炎症-内质网应激-肠道菌群在胰岛素抵抗发病中的作用

胰岛素抵抗(insulin resistance,IR)是肥胖导致的代谢综合征的典型表现,因其作用器官广泛和作用机制复杂成为糖尿病等代谢性疾病治疗中的一大难题。胰岛素抵抗涉及多个代谢器官、多种细胞因子和多条信号转导通路的交互作用,呈现出极其复杂的作用网络。目前认为,炎症、内质网应激和肠道菌群失调是引起胰岛素抵抗的最主要的三大机制。本文将综述胰岛素抵抗的三大病理机制,并探讨三者之间的关联性。     

DNA甲基化与胰岛素抵抗的研究进展

DNA甲基化属于表观遗传学之一,研究发现DNA甲基化可导致胰岛素抵抗(insulin resistance,IR),而IR是2型糖尿病发生的始动因素。因此对DNA甲基化的研究可加深对IR的认识,为防治2型糖尿病及其并发症提供重要的科学依据。     

脂肪组织细胞外基质与胰岛素抵抗北大核心CSCD

胰岛素抵抗(insulin resistance,IR)是指机体胰岛素促进葡萄糖摄取和利用的效率下降的病理性反应。肥胖引起的IR是2型糖尿病发生和发展的关键环节,其发病机制一直是糖尿病预防和治疗研究的焦点。大量证据表明:肥胖过程中,脂肪组织发生系列病理性改变,包括血管生成不足、缺氧、炎性反应和纤维化。其中,脂肪组织纤维化是脂肪组织细胞外基质重塑的表现,目前属于糖尿病及相关代谢异常基础研究的前沿。为促进相关研究的深入开展,增强临床和公共卫生领域工作人员对这一新兴课题的认识,本文围绕脂肪组织细胞外基质主要蛋白质成分以及基质蛋白修饰成分,就脂肪组织细胞外基质重塑、胰岛素抵抗以及2型糖尿病的发生发展的相关研究成果做出分析。     

胰岛素抵抗与糖尿病脑病

胰岛素抵抗(insulin resistance,IR)指胰岛素分泌量在正常水平时刺激靶细胞对葡萄糖的利用率减弱,或维持正常生理效应时需超常量的胰岛素,其主要机制是胰岛素信号通路敏感性下降。糖尿病脑病(diabetic encephalopathy,DE)是由糖尿病引起的认知功能障碍和大脑神经生理及结构的改变,目前认为胰岛素抵抗在糖尿病脑病的发生发展中起重要作用,本文从IR与DE的关系以及IR在DE中的主要作用机制作一综述.     

脂肪组织细胞外基质与胰岛素抵抗

胰岛素抵抗(insulin resistance,IR)是指机体胰岛素促进葡萄糖摄取和利用的效率下降的病理性反应。肥胖引起的IR是2型糖尿病发生和发展的关键环节,其发病机制一直是糖尿病预防和治疗研究的焦点。大量证据表明:肥胖过程中,脂肪组织发生系列病理性改变,包括血管生成不足、缺氧、炎性反应和纤维化。其中,脂肪组织纤维化是脂肪组织细胞外基质重塑的表现,目前属于糖尿病及相关代谢异常基础研究的前沿。为促进相关研究的深入开展,增强临床和公共卫生领域工作人员对这一新兴课题的认识,本文围绕脂肪组织细胞外基质主要蛋白质成分以及基质蛋白修饰成分,就脂肪组织细胞外基质重塑、胰岛素抵抗以及2型糖尿病的发生发展的相关研究成果做出分析。     

蛋白质组学在胰岛素抵抗研究中的应用

胰岛素抵抗（insulin resistance,IR）即指一定量的胰岛素与其特异性受体结合后所产生的生物效应低于正常。表现为外周组织尤其是肌肉、脂肪组织对葡萄糖摄取减少及胰岛素抑制肝葡萄糖输出的作用减弱．是肥胖、高血压、糖尿病及动脉粥样硬化等多种疾病的共同危险因素和基础。蛋白质组学技术的不断发展和完善,为真正了解胰岛素抵抗发生发展规律提供了可能,该文介绍蛋白质组学在胰岛素抵抗发生机制、标志物的寻找及治疗胰岛素抵抗新药开发中的应用．     

MG53在运动改善胰岛素抵抗中的作用

胰岛素抵抗(insulin resistance, IR)是多种代谢性疾病的共同病理基础,运动作为改善这一病理过程的重要辅助治疗手段,其干预方式、强度和持续时间等尚未明确。MG53(mitsugumin 53)是一种近年来备受关注的骨骼肌细胞膜修复蛋白,有研究表明其不仅是"效应分子",同时也是重要的信号分子——介导多条信号转导通路发挥广泛的生物学效应。本文通过综述MG53调控胰岛素抵抗发生发展的过程,以及MG53介导运动改善胰岛素抵抗的可能信号转导机制,为运动辅助治疗胰岛素抵抗提供新思路。     

PPARα,γ和δ:胰岛素抵抗治疗的靶点

胰岛素抵抗(insulin resistance,IR)是指外周组织对胰岛素的反应敏感性降低,是肝脏疾病和心血管病发生的共同基础,常常是高脂血症和2型糖尿病发病的前奏.过氧化物酶体增殖物激活受体(peroxisome proliferator-activated receptors,PPARs)属于核受体超家族的成员.PPARs激动剂可通过多种途径改善胰岛素敏感性,例如调节糖脂代谢、抗炎作用以及间接地改善氧化应激状态.这篇综述主要是回顾IR的病理机制及其治疗靶点:PPARα,δ和γ,并阐明针对此类靶点的胰岛素增敏药物的信号转导通路.     

mTORC1在慢性肾功能不全胰岛素抵抗中的作用

代谢综合征(MetS)在慢性肾功能不全(CKD)患者中普遍存在,与CKD预后密切相关。胰岛素抵抗(IR)作为MetS的基础,是非糖尿病CKD患者疾病进展的独立危险因素。而mTORC1信号通路可感受多种环境变化调节机体的生长代谢稳态,参与肿瘤、肥胖、2型糖尿病等多种疾病发生发展过程。mTORC1过度激活被认为是2型糖尿病IR的机制之一,但在CKD疾病状态下,mTORC1与IR的关系尚不十分清楚。本文就CKD疾病状下,mTORC1对胰岛素信号通路的影响,做一简要概述,为CKD患者IR的治疗提供参考。     

多囊卵巢综合征患者血清抗苗勒管激素与肥胖、胰岛素抵抗程度的相关性分析

目的:探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者血清抗苗勒管激素(anti-Müllerian hormone,AMH)水平与肥胖、胰岛素抵抗(insulin resistance,IR)程度的相关性。方法:选择在我院生殖中心就诊的139名PCOS患者为研究组,并以月经周期正常、因输卵管因素或男性因素导致不孕者48名作为对照组。检测和比较PCOS患者的血清AMH、性激素水平及代谢指标,分析血清AMH水平与PCOS患者肥胖、胰岛素抵抗程度的关系。结果:PCOS组患者体质量指数(body mass index,BMI)、黄体生成素(luteinizing hormone,LH)、睾酮(testosterone,T)、垂体泌乳素(pituitary prolactin PRL)、空腹血糖(fasting plasma glucose,FPG)、空腹胰岛素(fasting insulin,FINS)、稳态模型胰岛素抵抗指数(homenostasis models assessment-insulin resistance index,HOMA-IR)的水平均显著高于对照组(P0.05),PCOS组和对照组年龄、卵泡刺激素(follicle stimulating hormone,FSH)比较差异无统计学意义(P0.05)。PCOS各表型组的血清AMH浓度、LH/FSH比值均明显高于对照组(P0.05)。肥胖组患者的AMH浓度低于正常体重组,BMI、FPG、FINS、HOMA-IR、甘油三脂(triglycerides,TG)水平均高于正常体重组,LH、LH/FSH、高密度脂蛋白(high density lipoprotein,HDL-C)水平均低于正常体重组(P0.05)。高HOMA-IR组患者的血清AMH浓度、LH、LH/FSH水平均明显低于低HOMA-IR组,BMI、T、FPG、FINS、TG、低密度脂蛋白(low density lipoprotein,LDL-C)水平均高于低HOMA-IR组(P0.05)。PCOS患者血清AMH浓度和BMI及HOMA-IR均存在显著负相关。结论:PCOS患者血清的AMH水平较对照组明显升高,与其肥胖、胰岛素抵抗(IR)程度呈显著负相关。     

Clinical and biochemical characterization of women with polycystic ovary syndrome in North Rhine-Westphalia.

Polycystic ovary syndrome (PCOS), defined as the combination of oligoanovulation and hyperandrogenism, affects more than 5% of women of reproductive age. Insulin resistance and hyperinsulinemia appear to play an important role in its pathogenesis. Here, we will present a characterization of a PCOS cohort from North Rhine-Westphalia in Germany. Clinical features, family history as well as endocrine and metabolic parameters were prospectively recorded from 200 successive patients. All patients were evaluated for insulin resistance and beta-cell-function by oral glucose tolerance test. Patient data were compared with those of 98 age-matched control women. PCOS patients showed significantly higher BMI, body fat mass and androgen levels as well as impaired glucose and insulin metabolism. A positive family history of PCOS and diabetes was more frequent in PCOS patients. Insulin resistance (71%) was the most common metabolic abnormality in PCOS patients followed by obesity (52%) and dyslipidemia (46.3%), with an incidence of 31.5% for the metabolic syndrome. C-reactive protein and other cardiovascular risk factors were frequently elevated even in young PCOS patients. While the clinical characteristics and endocrine parameters of this German PCOS cohort were heterogeneous, they were comparable to those from other Caucasian populations.     

多囊卵巢综合征患者胰岛素受体基因外显子17的多态性研究

目的：探索胰岛素受体基因外显子17 的基因多态性与多囊卵巢综合症（PCOS）的关系,为多囊卵巢综合症的治疗寻找新的途径。方法：利用PCR-SSCP技术检测45 例多囊卵巢综合症患者（实验组）与40 例健康妇女（对照组）全血中胰岛素受体基因外显子17 位点1058 的基因多态性,同时测定PCOS 患者的一般指标及血清学指标。按照体重指数、胰岛素抵抗、有无高雄激素血症比较胰岛素受体基因外显子17位点1058 C、T等位基因出现的频率。结果：实验组患者T 等位基因出现的频率为71.2%,明显高于对照组的25%（P〉0.05）;实验组非肥胖组患者中T 等位基因出现的频率为69.2%,明显高于肥胖组患者的25%（P〈0.01）,亦高于对照组,差异具有统计学意义（P〈0.05）。根据胰岛素受体基因外显子17 出现T、C 基因的频率,将其分为1、2 两组,1 组出现T基因的频率的BMI（20.34± 2.47）明显低于2 组出现C 基因的频率的BMI（26.68± 5.52）;PCOS 患者胰岛素抵抗组与非胰岛素抵抗组中INSR 基因外显子17 出现T、C等位基因的频率无明显差别（P〉0.05）;PCOS 患者高雄激素组组与无高雄激素组中胰岛素受体基因外显子17 出现T、C等位基因的频率无明显差别（P〉0.05）。结论：胰岛素受体基因外显子17 中T/C 单核酸多态性表现与PCOS 患者的发病密切相关,T 等位基因的高发频率与非肥胖因型PCOS 患者的发病密切相关;瘦型PCOS 患者与肥胖型患者胰岛素抵抗的发病机制或许不同;T 等位基的高发频率与PCOS 的主要临床表现如：胰岛素抵抗、高雄激素血症并无明显相关关系。     

Association of insulin resistance with hyperandrogenia in women

In humans, the skin is a target tissue for androgen action; hair growth and sebum secretion are under active androgen control. An increased production or metabolism of testosterone, the main active androgen, shows up clinically in dermatological symptoms such as hirsutism, hyperseborrheic acne and alopecia. Polycystic ovary syndrome (PCOS) is the most frequent androgen disorder of ovarian function. PCOS patients have amenorrhea or severe oligomenorrhea, increased testosterone levels and most often enlarged polycystic ovaries on ultrasound examination. In addition, many PCOS patients have a tendency to accumulate abdominal fat and/or to develop obesity. Some also display a particular metabolic pattern including an atherogenic lipid profile, glucose intolerance and an increased fasting insulin level, which is known to be closely linked with an insulin resistant state. Several studies have now reported that PCOS patients show increased incidence of type 2 diabetes and cardiovascular disease. In addition to being a target for androgens the skin has abundant insulin receptors on the keratinocyte surface membrane and acanthosis nigricans is a common symptom of severe insulin resistance among patients with insulin receptor disorders. However, acanthosis nigricans could also be present in PCOS women given evidence of the intensity of their insulin resistance. This presentation will review the mutual relationship between hyperandrogenia and insulin resistance, with particular attention paid to: (1) insulin secretion and insulin sensitivity in PCOS; (2) the complexity of the molecular mechanisms involved in insulin resistance; (3) the paradoxical relationship between insulin resistance and hyperandrogenia; (4) the current genetic studies; and (5) new avenues for long-term treatment of PCOS women.     

二甲双胍对多囊卵巢综合征肥胖型患者LH和FSH的影响

目的：探讨二甲双胍对多囊卵巢综合征肥胖型患者血清中胰岛素、LH和FSH水平的影响。方法：将84例PCOS肥胖型患者随机分成44例对照组（克罗米芬）和40例观察组（二甲双胍）,采用放射免疫法测定黄体生成素（LH）和卵泡刺激素（FSH）的水平,分别于服药前（0分钟）和服后60、120分钟经前臂静脉采血,测血糖浓度及血清胰岛素水平。结果：对照组患者治疗前0min、60min及120min的血糖OGTT分别为（4．57±0．25）mmol／L、（8．38±7．05）mmol/L（7.21±0．12）mmol／L。治疗后0min、60min及120min的血糖OGTT无明显变化。观察组患者治疗前0min、60min及120min的血糖OGTT分别为（4．11±0．31）mmol／L、（8．23±6．57）mmol／L及（7．25±0．13）mmol／L,治疗后0min、60min及120min的血糖0GTT明显降低。对照组患者治疗前血清中胰岛素为（47．32±9．52）U／ml,治疗后为（42．25±7．65）U／ml,治疗前后无明显差异。观察组患者治疗前血清中胰岛素为（46．41±6．11）U／ml,治疗后血清胰岛素水平明显降低。对照组患者治疗后血清中LH为（17．22±2．14）mU／ml,FSH为（1．24±0．33）mU／ml,而与对照组相比,观察组患者血清中的LH明显降低,而FSH水平升高。结论：二甲双胍导致多囊卵巢综合征患者血清中胰岛素水平降低,从而减轻了胰岛素对LH的刺激作用,使LH水平下降,FSH升高,进而改善机体的激素紊乱,最终达到治疗PCOS的目的。     

非酒精性脂肪性肝病的药物治疗进展

非酒精性脂肪性肝病已日渐成为目前慢性肝病的主要病因,其与肥胖、2型糖尿病和代谢综合征等疾病密切相关,疾病谱主要包括非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎和肝硬化。早期诊断和及时治疗可望减轻NAFLD患者肝炎的严重程度并延缓肝纤维化的进展,减少并发症的出现。目前认为其发病与胰岛素抵抗、氧化应激及脂质过氧化和肠道菌群失调等因素有关。通过饮食调整和适当运动而减轻体重被认为是最基础的治疗措施,但单纯依靠减肥治疗脂肪性肝病(FLD)的效果并不理想,药物在脂肪性肝炎防治中的作用同样不可忽视。目前没有根治这一疾病的特效药物,单纯针对某一发病机制的药物亦难以治愈NAFLD这种复杂的疾病,本文主要从改善胰岛素抵抗、降脂、保肝抗炎及改善肠道菌群等四方面介绍一下本病的药物治疗进展。提倡改变生活方式的非药物治疗与药物干预治疗紧密结合,以取得最理想的治疗效果。     

Visfatin mRNA在PCOS患者网膜脂肪组织中的表达

目的：探讨visfatin基因在多囊卵巢综合征（PCOS）网膜脂肪组织中的表达及相关影响因素。方法：采用半定量RT-PCR方法检测PCOS组（30例）和对照组（25例）网膜脂肪组织visfatin mRNA表达,并测量体重指数、腰臀比、空腹血糖、空腹胰岛素、胰岛素抵抗指数和血清性激素水平。结果：①PCOS组网膜脂肪组织visfatin mRNA表达量高于对照组（P=0.000）。②网膜脂肪组织visfatin mRNA的表达量与BMI、WHR、FINS、HOMA-IR呈正相关（P〈0.05）。③多元逐步回归分析显示,HOMA-IR（P=0.000）和WHR（P=0.005）是影响网膜脂肪组织visfatin mRNA表达的相关因素。结论：网膜脂肪组织visfatin mRNA表达可能与PCOS胰岛素抵抗的发生和肥胖相关。     

铁与2型糖尿病发病的最新进展

糖尿病对人类健康的威胁日益加重,近年来大量的实验、临床及流行病学资料显示体内铁过载与糖尿病发生存在密切关联。作为机体必需的营养元素,铁在机体组织中的稳态平衡对维持正常的生理功能至关重要。同时铁还是一种极强的促氧化剂,机体铁含量升高往往导致氧化压力增强,进而加大罹患2型糖尿病的风险;膳食中血红素铁摄入量增加以及机体铁代谢紊乱都可能导致2型糖尿病及其并发症发生。此外,其他胰岛素抵抗疾病如代谢综合征、妊娠糖尿病以及多囊卵巢综合征都与铁过载呈显著关联,过量铁是诱发这些疾病的主要原因,并直接导致胰岛素抵抗。治疗中可通过铁螯合剂的使用来有效降低机体铁水平,并改善胰岛素抵抗。这些研究成果为2型糖尿病的干预治疗提供了新思路。对铁代谢与2型糖尿病及其并发症的最新研究做简要综述。     

APPL1 as an important regulator of insulin and adiponectin‐signaling pathways in the PCOS: A narrative review

Adaptor protein containing a PH domain, PTB domain and leucine zipper motif 1 (APPL1) plays a central role as the main contributing factor in the adiponectin and insulin signaling. This review aims to discuss previous and recent findings concerning the role of APPL1 in the polycystic ovary syndrome (PCOS) patients with conclusions regarding more efficient therapeutic approaches. A literature review was performed in PubMed, Web of Science, ScienceDirect, Scopus, and Google Scholar from August 1999 to May 2020. This study reveals that APPL1 has a key role in adiponectin, insulin, and follicle‐stimulating hormone signaling pathways occurring within the ovaries. Recent studies in mouse model systems have indicated that APPL1 can prevent diabetes, endothelial disorders, and insulin resistance. In contrast, APPL1 deficiency can lead to the metabolic and vascular disorders. APPL1 due to its potential roles in different signaling pathways might be suggested as a novel diagnostic and therapeutic option for prediction of ovarian dysfunctions and treatment of reproductive disorders, especially PCOS.     

Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials

Polycystic ovary syndrome (PCOS) affects 5%-10% of women in reproductive age, and it is the most common cause of infertility due to ovarian dysfunction and menstrual irregularity. Several studies have reported that insulin resistance is common in PCOS women, regardless of the body mass index. The importance of insulin resistance in PCOS is also suggested by the fact that insulin-sensitizing compounds have been proposed as putative treatments to solve the hyperinsulinemia-induced dysfunction of ovarian response to endogenous gonadotropins. Rescuing the ovarian response to endogenous gonadotropins reduces hyperandrogenemia and re-establishes menstrual cyclicity and ovulation, increasing the chance of a spontaneous pregnancy. Among the insulin-sensitizing compounds, there is myo-inosiol (MYO). Previous studies have demonstrated that MYO is capable of restoring spontaneous ovarian activity, and consequently fertility, in most patients with PCOS. With the present review, we aim to provide an overview on the clinical outcomes of the MYO use as a treatment to improve ovarian function and metabolic and hormonal parameters in women with PCOS.