抗精神病药物奥氮平引起肥胖的遗传学研究

奥氮平是非典型抗精神病药物中的一种,适用于精神分裂症或继发性情感障碍等,该药常见的不良反应即为引起肥胖问题,本研究探讨奥氮平引起肥胖的遗传学机理。方法:选取首发精神分裂症患者共98例,服用奥氮平12周,比较服药前后BMI值,并抽血检测组胺受体glu349asp多态性。结果:服用奥氮平会使患者BMI值升高,但是组胺受体多态性检测显示受试者均为glu349asp TT型,无统计学意义。结论:奥氮平会增加精神分裂症患者的体重,组胺受体1可能会影响到患者的体脂代谢。     

首发未服药精神分裂症患者中线粒体DNA拷贝数及其与血脂指标的相关性分析

精神分裂症是一种重度的精神疾病,伴发严重的能量代谢失衡。其中,脂代谢的异常近年来受到越来越多的关注。多项研究表明,线粒体在精神分裂症患者代谢异常的过程中发挥重要的作用。线粒体DNA拷贝数是线粒体含量及完整性的重要指标,直接参与线粒体的多项重要功能。本研究旨在通过考察首发精神分裂症患者线粒体DNA拷贝数的变化特征及其与相关代谢指标之间的相关性,为阐明精神分裂症代谢异常的机制提供支持。本研究共计纳入82例首发且未服用抗精神病药物的精神分裂症患者和77例健康对照,采用荧光定量PCR技术进行线粒体DNA拷贝数的检测,并进行了临床信息和血脂指标的采集。结果表明,精神分裂症患者组的线粒体DNA拷贝数显著低于健康对照组（P=0.000572,FC=-1.22）。血脂指标中,患者组的HDL-c显著低于健康对照组（P=0.001, FC=-1.12）,LDL-c（P=0.009, FC=1.09）、CHOL/HDL-c（P=0.000019, FC=1.17）、TG/HDL-c（P=0.000656, FC=1.31）和LDL-c/HDL-c（P=0.000004, FC=1.30）均显著高于健康对照组。相关性分析表示,在健康对照组中,mtDNA拷贝数与TG显著负相关（r=-0.232, P=0.0499）,与TG/HDL-c（r=-0.235, P=0.052）呈负相关,但不显著;在精神分裂症患者组,mtDNA拷贝数与各血脂指标的关系都不显著。本研究为精神分裂症患者的线粒体功能障碍、脂代谢异常提供了证据,提示了线粒体在精神分裂症患者并发心血管代谢疾病高风险中可能的重要作用。     

首发未服药精神分裂症患者线粒体DNA拷贝数及其与血脂指标的相关性

精神分裂症是一种重度的精神疾病,伴发严重的能量代谢失衡。其中,脂代谢的异常近年来受到越来越多的关注。多项研究表明,线粒体在精神分裂症患者代谢异常的过程中发挥重要的作用。线粒体DNA拷贝数是线粒体含量及完整性的重要指标,直接参与线粒体的多项重要功能。本研究旨在通过考察首发精神分裂症患者线粒体DNA拷贝数的变化特征及其与相关代谢指标之间的相关性,为阐明精神分裂症代谢异常的机制提供支持。本研究共计纳入82例首发且未服用抗精神病药物的精神分裂症患者和77例健康对照,采用荧光定量PCR技术进行线粒体DNA拷贝数的检测,并进行了临床信息和血脂指标的采集。结果表明,精神分裂症患者组的线粒体DNA拷贝数显著低于健康对照组(P=0.000572,FC=-1.22)。血脂指标中,患者组的HDL-c显著低于健康对照组(P=0.001,FC=-1.12),LDL-c(P=0.009,FC=1.09)、CHOL/HDL-c(P=0.000019,FC=1.17)、TG/HDL-c(P=0.000656,FC=1.31)和LDL-c/HDL-c(P=0.000004,FC=1.30)均显著高于健康对照组。相关性分析表示,在健康对照组中,mtDNA拷贝数与TG显著负相关(r=-0.232,P=0.0499),与TG/HDL-c(r=-0.235,P=0.052)呈负相关,但不显著;在精神分裂症患者组,mtDNA拷贝数与各血脂指标的关系都不显著。本研究为精神分裂症患者的线粒体功能障碍、脂代谢异常提供了证据,提示了线粒体在精神分裂症患者并发心血管代谢疾病高风险中可能的重要作用。     

首发未用药精神分裂症患者糖代谢异常的情况及相关影响因素分析

目的:分析首发未用药精神分裂症患者伴发糖代谢异常的情况及相关影响因素。方法:选择80例首发未用药的精神分裂症患者作为病例组及同期进行体检的80例健康人作为对照组,根据口服OGTT试验将病例组分为糖代谢正常者和糖代谢异常者,收集病例组及对照组一般资料、及血糖相关指标进行分析。结果:病例组糖代谢异常发生率为38.75%,明显高于对照组(26.25%)(P0.05);病例组糖化血红蛋白、胰岛素抵抗指数(IR)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、皮质醇水平均明显高于对照(P0.05),而TSH水平明显低于对照组(P0.05);病例组中,糖代谢异常者皮质醇、FT3、FT4、IR、BMI、腰臀比明显高于糖代谢正常者(P0.05),TSH水平明显低于糖代谢正常者(P0.05);病例组中,糖代谢异常者餐后血糖7.8的比例随用药时间延长明显增高(P0.05)。结论:首发未经治疗的精神分裂症患者中糖代谢异常的构成比较健康人明显增高,属于2型糖尿病的高危人群。无抗精神病药物影响的前提下,肥胖、IR、皮质醇增高、FT4增高、TSH降低可能为精神分裂症患者发生糖代谢异常的危险因素。首发未经治疗的精神分裂症患者应用抗精神病药物治疗后餐后血糖会明显升高。     

益生菌干预对肥胖孕鼠子代菌群及脂代谢的影响

目的分析高脂高糖饮食诱导肥胖母亲对子代菌群及脂代谢影响。方法C57BL/6J雌性小鼠30只随机分为正常对照组、肥胖组、益生菌干预组,每组10只。分别给予标准饲料、高脂高糖饲料以及高脂高糖饲料同时给予益生菌,连续喂养6周,制成肥胖母鼠模型。6周后雌、雄鼠合笼,受孕,孕期继续上述饮食。产后母乳喂养,3周后处死。留取雌性子鼠第21天粪便样本进行PCR-DGGE分析,同时酶反应比色法分析子鼠血脂情况。结果与正常对照组子代相比,肥胖母鼠子代菌群结构出现异常,益生菌干预组子代肠道菌群失调状况明显改善;肥胖母鼠子代血清总胆固醇、低密度脂蛋白含量升高,益生菌干预组子代血脂异常情况明显改善。结论高脂高糖饮食诱导肥胖母亲子代存在肠道菌群紊乱及脂代谢异常,益生菌干预母亲有利于改善子代菌群紊乱及脂代谢异常。     

溴隐亭不同给药方案治疗高泌乳素血症女性性腺激素促排卵临床研究

目的:研究溴隐亭不同给药方案在治疗高泌乳素血症(HPRL)女性不育症中的临床疗效,关注其对女性促性腺激素诱导排卵的影响。方法:本研究共纳入60例就诊于我院的确诊为高泌乳素血症不孕不育患者,随机分为两组。分为研究组与对照组:研究组采取先口服溴隐亭调整血清泌乳素水平至正常后予以促性腺激素诱导排卵;对照组采取促性腺激素与溴隐亭同步治疗方案。结果:观察两组患者的促排卵周期数、平均用药天数、雌二醇水平及妊娠率,两组治疗前后的血清泌乳素都显著改善(P0.05);但是两组之间相比,采取溴隐亭药物治疗后诱导排卵的研究组在促排卵、雌二醇水平和妊娠率方面具有显著优势(P0.05)。结论:采用溴隐亭治疗高泌乳素血症患者,调整至正常后再使用促卵泡激素药物促排卵治疗不孕不育具为较优的治疗方案。     

姜黄素治疗代谢综合征的研究进展

姜黄素是从姜黄中提取的一种多酚类物质,近年来对姜黄素的研究日趋广泛,已明确具有抗肿瘤,抗炎,抗氧化、降糖、降脂等多种药理作用,在临床上广泛应用于治疗肿瘤、肥胖、糖尿病等多种疾病.代谢综合征是一组以代谢紊乱为特征的症候群,包括中心性肥胖、糖脂代谢异常、高血压、非酒精性脂肪肝等,这些病理状态长期发展,可进一步导致心、脑血管患病率明显升高,研究发现姜黄素能够改善代谢综合征.现就近年来有关姜黄素治疗代谢综合征的研究进展综述如下.     

运动改善肥胖症瘦素抵抗及其机制研究进展

大部分肥胖患者体内出现瘦素抵抗,表现为血清瘦素水平异常升高,但机体对瘦素不敏感或无反应,使瘦素抑制食欲、增加能量消耗和降低血糖等功能不能有效发挥.减轻瘦素抵抗被认为是治疗肥胖及肥胖相关疾病的有效途径.运动减轻肥胖、改善糖脂代谢和增强胰岛素敏感性的作用与运动降低瘦素水平、改善瘦素抵抗密切相关.本文在概述瘦素实现生理功能的机制、肥胖症的中枢及外周瘦素抵抗的基础上,主要综述近年来运动减轻肥胖症瘦素抵抗机制的研究进展,包括减轻高瘦素血症、改善中枢和外周瘦素抵抗,以期为运动防治肥胖机制的研究提供新视角.     

运动调控FGF21在改善肥胖相关代谢性疾病中的作用

肥胖是糖尿病、脂肪肝、心血管疾病等慢性代谢性疾病发生发展的重要风险因素。运动可以改善肥胖,对相关代谢性疾病的预防与康复具有积极作用。成纤维细胞生长因子21 (fibroblast growth factor 21,FGF21)是一种对机体能量稳态、糖脂代谢有积极调控作用的内分泌因子,是代谢性疾病预防和治疗的有效靶点之一。FGF21抵抗是机体对FGF21反应性减弱的现象,表现为靶组织生物学效应降低,机体FGF21代偿性合成增加。这可能是由FGF21受体(fibroblast growth factor receptors,FGFRs)和β-klotho蛋白(β-klotho,KLB)表达减少或敏感性降低所致。肥胖患者常出现FGF21抵抗,改善FGF21抵抗是治疗肥胖及相关代谢性疾病的新思路。运动不仅可以增加部分组织FGF21表达量,还可以刺激FGFRs与KLB的表达来敏化FGF21的作用,改善FGF21抵抗。     

FOXO1在糖代谢和脂代谢及高甘油三酯血症中的作用

高甘油三酯血症与肥胖和2型糖尿病紧密相关。肥胖和2型糖尿病常伴随胰岛素抵抗,说明胰岛素抵抗可能是影响高甘油三酯血症的重要因素。胰岛素能够抑制叉头盒O1(Forkhead box protein O1,FOXO1)表达;而胰岛素抵抗状态下,FOXO1活性增加,且引起高甘油三酯血症。因此,本文将综述FOXO1在糖代谢和脂代谢及高甘油三酯血症中的作用,为治疗肥胖症和2型糖尿病患者的高甘油三酯血症提供新思路。     

Effects of hyperprolactinemia on prolactin and LH pulsatile pattern in female rats.

Prolactin (PRL) and luteinizing hormone (LH) secretions are very closely-related. To further understand these mechanisms, the pulsatile secretion pattern of both hormones in experimentally-induced hyperprolactinemia has been studied in adult female rats. Hyperprolactinemia was induced by the transplanting of two pituitary glands. Nine days after the transplant operation, rats were bled (75 or 100 microliters/7 min for 3 h). Serum samples were analyzed for prolactin and LH values by RIA. Hyperprolactinemia modifies pulsatile PRL secretion by increasing the absolute amplitude and duration of the peaks together with a decrease in their frequency. Also, the mean values of the hormone during the whole studied period were increased. Hyperprolactinemia was followed by an increase in the mean values of LH and in the absolute amplitude of the peaks. All these results suggest that hyperprolactinemia induced by pituitary grafting in adult female rats, is followed by a significant change in prolactin and LH pulsatility, which may explain, to some extent, the effects of hyperprolactinemia on reproduction.     

Prolactin response to sulpiride in non insulin dependent diabetes mellitus

Blood glucose, insulin and prolactin concentrations were determined before and after sulpiride injection (50 mg i.m.) in 20 non-insulin-dependent diabetic patients (10 with retinopathy and 10 without evidence of retinal damage) and 10 subjects with normal glucose tolerance. Prolactin response to sulpiride was significantly higher in diabetics than in controls (at 20 min., p less than 0.01; at 30 and 60 min., p less than 0.005; at 90 min., p less than 0.01; at 120 min., p less than 0.05). The sulpiride induced hyperprolactinemia did not influence blood glucose and plasma insulin levels in controls as well as in diabetic patients. Prolactin response to sulpiride was the same in diabetics with and in those without retinal changes. We conclude that acute hyperprolactinemia seems to have no influence on glucose homeostasis in normal and non insulin-dependent diabetic subjects.     

Hypogonadism Due to Hyperprolactinemia and Subsequent First Episode of Psychosis

BackgroundHyperprolactinemia causes hypogonadotrophic hypogonadism. Hyperprolactinemia can be pre-existing in some patients with schizophrenia. Dopamine is the most important prolactin-inhibiting factor, and dopaminergic hyperactivity has been implicated in the pathophysiology of psychosis.ObjectiveSince dopamine is a prolactin-inhibiting factor and dopamine imbalanced has been implicated in the pathophysiology of psychotic disorders, we investigated the probable relationship between hyperprolactinemia and the development of psychotic symptoms, in a patient with hypogonadism due to hyperprolactnemia and subsequent first episode of psychosis. Since dopamine is a prolactin-inhibiting factor and dopamine imbalance has been implicated in the pathophysiology of psychotic disorders, we investigated the probable relationship between hyperprolactinemia and the development of psychotic symptoms.MethodsWe present the case of a patient with hypogonadism secondary to chronic, untreated hyperprolactinemia who developed acute psychotic symptoms.ResultsPsychotic symptoms resolved soon after treatment with aripiprazole in conjunction with cabergoline, with a concomitant decrease in serum prolactin level.ConclusionThis is an interesting case illustrating a complicated relationship among hypogonadism secondary to a prolactinoma and dopamine and psychosis.     

The effects of prolactin on rat ovarian function

Hyperprolactinemia has been associated with several reproductive disorders. To investigate whether hyperprolactinemia directly affects rat ovarian function, we examined the ovarian histopathology and the activities of the four ovarian enzymes 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD), 17-hydroxylase (17-OH), 17,20-desmolase (17,20-D) and aromatase in hyperprolactinemic rats and controls. Hypophysectomized, gonadotropin-treated Fisher rats were made hyperprolactinemic by isografting pituitary glands under the kidney capsule. The control animals received skeletal muscle. The ovaries were resected, pooled according to prolactin levels and microsomal enzyme activities were measured from each pool. Prolactin (PRL) levels were 344 +/- 23 ng/ml in the hyperprolactinemic rats and 18 +/- 5 ng/ml in the controls (p less than 0.001). Estradiol concentrations were 609 +/- 47 pg/ml in the hyperprolactinemic animals and 56 +/- 13 pg/ml in the controls (p less than 0.001). Ovarian and uterine weights were significantly higher in the hyperprolactinemic rats (p less than 0.02). Ovarian histopathology demonstrated benign polycystic transformation in the hyperprolactinemic animals. Hyperprolactinemia had no effect on 3 beta-HSD, but was associated with significant decreases in the 17-OH, 17,20-D and aromatase activities when compared to controls (p less than 0.001). We conclude that prolactin has a direct effect on rat ovarian function which appears to be independent of changes in gonadotropin secretion.     

Role of prolactin on epididymal glycoprotein metabolism in matured monkeys, Macaca radiata: specific activities of glycosyltransferases and glycosidases.

Impact of altered serum prolactin status on enzymes involved in glycoprotein metabolism in epididymal tissue of matured monkeys was studied. Hyperprolactinemia (ovine prolactin-250 micrograms/kg body weight/day for 30 days) significantly inhibited the specific activities of dolichylphosphate mannosyl transferase, dolichylphosphate glucosyl transferase and galactosyl transferase, in the epididymal tissues. However, it had an enhanced effect on epididymal glycosidases such as beta-galactosidase, beta-N-acetyl glucosaminidase, beta-N-acetyl galactosaminidase, alpha-mannosidase and alpha-L-fucosidase. Hypoprolactinemia (bromocriptine mesylate-1-mg/kg body weight/day for 30 days) on other hand had no significant effect on the specific activities of both, glycosyltransferases and glycosidases, in the epididymal tissues. The results suggest that hyperprolactinemia inhibits epididymal glycoprotein metabolism by impairing the incorporation of oligosaccharide units into proteins with enhanced degradation. This may have adverse effect on events leading to sperm maturation in epididymal environment.     

Prolactin activation of the long form of its cognate receptor causes increased visceral fat and obesity in males as shown in transgenic mice expressing only this receptor subtype

To date the best defined function of prolactin (PRL) is its action on the ovary and mammary gland, although it has also been shown to have an effect on lipid metabolism. Using mice engineered to express only the long form of the prolactin receptor (PRL-RL), we demonstrate that PRL acting through PRL-RL alone causes severe adipose accumulation in visceral fat of males at 6 months of age. The increase in visceral fat accumulation is attributed to loss of adipose-derived leptin, which results in diminished lipolysis. The reduction in leptin also corresponds to decreased activation of AMP-activated protein kinase (AMPK), which further results in diminished fatty acid oxidation and increased fatty acid synthesis. Interestingly, the blunted AMPK response was only observed in adipose tissue and not in liver suggesting that this PRL mediated effect is tissue specific. A glucose tolerance study inferred that PRL-RL mice may suffer from insulin resistance or a reduction in insulin production that is not due to aberrant expression of glucose transporter 4 (Glut4). Collectively, our findings demonstrate that PRL signaling through the long form receptor causes reduced fatty acid oxidation, increased lipid storage, glucose intolerance, and obesity. These findings are of great importance towards understanding the etiology of obesity associated with hyperprolactinemia in humans as well as the role of PRL as a metabolic regulator in adipose tissue.     

Preclinical Atherosclerosis in Patients with Prolactinoma

ObjectiveThe aim of this study was to evaluate the effect of hyperprolactinemia on body fat, insulin sensitivity, inflammatory markers, and cardiovascular risk in patients with prolactinoma.MethodsThe study included 35 untreated hyperprolactinemic patients with pituitary adenomas, and 36 age-, gender-, and body mass index (BMI)-matched healthy controls without any known disease. Serum glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR, lipid profile, high-sensitivity C-reactive protein (hs-CRP), and heart-type fatty acid binding protein (H-FABP) levels were measured. Waist and hip circumference (WC and HC) were measured in all the participants. The body fat percentage was measured, and the visceral fat and abdominal fat percentages were measured via bioelectrical impedance (BIA). In addition, carotid intima media thickness (CIMT) was measured using high-resolution B-mode ultrasound.ResultsThe serum glucose level, HOMA-IR, triglyceride level, and SC were significantly higher in the patient group than in the control group. The hs-CRP level and CIMT were significantly higher in the hyperprolactinemic patients. Visceral and truncal fat percentages were significantly higher in the patients with prolactinoma. H-FABP levels were similar in the 2 groups, and there was a positive correlation between the prolactin (PRL) and H-FABP protein levels.ConclusionsBased on the present findings, hyperprolactinemia is associated with preclinical atherosclerosis and metabolic abnormalities. Patients with hyperprolactinemia might experience cardiovascular disease in the long term. Metabolic control should be achieved in addition to the control of hyperprolactinemia in the clinical management of patients diagnosed with prolactinoma. (Endocr Pract. 2014;20:447-451)     

Effects of Hyperprolactinemia on Plasma Prolactin and Glucose and on Local Cerebral Glucose Utilization

Elevated blood levels of prolactin increase the synthesis, turnover, and release of 3,4-dihydroxyphenylethylamine (dopamine) from the tuberoinfundibular dopaminergic neurons, which project to the median eminence. The present study examined whether hyperprolactinemia also increases local cerebral glucose utilization, as determined by the 2-deoxy-D-[1-14C]glucose method, in the median eminence and other brain structures. Adult male rats were given ovine prolactin (4 mg/kg) subcutaneously every 8 h for 48 h. This treatment exerted an autoregulatory feedback effect on endogenous rat prolactin secretion, as evidenced by decreased circulating levels of rat prolactin. Ovine prolactin treatment also decreased plasma glucose concentrations. However, in both partially immobilized and free-ranging rats, glucose utilization in brain structures containing tuberoinfundibular dopaminergic cell bodies (the arcuate nucleus) and terminals (the median eminence) was not affected by ovine prolactin treatment. Hyperprolactinemia was, however, associated with decreased glucose utilization in the medial forebrain bundle and the CA subfield of the dorsal hippocampus. The lack of a significant effect of prolactin treatment on glucose utilization in the median eminence indicates that the resolution of the deoxyglucose technique, as used here, is not adequate to detect the ovine prolactin-induced increase in tuberoinfundibular dopaminergic neuronal activity, that the median eminence does not utilize glucose as its primary energy substrate, or that ovine prolactin treatment causes a counterbalancing decrease in the activity of other neurons projecting to the median eminence.     

Prolactin enhances production of interferon-gamma,interleukin-12, and interleukin-10, but not of tumor necrosis factor-alpha,in a stimulus-specific manner

Prolactin, an anterior pituitary hormone, has been shown to have a role in immunomodulation. Some reports have shown the importance of prolactin in activating lymphocytes and macrophages, while in hyperprolactinemia patients, prolactin was found to decrease lymphocyte activation and natural killer function. In the present work, at physiological (15ng/ml) and stress-induced levels (30ng/ml) of prolactin, interferon-gamma (IFN-gamma) and interleukin (IL)-12 p70 levels, but not of IL-10 and tumor necrosis factor-alpha (TNF-alpha), increased significantly (p<0.05-0.006) in phytohemeagglutinin (PHA)+lipopolysaccharide (LPS)-stimulated whole blood. However, no such effect was observed at high concentrations of prolactin (100-300ng/ml). In addition, 15ng/ml of prolactin reversed hydrocortisone suppressive effect on IFN-gamma, IL-12 p70, and IL-10 production in PHA+LPS-stimulated whole blood. On the other hand, in LPS-stimulated whole blood, prolactin enhanced significantly (p=0.027) the production levels of IL-10, but not of IFN-gamma, IL-12 p70, and TNF-alpha, in non-concentration-dependent manner. These results suggest that prolactin modulates cytokine response during antigenic response, and this modulation is stimulus specific.