Insulin Sensitivity and Insulin Secretion Estimated by Homeostatic Model Assessment (HOMA) in Gestational Diabetes Mellitus

Background: Progressive insulin resistance (IR) is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). Homeostatic model assessment (HOMA) is commonly used as a parameter of the severity of insulin resistance. Aims: To determine indices of insulin resistance (IR) and β-cell function in gestational diabetes mellitus (GDM). Methods: This cross sectional study was conducted from March 2017 to September 2018 at Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was performed with 41 GDM and equal number of pregnant women with normal glucose tolerance (NGT) diagnosed on basis of WHO criterion-2013 during 24 - 40 weeks of gestation. Serum glucose was measured by glucose oxidase method and fasting serum insulin was measured by chemiluminescent immunoassay. Equations of homeostatic model assessment (HOMA) were used to calculate insulin indices like-insulin resistance (HOMA-IR), β-cell function (HOMA-B) and insulin sensitivity (HOMA-%S). Data were analyzed and compared by statistical tests. Results: A total of eighty-two (82) subjects [41 women with GDM (age: 28.29 ± 3.79 years, BMI: 27.16 ± 4.13 kg/m2) and 41 women with NGT (age: 26.22 ± 5.13 years, BMI: 25.27 ± 3.01 kg/m2)] were included in this study. It was observed that GDM women were significantly older (p = 0.041) and had significantly higher BMI (p = 0.020) than pregnant women with NGT. The GDM group had significantly higher IR as indicated by higher fasting insulin value [GDM vs. NGT;10.19 (7.71 - 13.34) vs. 6.88 (5.88 - 8.47) μIU/ml, median (IQR);p = 0.001] and HOMA-IR [GDM vs. NGT;2.31 (1.73 - 3.15) vs. 1.42 (1.15 - 1.76), median (IQR);p < 0.001], poor β-cell secretory capacity [GDM vs. NGT;HOMA-B: 112.63 (83.52 - 143.93) vs. 128.60 (108.77 - 157.58), median (IQR);p = 0.04] and low insulin sensitivity [GDM vs. NGT;HOMA-%S: 43.29 (31.77 - 57.98) vs. 70.42 (56.86 - 86.59), median (IQR);p < 0.001]. Conclusions: GDM is associated with both insulin resistance and inadequate insulin secretion.

Wrist circumference: A new marker for insulin resistance in African women with polycystic ovary syndrome

BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS women.Research has shown that hyperinsulinemia is correlated with increased bone mass.Given that most women with PCOS are insulin resistant,which is independent from body fat and characterized by hyperinsulinemia,it could be hypothesized that there would be an increased bone mass in the patient as a result.Subsequently,increased bone mass could be measured using the wrist circumference method.AIM To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.METHODS Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group,were enrolled in the study(mean age 24.33±5.36 years).Fasting biochemical parameters,and the Homeostasis Model Assessment of insulin resistance(HOMA-IR)and body composition were evaluated.The nondominant wrist circumference was measured manually,as was the waist circumference(WC),hip circumference,height and weight.Calculated measures included evaluation of body mass index(BMI),Waist-to-Height(WHtR)and Waist-to-hip ratio(WHR).In addition,body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.RESULTS The non-dominant wrist circumference was more closely correlated with HOMAIR(r=0.346;P=0.003)and was the best anthropometrical marker correlated with IR(P=0.011)compared with other anthropometrical markers in women with PCOS:Dominant Wrist Circumference(r=0.315;P=0.007),Waist Circumference(WC)(r=0.259;P=0.028),BMI(r=0.285;P=0.016),WHR(r=0.216;P=0,068)and WHtR(r=0.263;P=0.027).The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.72.A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.CONCLUSION Non-dominant wrist circumference is,to date,the best anthropometrical marker of IR in Sub-Saharan African women with PCOS.It could be suggested as an easy-to-detect marker for assessing IR.

Role of visfatin in obesity-induced insulin resistance

The growing worldwide burden of insulin resistance(IR) emphasizes the importance of early identification for improved management.Obesity,particularly visceral obesity,has been a key contributing factor in the development of IR.The obesity-associated chronic inflammatory state contributes to the development of obesity-related comorbidities,including IR.Adipocytokines,which are released by adipose tissue,have been investigated as possible indicators of IR.Visfatin was one of the adipocytokines that attracted attention due to its insulinmimetic activity.It is released from a variety of sources,including visceral fat and macrophages,and it influences glucose metabolism and increases inflammation.The relationship between visfatin and IR in obesity is debatable.As a result,the purpose of this review was to better understand the role of visfatin in glucose homeostasis and to review the literature on the association between visfatin levels and IR,cardiovascular diseases,and renal diseases in obesity.

Surrogate markers of insulin resistance:A review

Insulin resistance is a hallmark of obesity,diabetes,and cardiovascular diseases,and leads to many of the abnormalities associated with metabolic syndrome. Our understanding of insulin resistance has improved tremendously over the years,but certain aspects of its estimation still remain elusive to researchers and clinicians.The quantitative assessment of insulin sensitivity is not routinely used during biochemical investigations for diagnostic purposes,but the emerging importance of insulin resistance has led to its wider application research studies.Evaluation of a number of clinical states where insulin sensitivity is compromised calls for assessment of insulin resistance. Insulin resistance is increasingly being assessed in various disease conditions where it aids in examining their pathogenesis,etiology and consequences. The hyperinsulinemic euglycemic glucose clamp is the gold standard method for the determination of insulin sensitivity,but is impractical as it is labor-and time-intensive.A number of surrogate indices have therefore been employed to simplify and improve the determination of insulin resistance.The object of this review is to highlight various aspects and methodologies for current and upcoming measures ofinsulin sensitivity/resistance.In-depth knowledge of these markers will help in better understanding and exploitation of the condition.

Salivary resistin level and its association with insulin resistance in obese individuals

The escalating global burden of type 2 diabetes mellitus necessitates the implementation of strategies that are both more reliable and faster in order to improve the early identification of insulin resistance(IR)in high-risk groups,including overweight and obese individuals.The use of salivary biomarkers offers a promising alternative to serum collection because it is safer,more comfortable,and less painful to obtain saliva samples.As obesity is the foremost contributory factor in IR development,the adipocytokines such as leptin,adiponectin,resistin,and visfatin secreted from the adipose tissue have been studied as potential reliable biomarkers for IR.Measurement of salivary adipokines as predictors for IR has attracted widespread attention because of the strong correlation between their blood and salivary concentrations.One of the adipokines that is closely related to IR is resistin.However,there are conflicting findings on resistin’s potential role as an etiological link between obesity and IR and the reliability of measuring salivary resistin as a biomarker for IR.Hence this study reviewed the available evidence on the potential use of salivary resistin as a biomarker for IR in order to attempt to gain a better understanding of the role of resistin in the development of IR in obese individuals.

Hepatitis C virus induced insulin resistance impairs response to anti viral therapy

Hepatitis C virus (HCV) infection is an important risk factor for insulin resistance (IR). The latter is the pathogenic foundation underlying metabolic syndrome, steatosis and cirrhosis, and possibly hepatocellular carcinoma (HCC). The interplay between genetic and environmental risk factors ultimately leads to the development of IR. Obesity is considered a major risk factor, with dysregulation of levels of secreted adipokines from distended adipose tissue playing a major role in IR. HCV-induced IR may be due to the HCV core protein inducing proteasomal degradation of insulin receptor substrates 1 and 2, blocking intracellular insulin signaling. The latter is mediated by increased levels of both tumour necrosis factor-α (TNF-α) and suppressor of cytokine signaling 3 (SOC-3). IR, through different mechanisms, plays a role in the development of steatosis and its progression to steatohepatitis, cirrhosis and even HCC. In addition, IR has a role in impairing TNF signaling cascade, which in turn blocks STAT-1 translocation and interferon stimulated genes production avoiding the antiviral effect of interferon.

The Association of Visceral Adiposity Index with Insulin Resistance in Adults with Prediabetes

Visceral adiposity mediates insulin resistance, but their association among adults with prediabetes is scarce in the literature. This study is aimed to determine the association of visceral adiposity index (VAI) with insulin resistance in adults with prediabetes. This cross-sectional study was done among 117 adults with newly detected prediabetes [m/f;23/94;mean ± SD: Age 36.30 ± 9.99 years, BMI 28.89 ± 4.35 kg/m2] based on American Diabetes Association 2018 criteria and 141 matched healthy controls [m/f: 28/113;mean ± SD: 35.30 ± 6.88 years, BMI 25.03 ± 4.58]. Waist circumference, body mass index, fasting triglyceride, HDL cholesterol, fasting blood glucose and insulin were measured in each group to calculate VAI and homeostatic model assessment of insulin resistance (HOMA-IR). People with prediabetes had significantly higher median value of VAI {3.08 (2.26) vs. 1.86 (2.31);p < 0.001} with higher frequency of high VAI (>1) (98.3% vs. 85.8%;p < 0.001) than the control population. HOMA-IR level was significantly higher in prediabetes with high VAI (cut-off of 2.64) than control with normal VAI [2.78 (2.22, 4.15) vs. 2.20 (1.53, 3.36);p = 0.002]. VAI was positively correlated with HOMA-IR in females with prediabetes (r = 0.299, p = 0.003). VAI had predictive association with prediabetes [OR (95% CI: 9.504 (2.173, 41.576);p = 0.03] and high insulin resistance (HOMA-IR ≥ 2.6) in females with prediabetes [OR (95% CI) = 3.50 (1.476, 8.297);p = 0.004] only. It could satisfactorily discriminate prediabetes in both sexes (male: AUC = 0.767, p = 0.001;female: AUC = 0.641, p < 0.001) and high insulin resistance in females with prediabetes (AUC = 0.641;p = 0.019) only. So, VAI was associated with prediabetes and insulin resistance only in females with prediabetes.

Nonalcoholic steatohepatitis and insulin resistance in children

Various pathological conditions can cause fatty liver in children. Nonalcoholic steatohepatitis(NASH) in children has been known since 1983. However, NASH diagnosed in childhood does not have a favorable outcome.The pathological characteristics of NASH are significantly different between children and adults. Nonalcoholic fatty liver disease(NAFLD)/NASH is accompanied by insulin resistance, which plays a pivotal role in its pathophysiology in both children and adults. In NASH,a "two-hit" model involving triglyceride accumulation(first hit) and liver damage(second hit) has been accepted. Insulin resistance was found to correlate with changes in fat levels; however, it did not correlate with fibrosis or NAFLD activity score in children. Therefore,insulin resistance may be important in the first hit.Because there is obvious familial clustering in NASH,genetic predisposition as well as environmental factors including diet might be the second hit of NAFLD/NASH.

A nutraceutical combination improves insulin sensitivity in patients with metabolic syndrome

AIM:To test the efficacy of a proprietary nutraceutical combination in reducing insulin resistance associated with the metabolic syndrome(MetS).METHODS:Sixty-four patients with MetS followed at a tertiary outpatient clinic were randomly assigned to receive either placebo or a proprietary nutraceutical combination(AP)consisting of berberine,policosanol and red yeast rice,in a prospective,double-blind,placebo-controlled study.Evaluations were performed at baseline and after 18 wk of treatment.The homeostasis model assessment of insulin resistance(HOMAIR)index was the primary outcome measure.Secondary endpoints included lipid panel,blood glucose and insulin fasting,after a standard mixed meal and after an oral glucose tolerance test(OGTT),ow-mediated dilation(FMD),and waist circumference.RESULTS:Fifty nine patients completed the study,2 withdrew because of adverse effects.After 18 wk there was a signif icant reduction in the HOMA-IR index in the AP group compared with placebo(ΔHOMA respectively-0.6 ± 1.2 vs 0.4 ± 1.9;P < 0.05).Total and low density lipoprotein cholesterol also significantly decreased in the treatment arm compared with placebo(Δlow density lipoprotein cholesterol-0.82 ± 0.68 vs-0.13 ± 0.55 mmol/L;P < 0.001),while triglycerides,high density lipoprotein cholesterol,and the OGTT were not affected.In addition,there were significant reductions in blood glucose and insulin after the standard mixed meal,as well as an increase in FMD(ΔFMD 1.9 ± 4.2 vs 0 ± 1.9 %;P < 0.05)and a significant reduction in arterial systolic blood pressure in the AP arm.CONCLUSION:This short-term study shows that AP has relevant beneficial effects on insulin resistance and many other components of MetS.

miR-2467、miR-96-5p在妊娠期糖尿病中的临床意义

目的:探讨微小核糖核酸-2467(miR-2467)、miR-96-5p在妊娠期糖尿病(GDM)中的临床意义。方法:纳入108例GDM住院患者作为GDM组,另选取同期产检的糖耐量正常孕妇82例为对照组。比较2组血清miR-2467、miR-96-5p相对表达量以及空腹血糖(FBG)、餐后2 h血糖(2hFBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR),分析miR-2467、miR-96-5p与上述血糖指标的相关性。采用Logistic多元回归模型分析GDM发生的危险因素,绘制受试者工作特征曲线,分析miR-2467、miR-96-5p评估GDM的曲线下面积(AUC)。结果:GDM组血清miR-2467表达、FBG、2hPG、HbA1c水平及HOMA-IR高于对照组,miR-96-5p表达低于对照组(P均<0.05)。Pearson相关性分析显示血清miR-2467表达与FBG、2hPG、HbA1c、HOMA-IR呈正相关,血清miR-96-5p表达与上述4项指标呈负相关(P均<0.05)。Logistic多元回归分析示孕早期BMI增长≥1.73kg/m^(2)、孕中期BMI增长≥4.88kg/m^(2)、糖尿病家族史、miR-2467≥3.44是GDM发生的危险因素,miR-96-5p≥1.95是GDM发生的保护因素(P<0.05)。血清miR-2467联合miR-96-5p评估GDM的AUC为0.865,敏感度、特异度分别为91.50%、81.50%。结论:miR-2467、miR-96-5p与GDM患者血糖指标及HOMA-IR存在相关性,对评估GDM具有一定意义。

CTRP6与妊娠期糖尿病患者糖脂代谢功能的相关性

目的分析C1q/肿瘤坏死因子相关蛋白6(CTRP6)与妊娠期糖尿病(GDM)患者糖脂代谢功能的相关性。方法选取50例GDM患者列为病例组,另选择同期孕检的66例正常产妇列为对照组,比较两组的一般资料(年龄、孕周、体质量指数、产次),临床资料(血糖指标、血脂指标、胰岛素功能、CTRP6表达),采用单因素分析、Logistic多因素回归分析归纳可导致GDM发病的危险因素,经Spearman相关性系数验证CTRP6表达与GDM患者糖脂代谢指标及胰岛素功能的相关性。结果Logistic多因素回归分析结果显示,空腹血糖(FBG)≥10.0 mmol/L、糖化血红蛋白(HbA1c)≥10%、甘油三酯(TG)≥2.5 mmol/L、低密度脂蛋白胆固醇(LDL-C)≥2.0 mmol/L、载脂蛋白A5(ApoA5)≤100μg/L、CTRP6≥600μg/L、空腹胰岛素(FINS)≥10 mU/L、胰岛β细胞功能(HOMA-β)≤50、胰岛素抵抗(HOMA-IR)≥2.25为发生GMD的危险因素。经Spearman相关性系数检验,CTRP6表达水平与FBG、HbA1c、TG、LDL-C、FINS、HOMA-IR正相关,与ApoA5、HOMA-β负相关。结论CTRP6表达水平随FBG、HbA1c、TG、LDL-C、FINS、HOMA-IR升高,随ApoA5、HOMA-β降低而不断上升。

hs-CRP、HOMA-IR、SHBG与多囊卵巢综合征合并不孕症病情和预后的相关性

目的探讨超敏C-反应蛋白(hs-CRP)、稳态模型胰岛素抵抗指数(HOMA-IR)、性激素结合球蛋白(SHBG)与多囊卵巢综合征(PCOS)合并不孕症患者病情和预后的相关性。方法选取2020年1月至2022年2月海安市人民医院收治的158例PCOS患者作为研究对象。根据子宫内膜容受性(ERT)检测结果分为容受性良好组和容受性不良组,根据促排卵治疗1年后是否受孕分为预后良好组和预后不良组。分析影响PCOS合并不孕症的高危因素;比较不同ERT和预后的hs-CRP、HOMA-IR和SHBG水平;分析PCOS合并不孕症hs-CRP、HOMA-IR、SHBG与体重指数(BMI)、甘油三酯葡萄糖指数(TyG)和抗米勒管激素(AMH)的相关性,绘制受试者工作特征(ROC)曲线分析hs-CRP、HOMA-IR和SHBG的评估效能。结果容受性不良组的hs-CRP和HOMA-IR水平显著高于容受性良好组,SHBG水平显著低于容受性良好组(P<0.05);预后不良组的hs-CRP和HOMA-IR水平显著高于预后良好组,SHBG水平显著低于预后良好组(P<0.05)。Pearson分析显示,PCOS合并不孕症的hs-CRP、HOMA-IR与BMI、TyG呈正相关,与AMH呈负相关(P<0.05);SHBG与AMH呈正相关,与BMI、TyG呈负相关(P<0.05)。ROC曲线显示,hs-CRP、HOMA-IR和SHBG联合诊断PCOS合并不孕症的曲线下面积、灵敏度、特异度均高于任一单项效能(P<0.05)。结论hs-CRP、HOMA-IR和SHBG联合检测对PCOS合并不孕症的病情和预后的评估价值较高。

不同血液净化方式治疗终末期糖尿病肾病的临床对比

目的探究不同血液净化方式治疗终末期糖尿病肾病的临床效果。方法回顾性选取2022年6月—2023年12月泉州市第一医院收治的96例终末期糖尿病肾病患者的临床资料,按照治疗方式的不同分为对照1组、对照2组和观察组,各32例。对照1组患者接受低通量血液透析(hemodialysis,HD)治疗,对照2组患者接受血液透析滤过治疗,观察组患者接受HD+血液灌流治疗。对比3组血清甲状旁腺激素(parathyroid hormone,PTH)清除率、胰岛素抵抗指数(homeostasis model assessment-insulin resistance,HOMA-IR)及微炎症状态指标、不良反应发生率。结果观察组血清PTH清除率高于对照1组、对照2组,HOMA-IR低于对照1组、对照2组,差异有统计学意义(P均<0.05)。观察组超敏C反应蛋白、白细胞介素-6、肿瘤坏死因子-α水平低于对照1组、对照2组,差异有统计学意义(P均<0.05)。观察组不良反应发生率低于对照1组、对照2组,差异有统计学意义(P<0.05)。结论终末期糖尿病肾病患者采取血液透析+血液灌流治疗效果较理想,可有效改善患者胰岛素抵抗指数、微炎症状态,且不良反应发生率较低。

肥胖及非酒精性脂肪性肝病患者血清内脂素的变化及意义

目的探讨肥胖以及非酒精性脂肪性肝病(NAFLD)患者血清内脂素的变化。方法选取非酒精性脂肪性肝病患者30例(NAFLD组),同期年龄、BMI与NAFLD组相匹配的肥胖但无脂肪肝者30例(肥胖组),与健康体检者30例(对照组)相比较,ELISA法测定血清内脂素水平,并与体质指数(BMI)、腰臀比(WHR)、甘油三酯(TG)、总胆固醇(Tchol)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、稳态模型评估的胰岛素抵抗指数(HOMA-IR)相结合,从而判定内脂素在NAFLD中的作用。结果 NAFLD组血清内脂素水平明显高于对照组[(30.47±4.10)mg/Lvs(22.93±5.44)mg/L,P<0.05)],肥胖组血清内脂素水平明显高于对照组[(29.61±5.17)mg/Lvs(22.93±5.44)mg/L,P<0.05)],而在NAFLD组和肥胖组之间内脂素水平无差异(P>0.05);Spearman分析提示内脂素与ALT、GGT、HOMA-IR、TG、FBG、WHR、BMI呈正相关,与HDL-C呈负相关;多元线性回归分析显示内脂素与HOMA-IR呈独立正相关(r=0.548,P<0.01)。结论 NAFLD患者及肥胖者血清内脂素水平均升高,内脂素与胰岛素抵抗独立相关。

郑州市居民高血压前期的患病率及其危险因素分析

目的研究郑州市居民高血压前期的患病率及其危险因素。方法采用随机分层抽样方法选取郑州市6个社区18岁以上成人共4800名社区居民进行流行病学调查。通过问卷调查、体格检查、血压测量、生化检测等方法记录居民的基线情况。采用多重Logistic回归分析高血压前期的危险因素。结果郑州市成人高血压前期的患病率为30.3%。多重Logistic回归分析表明,性别、年龄、体质指数、腰围、胰岛素抵抗指数和吸烟是高血压前期的独立危险因素。结论高血压前期已成为郑州市居民的一个重要健康问题,肥胖和胰岛素抵抗是重要的危险因素。

苍附导痰汤加二甲双胍联合穴位埋线对肥胖型多囊卵巢综合征不孕症患者免疫功能及肠道菌群的影响

目的观察苍附导痰汤加二甲双胍联合穴位埋线对肥胖型多囊卵巢综合征(polycystic ovary syndrome,PCOS)不孕症患者免疫功能及肠道菌群的影响。方法选取肥胖型PCOS不孕症120例,采用随机数字表法随机将其分为观察组和对照组两组各60例,其中84例顺利完成研究,观察组40例,对照组44例。观察组采用苍附导痰汤加二甲双胍联合穴位埋线进行治疗,对照组采用苍附导痰汤加二甲双胍进行治疗,均治疗12周。比较两组治疗前后T细胞免疫应答指标、胰岛素抵抗指标和肠道菌群情况,并观察两组治疗期间不良反应发生情况。结果治疗前,两组T细胞免疫应答指标、胰岛素抵抗指标及肠道菌群情况比较差异均无统计学意义(P>0.05)。治疗后,两组血清转化生长因子-β1(TGF-β1)、白细胞介素-10(IL-10)水平及乳酸杆菌、双歧杆菌均较治疗前升高;血清白细胞介素-17(IL-17),空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、空腹胰岛素(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)水平,以及肠杆菌均较治疗前降低,差异有统计学意义(P<0.01)。治疗后,观察组血清TGF-β1、IL-10水平及乳酸杆菌、双歧杆菌高于对照组;血清IL-17,FBG、2 h PBG、FINS、HOMA-IR水平,以及肠杆菌低于对照组,差异有统计学意义(P<0.01)。治疗期间,观察组出现皮疹5例,因埋线导致皮肤红肿1例;对照组出现皮疹5例。结论苍附导痰汤加二甲双胍联合穴位埋线应用于肥胖型PCOS不孕症可以减少胰岛素抵抗、纠正Treg/Th17失衡、调节T细胞免疫应答、改善肠道微生物稳态失衡,且不良反应较少。

两种不同麻醉和镇痛方法对术后胰岛素抵抗状态影响的比较

目的研究两种不同麻醉方法对术前存在胰岛素抵抗(IR)患者术后IR的影响。方法利用稳态模式评估法计算胰岛素抵抗指数(HOMA-IR),筛选术前存在IR的择期髋关节置换术患者64例,将患者随机均分为两组:研究组和对照组。采用视觉模拟评分法(VAS)观察术后48h内的镇痛效果。分别于麻醉前30min(T0)、手术结束时(T1)、术后24h(T2)、48h(T3)测定血浆葡萄糖(FPG)、胰岛素(FINS)浓度并计算出相应HOMA指数用以判断患者术后IR状态。结果两组VAS差异均无统计学意义。研究组FPG、FINS、ln(HOMA-IR)在T1时均显著降低(P<0.01),但FPG在T2时基本恢复至术前,而FINS、ln(HOMA-IR)与T0时比差异均有统计学意义(P<0.01)。对照组FPG始终变化不大,而FINS、ln(HOMA-IR)T1、T2时升高显著(P<0.05或P<0.01)。T3时研究组ln(HOMA-IR)依然很低(1.13±0.26)(P<0.01),而对照组基本恢复至术前(1.50±0.51)。结论硬膜外麻醉(EA)+硬膜外自控镇痛(PCEA)在术后48h内可以减轻术前存在IR患者的术后IR程度,尤其在术后即时作用最明显。

两种儿童青少年代谢综合征定义的临床应用比较

目的：比较2012年中国儿童青少年代谢综合征（MetS）定义和2007年国际糖尿病联盟（IDF）定义在肥胖儿童青少年中的临床应用情况，并评价其适用性。方法：对2006年7月至2012年12月593名10～16岁肥胖儿童青少年的住院检查资料进行分析，比较两种定义诊断MetS及其组分的一致性，以及检出胰岛素抵抗、早期血管病变的敏感性和特异性。结果：两种定义对研究对象的MetS诊断一致性较好（K=0．626），对各组分异常率的诊断一致性由高到低依次为中心性肥胖、高甘油三脂血症、高血糖、胆固醇代谢异常、高血压，其K值分别为1．000、0．803、0．780、0．734和0．594。两种定义对胰岛素抵抗和早期血管病变的检出率均随着MetS组分异常数的增多而显著升高（尸〈0．05）；对胰岛素抵抗的检出，中国定义的敏感度和特异度分别为54．5％和65．7％，IDF定义分别为36．1％和83．1％；对早期血管病变的检出，中国定义的敏感度和特异度分别为58．3％和55．8％，IDF定义分别为37．3％和70．8％。校正年龄和性别因素后，相较于非MetS儿童，中国定义的MetS儿童发生胰岛素抵抗和早期血管病变的OR值分别为2．166（P〈0．001）和1．771（P=0．008），而根据IDF定义，MetS儿童发生胰岛素抵抗和早期血管病变的OR值分别为2．618（P〈0．001）和1．357（P=0．190）。结论：中国定义和IDF定义在国内肥胖儿童青少年MetS诊断上具有较好的一致性，中国定义诊断高血压、高血糖、高非高密度脂蛋白胆固醇血症的敏感度较高，能较早发现肥胖儿童青少年的胰岛素抵抗和早期血管病变。

外科感染病人胰岛素抵抗及其相关因素分析

目的:观察外科感染病人胰岛素抵抗(IR)状况,研究其临床意义,并探讨如何应用临床常用参数评价感染病人的胰岛素敏感性(ISI)。方法:检测外科不同病情严重程度感染患者空腹血糖(FBG)、空腹胰岛素(FINS),以正常健康人为对照,利用稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-)β,观察外科感染病人ISI,并且分析不同病情严重程度和不同病种感染病人之间ISI是否存在显著差异。使用多元线性回归方程和多因素Logistic进行多因素分析,应用临床常用的参数评价感染ISI状况。结果:①外科感染病人中IR发生率为92.06%(58/63)。不同病种,包括急性重症胰腺炎病人、肠瘘病人和急性胆管炎病人,不论HOMA-IRl、gHOMA-IR还是HOMA-β均无显著差异(P>0.05)。②按病情严重度和最终预后对病人分组:SIRS病人IR发生率为20%(7/35),脓毒症病人IR发生率为86.20%(25/29),脓毒性休克和MODS组病人IR发生率为95.83%(23/24),死亡组病人IR发生率为100%(10/10)。各组间IR有显著差异(P<0.01),而HOMA-β无显著差异(P>0.05)。③临床各常用参数与ISI之间相关性分析显示器官功能衰竭连续评分(sequential organ failure assessment,SOFA)、FINS、FBG、转铁蛋白、脓毒症评分(sepsis scores,SS)评分、C-反应蛋白(CRP)、前白蛋白、三酰甘油(TG)和胰岛素用量/葡萄糖用量与ISI呈独立正相关,方程的R2为0.900。各临床参数对IR的多因素Logistic回归显示FINS、FBG、低密度脂蛋白(LDL)和SOFA进入模型,其中FBG和FINS与IR的回归关系更明显,而其他临床指标与IR未显示有意义的回归关系。结论:①外科感染病人中普遍存在IR,并与引起感染的病种无关;②IR与疾病严重程度最终预后密切相关,可作为判断危重病人病情转归和预后的预警指标;③临床常用参数SOFA评分、FINS、FBG、转铁蛋白、SS评分、CRP、前白蛋白和TG与感染病人ISI的关系更为密切。

PCOS患者AMH水平与内分泌代谢异常间关系的研究

目的分析多囊卵巢综合征(PCOS)患者抗苗勒管激素(AMH)水平与内分泌代谢异常之间的关系,比较高雄激素和非高雄激素型患者AMH及其它指标的差异。方法 210例PCOS患者,据AMH水平分为高AMH组(AMH≥10ng/ml,86例)和低AMH组(AMH<10ng/ml,124例);根据高雄激素临床表现或高雄激素血症分为高雄组(58例)和非高雄组(152例)。测定血清AMH、卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇、睾酮(T)、空腹血糖和空腹胰岛素、总胆固醇、甘油三酯和低密度脂蛋白,计算稳态模型胰岛素抵抗指数(HOMA-IR),比较各组AMH及内分泌代谢指标差异,分析AMH水平的影响因素。结果 (1)低AMH组与高AMH组比较,BMI(24.73±5.02kg/m2 vs.23.08±4.34kg/m2)、空腹胰岛素(93.26±57.64pmol/L vs.73.81±42.62pmol/L)、HOMA-IR(3.23±2.20vs.2.51±1.64)均显著增高(P<0.05);(2)高雄组与非高雄组比较,AMH水平(11.71±5.86ng/ml vs.9.64±4.91ng/ml)、LH/FSH比值(1.94±0.93vs.1.54±0.80)、总胆固醇水平(4.94±1.38 mmol/L vs.4.36±0.83 mmol/L)、低密度脂蛋白水平(3.06±1.22 mmol/L vs.2.63±0.68mmol/L)均显著增高(P<0.05);(3)多元线性回归分析显示AMH水平与睾酮水平正相关(β=0.281,P<0.05),与BMI负相关(β=-0.264,P<0.05)。结论 PCOS患者BMI、空腹胰岛素和HOMA-IR升高导致AMH水平降低,而高雄激素型患者AMH水平和LH/FSH显著升高,并增加脂质代谢异常的风险。