were obtained if waist circumference replaced body mass index. CONCLUSIONS: The strong relation of leptin with obesity is consistent with leptin production being proportional of mass to adipose tissue. The relation with insulin independent of body mass index suggests a possible role for leptin in insulin resistance or hyperinsulinaemia.