Hyperinsulinemia,Insulin Resistance and Cognitive Decline in Older Cohort

Objective decline of resistance whether H Type 2 diabetes has been recently recognized as an important risk factor for cognitive patients with Alzheimer＇s disease （AD）. But the roles of hyperinsulinemia （HI） and insulin （IR） in the development of AD are still controversial. This study was designed to evaluate or IR influenced the cognitive functions of older cohort. Methods The cognitive functions of 328 consecutive elderly patients were evaluated with a battery of cognitive rating scales. Their fasting blood glucose （FBG） and fasting insulin （FINS） were analyzed and IR was calculated with modified-Homa. The cognitive scores in different groups and the correlation of cognitive functions with HI or IR were analyzed. Results In our study, there were 180 participants with HI and 148 without HI, and 192 with iR and 136 without IR. The participants with HI showed worse cognitive functions than those without HI in MMSE, MOCA, CDR, orientation, delayed memory, and attention/calculation domains. Similarly, the elderly with IR had lower cognitive scores than those without IR in MMSE, MOCA, CDR, GDS, orientation, delayed memory, and attention/calculation domains. The insulin levels and Homa IR had negative correlation with the scores of MMSE and delayed memory, not only in the model I adjusted for FBG and diabetes history, but also in the model 2 adjusted for all nine demographic characteristics. Conclusion HI and IR are important risk factors for cognitive decline of the elderly, especially for the dysfunctions in delayed memory domains.

Hyperinsulinemia,cancer and maqui berry:The promise of nutritional supplementation

Nutritional supplementation has long been studied as a possible treatment alternative or as an adjunct to the standard treatments for common ailments and diseases.According to the latest research,the Chilean maqui berry,Aristotelia chilensis,has been shown to reduce postprandial insulin levels by as much as fifty percent.The berry,which has been shown to be as effective as metformin at increasing insulin sensitivity and controlling blood glucose levels,follows a simple mechanism of action that involves the inhibition of sodium dependent glucose transporters in the small intestine,slowing the rate at which sugars enter the bloodstream and thereby decreasing blood sugar spikes and the corresponding increase in insulin levels.Chronically high blood glucose levels have been proven to play a significant role in the development of cancers,as diabetics and prediabetics have been proven to have elevated risk of developing cancerous growth.Consistent dietary supplementation with maqui berry may therefore indirectly reduce the risk of cancer,as well as other diseases which respond negatively to hyperglycemia and hyperinsulinemia.

Influence of Thioctic Acid on the Hyperinsulinemia and Ovarian Volume in Female Patients with Polycystic Ovary Syndrome

45 female patients with polycystic ovary syndrome took thioctic acid (Thioctacid-HR), 600 mg (n = 25) or high protein diet (n = 20). Fast insulin and glucose stimulus insulin were investigated before and after 3 months taken treatment. The use of thioctic acid, 600 mg is a new effective pathogenetics therapy of polycystic ovary syndrome on influence of hyperinsulinemia, HOMA-IR index and ovary volume in female patients with polycystic ovary syndrome.

Levels of TNF-α,IL-1β,TGF-β,and IL-6 in patients with chronic hepatitis C virus infection and hyperinsulinemia

Background: Previous evidences support to inflammatory process associated with the IR those important factors in the development of fibrosis and hepatic damage in patients with HCV infection. Objectives: Determine the presence of immunological or histological differentces between hyperinsulinemic and non-hyperinsulinemic chronic HCV-infected patients with at least 10 years of evolution. Material and Methods: The body mass index, Child-Puigh score, liver function tests, and biochemical profile were evaluated in 30 control, 40 chronic HCV-infected patients with hyperinsulinemia, and in 40 normoinsulinemic chronic HCV-infected patients with at least 10 years of evolution. In addition, HCV genotype and viral load were established with the Amplicor System. In addition, nitrites in plasma, and TNF-α, IL-1β, TGF-β, IL-6, and insulin levels were determined. Results: No differences were found in BMI, Child-Pugh “A” scores, ALT, viral load, or genotype between the hyperinsulinemic (>25 IU/ml) and normoinsulinemic ( Hyperinsulinemia patients had a higher HOMA- IR value (13.6) than normoinsulinemia patients (3.4), and none had a glycemia > 126 mg/dl. Cy- tokines concentration did not show differences with respect to controls. Nitrites showed a slight increase only in patients with HCV infection. Conclusions: Absence of changes in the proinflammatory cytokines concentration or in some inflammation markers in chronic HCV patients with hyperinsulinemia suggests that long-term insulin levels, in presence of HCV, cannot explain by themselves the hepatic alterations observed in the patient with HCV infection, the presence of others elements (alcoholism, cirrhosis, etc.) is necessary to onset hepatic damage in these patients.

Hyperinsulinemia and insulin resistance in a patient with type 2 diabetes complicated with myelofibrosis

Inflammation induces insulin resistance and hyperinsulinemia due to elevation of serum cytokines such as tumor necrosis factor-α and interleukins. Chronic myeloproliferative diseases including myelofibrosis show higher serum interleukin levels than healthy subjects, which has been suggested to be the useful markers for disease activity. However, an association between myelofibrosis and insulin resistance has not ever been discussed anywhere. Here we report a case of type 2 diabetes showing remarkable hyperinsulinemia and insulin resistance possibly due to myelofibrosis.

Protein causes hyperinsulinemia： a Chinese patient with hyperinsulinism/hyperammonaemia syndrome due to a glutamate dehydrogenase gene mutation

Glucose is derived from three sources： intestinal absorption, glycogenolysis, and gluconeogenesis.Hypoglycemia in child is often attributed to depletion of glycogen stores. However, recently, congenital hyperinsulinism becomes an important cause of hypoglycaemia in early infancy.

BRSK2 in pancreatic β cells promotes hyperinsulinemia-coupled insulin resistance and its genetic variants are associated with human type 2 diabetes

Brain-specific serine/threonine-protein kinase 2(BRSK2)plays critical roles in insulin secretion andβ-cell biology.However,whether BRSK2 is associated with human type 2 diabetes mellitus(T2DM)has not been determined.Here,we report that BRSK2 genetic variants are closely related to worsening glucose metabolism due to hyperinsulinemia and insulin resistance in the Chinese population.BRSK2 protein levels are significantly elevated inβcells from T2DM patients and high-fat diet(HFD)-fed mice due to enhanced protein stability.Mice with inducibleβ-cell-specific Brsk2 knockout(βKO)exhibit normal metabolism with a high potential for insulin secretion under chow-diet conditions.Moreover,βKO mice are protected from HFD-induced hyperinsulinemia,obesity,insulin resistance,and glucose intolerance.Conversely,gain-of-function BRSK2 in matureβcells reversibly triggers hyperglycemia due toβ-cell hypersecretion-coupled insulin resistance.Mechanistically,BRSK2 senses lipid signals and induces basal insulin secretion in a kinase-dependent manner.The enhanced basal insulin secretion drives insulin resistance andβ-cell exhaustion and thus the onset of T2DM in mice fed an HFD or with gain-of-function BRSK2 inβcells.These findings reveal that BRSK2 links hyperinsulinemia to systematic insulin resistance via interplay betweenβcells and insulin-sensitive tissues in the populations carrying human genetic variants or under nutrient-overload conditions.

Apo A5、Alarin、C5a在单纯肥胖儿童高胰岛素血症中评估价值及临床意义

目的探讨载脂蛋白A5(Apo A5)、脂肪因子Alarin、补体C5a(C5a)在单纯肥胖儿童高胰岛素血症(HINS)中评估价值及意义。方法根据是否有HINS将2020年9月至2023年8月我院收治的302例单纯肥胖儿童分为HINS组、无HINS组,比较两组基线数据与血清Apo A5、Alarin、C5a水平,对相关数据进行统计分析。结果HINS组有糖尿病家族史患儿占比及FINS高于无HINS组(P<0.05);HINS组Apo A5低于无HINS组,Alarin、C5a高于无HINS组(P<0.05);相关性分析显示,Apo A5与FINS呈负相关(r=-0.759,P<0.05),Alarin、C5a与FINS呈正相关(r=0.816、0.829,P<0.05);Apo A5与Alarin、C5a呈负相关(r=-0.841、-0.827,P<0.05),Alarin与C5a呈正相关(r=0.860,P<0.05);线性回归分析显示,控制了糖尿病家族史等混杂因素后,Apo A5、Alarin、C5a仍与单纯肥胖儿童HINS呈显著的相关性(P<0.001);Apo A5、Alarin、C5a评估HINS的AUC依次为0.705、0.725、0.717,Apo A5+Alarin+C5a评估HINS的AUC最高为0.932,敏感度为79.17%,特异度为94.17%(P<0.05)。结论Apo A5、Alarin、C5a是单纯肥胖儿童HINS独立相关影响因素,联合检测三者水平有望成为预测HINS的一个有效方案,三者或可为儿童肥胖及HINS的预防提供新思路。

高胰岛素血症与亚临床甲减患者颈动脉粥样硬化的关系

目的探讨高胰岛素血症(HINS)与亚临床甲状腺功能减退(SCH)患者发生颈动脉粥样硬化的关系。方法收集2020年9月至2022年12月于潍坊医学院附属医院住院的305例SCH患者的临床资料,按照HINS发生情况将其分为HINS组(n=166)和NHINS组(n=139)。收集患者的相关指标,采用Pearson或Spearman分析SCH患者颈动脉内膜中层厚度(CIMT)的影响因素,应用Logistic回归模型分析SCH合并HINS患者发生颈动脉粥样硬化的危险因素。结果两组患者糖尿病、高血压、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、稳态模型胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、2 h胰岛素(2 h INS)、空腹C肽、2 h C肽、CIMT、颈动脉粥样硬化发生率比较,差异均有统计学意义(P﹤0.05)。Pearson或Spearman相关性分析结果显示,CIMT与年龄、高血压、HOMA-IR、FINS、2 h INS、空腹C肽、2 h C肽、LDL-C、促甲状腺激素(TSH)均呈正相关(P﹤0.05)。Logistic回归模型分析结果显示,HINS、年龄、TSH均是发生颈动脉粥样硬化的影响因素(P﹤0.05)。结论HINS、年龄、TSH均是SCH患者发生颈动脉粥样硬化的影响因素,SCH合并HINS患者发生颈动脉粥样硬化风险更高。

糖尿病孕妇孕期和产时胰岛素管理与新生儿低血糖的相关性研究

目的探讨糖尿病孕妇产时静脉泵入胰岛素控制血糖的疗效以及孕期和产时糖尿病控制对新生儿低血糖的影响。方法回顾性分析2022年1月—2023年12月在扬州大学附属苏北人民医院妇产科产检的100例糖尿病孕妇的临床资料。结果65例孕妇所娩新生儿血糖<2.2 mmol/L,46例孕妇所娩新生儿需要静脉注射葡萄糖治疗。产妇分娩时血糖>7.0 mmol/L与新生儿血糖<2.2 mmol/L的发生有相关性(P=0.034),但不需要静脉滴注葡萄糖治疗或转至新生儿科住院治疗。糖尿病孕妇孕晚期糖化血红蛋白(HbA1c)>6.5%与新生儿低血糖需要相关干预有相关性[比值比(OR)=3.89,95%CI:1.42~10.68]。结论产妇分娩时血糖>7.0 mmol/L可预测新生儿低血糖,但与新生儿低血糖的严重程度无关;孕妇孕晚期HbA1c升高反映了孕妇高血糖可预测新生儿严重的高胰岛素血症,需要积极干预,孕晚期HbA1c<6.5%对改善新生儿低血糖有重要意义。

二甲双胍对多囊卵巢综合征合并高胰岛素血症女性妊娠结局的影响

目的探讨二甲双胍对多囊卵巢综合征(PCOS)合并高胰岛素血症女性妊娠结局的影响。方法选取2020年6月至2022年5月漳州市第三医院收治的62例PCOS合并高胰岛素血症患者作为研究对象,按照随机数字表法分为对照组与观察组,每组31例。对照组给予常规胰岛素治疗,观察组给予二甲双胍治疗,比较两组性激素水平、胰岛功能、卵巢功能、妊娠结局及新生儿不良结局发生率。结果治疗6周后,两组促卵泡成熟素(FSH)、促黄体生成素(LH)、雌二醇(E2)、总睾酮(T)、孕酮(P)水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组胰岛素抵抗指数(HOMA-IR)、空腹胰岛素(FINS)水平均低于治疗前,HOMA-β均高于治疗前,且观察组HOMA-IR、FINS水平均低于对照组,HOMA-β高于对照组,差异有统计学意义(P<0.05)。治疗后,两组卵巢体积均小于治疗前,平均卵巢直径(MOD)均长于治疗前,窦状卵泡数(AFC)均少于治疗前,且观察组卵巢体积小于对照组,MOD长于对照组,AFC少于对照组,差异有统计学意义P<0.05)。观察组剖宫产、羊水增多、流产发生率均低于对照组,差异有统计学意义(P<0.05)。观察组新生儿不良结局发生率低于对照组,差异有统计学意义(P<0.05)。结论二甲双胍治疗PCOS合并高胰岛素血症效果确切,可调节患者性激素水平,增强胰岛功能,改善妊娠结局,降低新生儿不良结局发生率。

胰岛素抵抗引起的代偿性高胰岛素血症预测非糖尿病人群血压升高——170例非糖尿病成年人6年随访

目的探讨非糖尿病成年人血压升高是胰岛素抵抗本身还是其代偿性高胰岛素血症所致。方法大庆地区1986年以标准口服葡萄糖耐量实验(OGTT)检出170例(NGT107例,IGT63例)非糖尿病成年人,年龄25～74岁。初访时测定身高、体重、血压、血糖、血浆胰岛素并全部跟踪随访至1992年,重复监测胰岛素以外各项指标。随访中恶化为糖尿病者被排除在本分析之外。计算OGTT曲线下胰岛素面积INSAUC,胰岛素敏感性指数IAI=1/(FPG×FINS)。以方差检验、相关分析及多因素线性回归分析探讨基线胰岛素敏感性、血浆胰岛素曲线下面积是否能预测随访6年后血压水平升高。结果在基线OGTT胰岛素曲线下面积四分变量组(Quartiles)中,随访6年后的SBP、DBP水平随基线INSAUC增大而升高,在INSAUC值为58.5、121.0、175.6及291.6mu/L时,SBP分别为(119.5±2.3)、(122.1±2.5)、(129.4±2.4)及(128.3±2.6)mmHg,DBP分别为(78.6±1.6)、(79.7±1.7)、(85.2±1.7)及(84.0±1.8)mmHg。多因素线性回归分析结果显示,基线值年龄、SBP与6年后之SBP水平呈显著正相关(P=0.04～0.0001),2h血糖水平与SBP相关性不显著。除此之外,基线INSAUC与随访之SBP显著独立相关基线胰岛素敏感性指数与6年后SBP相关不显著。以DBP代替SBP做因变量分析结果相似。

高血压病患者血清胰岛素、C肽水平与中医辨证分型的关系

目的：探讨高血压病患者胰岛素抵抗及高胰岛素血症与中医证型的相关规律。方法：将高血压病的４种证型及健康对照组各选３０例，测定血中胰岛素及Ｃ肽水平等。结果：高血压病患者血中胰岛素水平显著高于健康对照组，并且各证型之间也存在明显差异，其顺序为痰湿■盛＞肝火亢盛＞阴阳两虚＞阴虚阳亢＞健康对照。结论：高血压病患者高胰岛素血症以实证为重而虚证较轻。其变化规律与中医病因病机相符合，这对于中医。

荔枝核皂苷改善高脂血症-脂肪肝大鼠胰岛素抵抗作用的机制研究

目的:研究荔枝核皂苷改善高脂血症-脂肪肝大鼠胰岛素抵抗(IR)的作用机制。方法:采用高脂血症-脂肪肝建立大鼠IR模型,观察荔枝核皂苷、罗格列酮、格列齐特对模型大鼠给药2h后空腹血清血糖(FSG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL -C)、肿瘤坏死因子(TNF) -α、胰岛素含量及胰岛素敏感指数(ISI)等指标的影响。结果:荔枝核皂苷能显著降低模型大鼠FSG、TC、TG、胰岛素含量及TNF -α浓度(P<0. 05或P<0 .01) ,并能显著提高HDL -C含量(P<0 .05)及ISI(P<0 .05) ,增强胰岛素敏感性。结论:荔枝核皂苷能调整高脂血症-脂肪肝所致的糖脂代谢障碍,改善模型大鼠高脂血症、高胰岛素血症及拮抗其IR ,提高胰岛素敏感性。

二甲双胍对多囊卵巢综合征伴胰岛素抵抗患者的作用

目的 探讨二甲双胍在多囊卵巢综合征患者伴胰岛素抵抗 (PCOS IR)中的临床作用。方法 4 6例PCOS IR患者 ,未婚组 2 0例 ,已婚组 2 6例 ,口服二甲双胍 12周 ,采取自身对照法 ,观察试验组用药前、后临床症状、血生殖激素、血糖、胰岛素水平的变化。结果 未婚组 18例恢复排卵性月经 ,2例仍闭经。已婚组 16例恢复排卵 ,4例妊娠 ,10例无效。用药后两组血胰岛素和雄激素水平均降低 ,胰岛素敏感指数上升 ,差异有显著性 (P <0 .0 1)。结论 二甲双胍可有效地改善PCOS患者的胰岛素抵抗 。

高胰岛素血症、高脂血症致动脉粥样硬化的实验研究

使用加与不加高脂血清的不同浓度胰岛素对培养的动脉平滑肌细胞进行刺激，以了解其光学及电镜结构改变。结果显示：胰岛素促细胞生长强度与胰岛素浓度成正比，高脂血清使平滑肌细胞排列无序化，失去特征结构，变为泡沫细胞；胰岛素与高脂血清复合作用，不仅使细胞形态、结构改变，并使之由收缩型变为增殖型，还导致胶原纤维产生。结果提示：控制高胰岛素血症、高脂血症患者的血胰岛素、血脂水平，有助于预防和推迟动脉粥样硬化的产生和发展。

荔枝核拮抗2型糖尿病大鼠胰岛素抵抗作用的药理学机制

目的 :研究荔枝核水提取物 (waterextractfromSemenLitchi ,以下简称荔枝核 )改善 2型糖尿病大鼠(T2DM)胰岛素抵抗 (IR)的药理学机制。方法 :采用T2DR IR模型 ,观察荔枝核对T2DM IR大鼠空腹血清血糖(FSG)、总胆固醇 (TC)、甘油三酯 (TG)、游离脂肪酸 (FFA)、血清尿素氮 (BUN)、肌酐 (Cr)、总蛋白 (TP)、白蛋白 (A)、丙二醛 (MDA)、瘦素 (leptin)、肿瘤坏死因子 α(TNF α)、胰岛素 (Fins)含量及胰岛素敏感指数 (ISI) ,以及丙氨酸氨基转移酶 (ALT)、天冬氨酸氨基转移酶 (AST)、超氧化物歧化酶 (SOD)活性等指标的影响。结果 :荔枝核能显著降低T2DM IR大鼠FSG、TC、TG、FFA、leptin和TNF α含量及高胰岛素血症 (P <0 0 5～ 0 0 1) ,显著提高ISI(P <0 0 1) ,增强胰岛素敏感性 ;加强SOD活性和降低MDA的含量 (P <0 0 1) ,增强抗氧化能力 ;降低ALT、AST活性和BUN、Cr含量 ,提高TP、A含量 (P <0 0 5～ 0 0 1) ,改善肝肾功能。结论 :荔枝核能调整T2DM IR大鼠Lept和TNF α含量及高胰岛素血症 ,拮抗IR ,改善胰岛素敏感性 ,调节糖脂代谢紊乱 ,增强抗氧化作用 。

荔枝核皂苷改善地塞米松致大鼠胰岛素抵抗作用机制研究

目的 :研究荔枝核皂苷改善地塞米松 (DX)致大鼠胰岛素抵抗 (IR)的作用机制。方法 :采用DX诱导制作IR大鼠模型 ,观察荔枝核皂苷对模型鼠给药2h后空腹血清血糖 (FSG)、总胆固醇 (TC)、三酰甘油 (TG )、皮质醇 (Cortisol)、胰岛素含量及胰岛素敏感指数 (ISI)等指标的影响。结果 :荔枝核皂苷能显著降低模型鼠FSG、TC、TG含量 ,显著提高ISI值 (P<0 05或P<0 01)。结论 :荔枝核皂苷可改善DX所致糖、脂代谢障碍 ,降低模型鼠中血皮质醇及胰岛素水平 ,改善其胰岛素敏感性。

多囊卵巢综合征患者胰岛素抵抗与雄激素和糖代谢变化的关系

目的 探讨多囊卵巢综合征 (PCOS)患者胰岛素抵抗 (IR)与雄激素和糖代谢的关系。方法 2 5例正常生育期妇女为对照组。 15 9例PCOS患者分为三组 :非胰岛素抵抗 (NIR)组 5 6例 ;高胰岛素血症 (HI)组 81例 ;异常糖代谢 (AGM )组 2 2例。分别比较四组LH FSH比值、雄激素水平、血糖和胰岛素水平、糖曲线下面积 (GAUC)、胰岛素曲线下面积 (IAUC)和胰岛素敏感指数 (ISI)。结果 LH FSH比值和血雄激素水平 :AGM组 >HI组 >NIR组 >对照组 ;GAUC和IAUC :对照组≈NIR组 <HI组 <AGM组 ;ISI :对照组≈NIR组 >HI组 >AGM组。结论 PCOS部分患者可能经历了NIR→IR→HI→IGT→DM的渐进性病理生理过程 ;胰岛素抵抗是PCOS患者高雄激素血导致持续性无排卵的重要因素之一 。

补肾阴药治疗高胰岛素高雄激素无排卵症的临床观察

本研究对高胰岛素高雄激素无排卵症患者３５例采用补肾阴为主的中药治疗３个周期。治疗期间选用基础体温（ＢＢＴ）、系列Ｂ超和血中激素测定以监测排卵，并测定治疗前后口服糖耐量试验（ＯＧＴＴ）中血糖及胰岛素水平的变化。３５例患者的血睾酮及胰岛素水平均高于正常，而脱氢表雄酮（ＤＨＥＡ）则属正常。１０例（２８．６％）患者黄体生成激素／卵泡激素（ＬＨ／ＦＳＨ）比例在正常范围。２４例患者接受了规则的治疗，其中２０例４３个周期有排卵，排卵率为５９．７％；合并不孕的１７例患者中有７例妊娠，妊娠率为４１．２％。经用中药治疗后血糖反应显著下降（Ｐ＜０．０５），胰岛素水平也显著下降（Ｐ＜０．０５），但尚未达正常。血睾酮水平则显著下降达正常水平（Ｐ＜０．０１）。提示卵巢微环境得到改善，使卵泡发育而排卵、妊娠。