Association between triglyceride-glucose index and colorectal polyps:A retrospective cross-sectional study

BACKGROUND Colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses metabolic health and insulin resistance,and has been linked to gastrointestinal cancers.AIM To investigate the potential association between the TyG index and CPs,as the relation between them has not been documented.METHODS A total of 2537 persons undergoing a routine health physical examination and colonoscopy at The First People's Hospital of Kunshan,Jiangsu Province,China,between January 2020 and December 2022 were included in this retrospective cross-sectional study.After excluding individuals who did not meet the eligibility criteria,descriptive statistics were used to compare characteristics between patients with and without CPs.Logistic regression analyses were conducted to determine the associations between the TyG index and the prevalence of CPs.The TyG index was calculated using the following formula:Ln[triglyceride(mg/dL)×glucose(mg/dL)/2].The presence and types of CPs was determined based on data from colonoscopy reports and pathology reports.RESULTS A nonlinear relation between the TyG index and the prevalence of CPs was identified,and exhibited a curvilinear pattern with a cut-off point of 2.31.A significant association was observed before the turning point,with an odds ratio(95% confidence interval)of 1.70(1.40,2.06),P<0.0001.However,the association between the TyG index and CPs was not significant after the cut-off point,with an odds ratio(95% confidence interval)of 0.57(0.27,1.23),P=0.1521.CONCLUSION Our study revealed a curvilinear association between the TyG index and CPs in Chinese individuals,suggesting its potential utility in developing colonoscopy screening strategies for preventing CRC.

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.

The relationship between insulin resistance/β-cell dysfunction and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus： the Desheng Diabetic Eye Study

AIM： To investigate the relationship between insulin resistance （IR）/β-cell dysfunction and diabetic retinopathy （DR） in Chinese patients with type 2 diabetes mellitus （T2DM）, and to explore further whether there were differences in the relationship among diabetic patients with higher and lower body mass index （BMI）. METHODS： Cross-sectional study. A total of 1466 subjects with T2DM were recruited in a local Desheng Community of urban Beijing from November 2009 to June 2012 for the cohort of Beijing Desheng Diabetic Eye Study. Standardized evaluation was carried out for each participant, including questionnaire, ocular and anthropometric examinations, and laboratory tests. Seven fields 30° color fundus photographs were used for DR grading according to the Early Treatment Diabetic Retinopathy Study protocols. Homeostatis Model Assessment （HOMA） method was employed for IR and β-cell function assessment. RESULTS： After excluding those participants who were treated with insulin （n=352） or had missing data of fasting insulin （n=96）, and further excluding those with poor quality of retinal photographs （n=10）, a total of 1008 subjects were included for the final analysis, 406 （40.3%） were men and 602 （59.7%） were women, age ranging fiom 34 to 86 （64.87±8.28）y. Any DR （levels 14 and above） was present in 278 （27.6%） subjects. After adjusting for possible covariates, the presence of any DR did not correlate with HOMA IR [odds ratio （OR） 1.51, 95% confidence interval （Cl） 0.87-2.61, P=0.14] or HOMA β-cell （OR 0.71, 95%CI 0.40-1.26, P=0.25）. After stratification by BMI, the presence of any DR was associated positively with HOMA IR （OR 2.46, 95%CI： 1.18-5.12, P=0.016）, and negatively with HOMA β-cell （OR 0.40, 95%CI： 0.19-0.87, P=0.021） in the group of patients with higher BMI （225 kg/m2）. In the group of patients with lower BMI （〈25 kg/m2）, the presence of any DR was not associated with HOMA IR （OR 1.00, 95%C1： 0.43-2.33, P=I.00） or HOMA β-cell （OR 1.41, 95%CI： 0.60-3.32, P=0.43）. CONCLUSION： The data suggest that higher IR and lower 13-cell function are associated with the presence of DR in the subgroup of diabetic patients with higher BMI. However, this association is not statistically significant in diabetic patients with lower BMI.

Cardiometabolic risk factors in young Indian men and their association with parameters of insulin resistance and beta-cell function

BACKGROUND There is an unmet need to evaluate the burden of cardiometabolic risk factors in young South Asian adults,who are not preselected for glycaemia.AIM To evaluate young North Indian men(aged 20-50 years)for burden of cardiometabolic risk factors,in relation to parameters of homeostatic model assessment for insulin resistance(HOMA-IR)and beta-cell function(oral disposition index[oDI]).METHODS Study participants were invited in a fasting state.Sociodemographic,anthropometric,and medical data were collected,and 75 g oral glucose tolerance test was performed with serum insulin and plasma glucose estimation at 0,30,and 120 min.Participants were divided into quartiles for HOMA-IR and oDI(category 1:Best HOMA-IR/oDI quartile;category 3:Worst HOMA-IR/oDI quartile)and composite HOMA-IR/oDI phenotypes(phenotype 1:Best quartile for both HOMA-IR and oDI;phenotype 4:Worst quartile for both HOMA-IR and oDI)were derived.RESULTS We evaluated a total of 635 men at a mean(±SD)age of 33.9±5.1 years and body mass index of 26.0±3.9 kg/m^(2).Diabetes and prediabetes were present in 34(5.4%)and 297(46.8%)participants,respectively.Overweight/obesity,metabolic syndrome,and hypertension were present in 388(61.1%),258(40.6%),and 123(19.4%)participants,respectively.The prevalence of dysglycaemia,metabolic syndrome,and hypertension was significantly higher in participants belonging to the worst HOMA-IR and oDI quartiles,either alone(category 3 vs 1)or in combination(phenotype 4 vs 1).The adjusted odds ratios for dysglycaemia(6.5 to 7.0-fold),hypertension(2.9 to 3.6-fold),and metabolic syndrome(4.0 to 12.2-fold)were significantly higher in individuals in the worst quartile of HOMA-IR and oDI(category 3),compared to those in the best quartile(category 1).The adjusted odds ratios further increased to 21.1,5.6,and 13.7,respectively,in individuals with the worst,compared to the best composite HOMA-IR/oDI phenotypes(phenotype 4 vs 1).CONCLUSION The burden of cardiometabolic risk factors is high among young Asian Indian men.Our findings highlight the importance of using parameters of insulin resistance and beta-cell function in phenotyping individuals for cardiometabolic risk.

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.

Over expression of resistin in adipose tissue of the obese induces insulin resistance

AIM: To compare resistin mRNA expression in subcutaneous adipose tissue (SAT) and its correlation with insulin resistance (IR) in postmenopausal obese women. METHODS: A total of 68 postmenopausal women (non obese = 34 and obese = 34) were enrolled for the study. The women of the two groups were age matched (49-70 years). Fasting blood samples were collected at admission and abdominal SAT was obtained during surgery for gall bladder stones or hysterectomy. Physical parameters [age, height, weight, body mass index (BMI)] were measured. Biochemical (plasma insulin and plasma glucose) parameters were estimated by enzymatic methods. RNA was isolated by the Trizol method.SAT resistin mRNA expression was done by real time- reverse transcription polymerase chain reaction (RT-PCR) by using Quanti Tect SYBR Green RT-PCR master mix. Data was analyzed using independent Student's t test, correlation and simple linear regression analysis. RESULTS: The mean weight (52.81 ± 8.04 kg vs 79.56 ± 9.91 kg; P < 0.001), BMI (20.23 ± 3.05 kg/m 2 vs 32.19 ± 4.86 kg/m 2 ; P < 0.001), insulin (8.47 ± 3.24 U/mL vs 14.67 ± 2.18 U/mL; P < 0.001), glucose (97.44 ± 11.31 mg/dL vs 109.67 ± 8.02 mg/dL; P < 0.001) and homeostasis model assessment index (2.01 ± 0.73 vs 3.96 ± 0.61; P < 0.001) were significantly higher in postmenopausal obese women compared to postmenopausal non obese women. The mean serum resistin level was also significantly higher in postmeno-pausal obese women compared to postmenopausal non obese women (9.05 ± 5.15 vs 13.92 ± 6.32, P < 0.001). Furthermore, the mean SAT resistin mRNA expression was also significantly (0.023 ± 0.008 vs 0.036 ± 0.009; P < 0.001) higher and over expressed 1.62 fold (upregulated) in postmenopausal obese women compared to postmenopausal non obese women. In postmeno-pausal obese women, the relative SAT resistin mRNA expression showed positive (direct) and significant correlation with BMI (r = 0.78, P < 0.001) and serum resistin (r = 0.76, P < 0.001). Furthermore, the SAT resistin mRNA expression in postmenopausal obese women also showed significant and direct association (r = 0.45, P < 0.01) with IR, while in postmenopausal non obese women it did not show any association (r = -0.04, P > 0.05). CONCLUSION: Increased SAT resistin mRNA expres-sion probably leads to inducing insulin resistance and thus may be associated with obesity-related disorders in postmenopausal obese women.

Insulin resistance in H pylori infection and its association with oxidative stress

AIM: To determine the insulin resistance (IR) and oxidative status in H pylori infection and to find out if there is any relationship between these parameters and insulin resistance. METHODS: Fifty-five H pylori positive and 48 H pylori negative patients were enrolled. The homeostasis model assessment (HOMA) was used to assess insulin resistance. Serum total antioxidant capacity (TAC), total oxidant status (TOS) and oxidative stress index (OSI) were determined in all subjects. RESULTS: The total antioxidant capacity was significantly lower in H pylori positive group than in H pylori negative group (1.36 ± 0.33 and 1.70 ± 0.50, respectively; P < 0.001), while the total oxidant status and oxidative stress index were significantly higher in H pylori positive group than in H pylori negative group (6.79 ± 3.40 and 5.08 ± 0.95, and 5.42 ± 3.40 and 3.10 ± 0.92, respectively; P < 0.001). Insulin resistance was significantly higher in H pylori positive group than in H pylori negative group (6.92 ± 3.86 and 3.61 ± 1.67, res- pectively; P < 0.001). Insulin resistance was found to be significantly correlated with total antioxidant capacity (r = -0.251, P < 0.05), total oxidant status (r = 0.365, P < 0.05), and oxidative stress index (r = 0.267, P < 0.05). CONCLUSION: Insulin resistance seems to be associated with increased oxidative stress in H pylori infection. Further studies are needed to clarify the mechanisms underlying this association and elucidate the effectof adding antioxidant vitamins to H pylori eradication therapy on insulin resistance during H pylori infection.

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.

Comparison of body mass index, anti-müllerian hormone and insulin resistance parameters among different phenotypes of polycystic ovary syndrome

Background:Diagnosis of polycystic ovary syndrome(PCOS)depends on 2003 Rotterdam Criteria.According to these criteria there are four possible combinations resulting in various phenotypes.We aimed(i)to confirm that the levels of body mass index(BMI),anti-müllerian hormone(AMH)levels and insulin resistance(IR)are higher in PCOS patients and higher in phenotype-A among PCOS patients,and(ii)to determine cut-off values for the diagnosis of PCOS and phenotype-A.Materials and methods:This study was conducted in an IVF Center,between November 2019 and January 2021.Data of infertile women participating in the study was evaluated retrospectively.Parameters such as menstruation pattern,clinical hyperandrogenism,age,BMI,follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol,thyroid stimulating hormone(TSH),prolactin,AMH,dehydroepiandrosterone sulphate(DHEA-S),fasting blood glucose,fasting insulin levels,antral follicle counts(AFC)and ovarian volumes were recorded for each patient.Women were grouped as PCOS and non-PCOS,and PCOS group was further divided into 4 subgroups according to their phenotypes.Data of infertile patients with PCOS patients were compared with infertile non-PCOS patients and PCOS phenotypes were compared among each other.Results:Data of 244 infertile patients was included in the study.BMI,AMH,AFC,and HOMA-IR were statistically higher in PCOS patients,compared to non-PCOS patients.We found the AMH level of>3.105 ng/ml to be having 90.8%sensitivity and 90%specificity to diagnose a patient as PCOS.Among different phenotypes,also BMI,AMH,and insulin resistance index(HOMA-IR)levels were significantly higher in infertile PCOS phenotype-A when compared to other three phenotypes(p:0.003,p:0.000,and p:0.000,respectively).The AMH cut-off value to estimate phenotype-A was found as 6.095 ng/ml with 69.2%sensitivity and 86.7%specificity.We did not found threshold levels of BMI and HOMA-IR with high sensitivity to identify phenotype-A.Conclusion:Properly diagnosing PCOS and determining the phenotype are crucial due to the long-term health conditions.Therefore,we suggest that serum AMH level could be included in PCOS diagnosis criteria,and the value of 3.105 ng/ml would have a 90.8%sensitivity and 90%specificity.Also,to identify phenotype-A,AMH level could be used.Therefore,we speculate that AMH may serve to identify PCOS and PCOS phenotype-A in places where ultrasound imaging is not straightforward to perform or not easily accessible.

Correlation of body mass index with Th1/Th2 balance, adhesion molecules and insulin signal transduction in infertile patients

Objective: To study the correlation of body mass index with Th1/Th2 balance, adhesion molecules and insulin signal transduction in infertile patients. Methods: A total of 132 patients who received diagnostic curettage due to infertility in Tangshan Maternal and Child Health Hospital between June 2015 and March 2016 were selected as the research subjects and divided into the normal group with BMI<25 kg/m2, the overweight group with BMI 25-30 kg/m2 and the obesity group with BMI > 30 kg/m2 according to BMI, and the levels of Th1/Th2 cytokines in serum as well as the expression of Th1/Th2 transcription factors, adhesion molecules and insulin signal pathway molecules in endometrial tissue were detected. Results:IFN-γ and TNF-α levels in serum of obesity group and overweight group were significantly higher than those of control group while IL-4, IL-5 and IL-13 levels in serum as well as CD44V6, N-cadherin, FAK, ICAM-1, GLUT-4, IRS-1, PI3K and AKT mRNA expression in endometrial tissue were significantly lower than those of control group;IFN-γ and TNF-α levels in serum of obesity group were significantly higher than those of overweight group while IL-4, IL-5 and IL-13 levels in serum as well as CD44V6, N-cadherin, FAK, ICAM-1, GLUT-4, IRS-1, PI3K and AKT mRNA expression in endometrial tissue were significantly lower than those of overweight group. Conclusion: Weight gain can aggravate the Th1/Th2 disorder, reduce the adhesion molecule expression and hinder the insulin signal transduction in infertile patients.

脾瘅方加减联合二甲双胍治疗肥胖型2型糖尿病的临床疗效及对其血脂、胰岛素抵抗指数的影响

目的分析脾瘅方加减联合二甲双胍治疗肥胖型2型糖尿病(Diabetes mellitus type 2,T2DM)患者的临床疗效及对其血脂、胰岛素抵抗指数(Homeostatic Model Assessment of Insulin Resistance,HOMA-IR)的影响。方法选取2022年1月—2023年2月期间就诊于济宁市中医院的肥胖型T2DM患者100例作为研究对象,按随机数表法分为对照组和观察组,每组各50例。对照组常规服用二甲双胍0.5 g/次,3次/d;观察组在对照组基础上加用脾瘅方对症加减治疗。治疗12周后观察比较两组患者临床疗效,治疗前后血糖指标[血糖(Fasting blood glucose,FBG)、餐后2 h血糖(2-hour postprandial blood glucose,2 h PBG)、糖化血红蛋(Glycosylated hemoglobinA1c,HbA1c)]、中医证候积分、血脂指标[总胆固醇(Total cholesterol,TC)、甘油三酯(Triglycerides,TG)、低密度脂蛋白(Low density lipoprotein,LDL-C)]、胰岛素指标[空腹胰岛素(Fasting insulin,FINS)、胰岛素抵抗指数(Homeostasis Model Assessment-Insulin Resistance,HOMA-IR)、胰岛β细胞功能指数(Homeostatic model assessment ofβ-cell function,HOMA-β)]及炎症因子[白介素-6(Interleukin-6,IL-6)、超敏C反应蛋白(Highsensitivity C-reactive protein,hs-CRP)]水平。结果治疗后观察组临床总有效率94.00%(47/50)明显高于对照组78.00%(39/50),差异有统计学意义(P<0.05)。治疗后两组患者血糖FBG、2 h PBG、HbAlc指标及中医证候积分均较治疗前降低,差异有统计学意义(P<0.05);且观察组血糖FBG、2 h PBG、HbAlc指标及中医证候积分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血脂指标TG、TC、LDL-C均较治疗前降低,差异有统计学意义(P<0.05);且观察组血脂指标TG、TC、LDL-C均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者胰岛素FINS、HOMA-IR指标均较治疗前降低,HOMA-β指标均较治疗前升高,差异有统计学意义(P<0.05);且观察组胰岛素FINS、HOMA-IR指标明显低于对照组,HOMA-β指标明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者炎症因子IL-6、hs-CRP水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组炎症因子IL-6、hs-CRP水平均明显低于对照组,差异有统计学意义(P<0.05)。结论脾瘅方加减联合二甲双胍治疗肥胖型T2DM患者能有效调节血糖、血脂水平,改善胰岛素抵抗,减轻炎症反应,临床疗效显著。

体重指数、腰臀比及胰岛素抵抗与绝经后子宫内膜息肉发病的相关性分析

目的探究体重指数(BMI)、腰臀比(WHR)及胰岛素抵抗(IR)与绝经后子宫内膜息肉(EP)发病的相关性。方法选取2021年10月至2023年1月资阳市人民医院收治的180例怀疑为绝经后EP患者作为研究对象。根据病理检查结果将其分为EP组(n=90)和非EP组(n=90)。比较两组的BMI、WHR、IR发生情况、性激素水平,分析BMI、WHR及IR与绝经后EP发病的关系。结果EP组的BMI、腰围、臀围、WHR均高于对照组(P<0.05);EP组空腹血糖(FBG)、空腹胰岛素(FIN)、稳态模型胰岛素抵抗指数(HOMA-IR)水平及IR发生率均高于非EP组(P<0.05);两组黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_(2))、孕酮(P)水平比较,差异无统计学意义(P>0.05);EP患者BMI、WHR与HOMA-IR均呈正相关(P<0.05);BMI、WHR、HOMA-IR是EP发生的独立危险因素。结论BMI、WHR、HOMA-IR与绝经后EP发生均具有相关性,临床需重视肥胖、胰岛素水平过高患者,定期进行妇科检查。

新发2型糖尿病患者维生素D与胰岛素抵抗的相关性

目的探讨新发2型糖尿病(type 2 diabetes mellitus,T2DM)患者25-羟基维生素D3[25(OH)D3]水平与胰岛素抵抗、尿pH值等因素的相关性。方法分别测定325例非糖尿病患者(对照组)及208例新发T2DM患者(新发T2DM组)的25(OH)D_(3)水平,并根据25(OH)D_(3)水平将新发T2DM患者分成新发T2DM患者维生素D缺乏组(n=92)及新发T2DM患者维生素D非缺乏组(n=116)。非缺乏组25(OH)D_(3)水平为20~100 ng/mL;缺乏组25(OH)D_(3)水平为<20 ng/mL;25(OH)D_(3)与胰岛素抵抗、尿pH值等的相关性采用SPSS 26.0统计软件来进行统计分析。结果新发T2DM组25(OH)D_(3)水平低于对照组(P<0.01);新发T2DM患者维生素D缺乏组的年龄、糖化血红蛋白、胰岛素抵抗指数、尿pH值、游离三碘甲状腺原氨酸(FT_(3))和游离甲状腺素(FT_(4))均高于非缺乏组(P<0.05),而组间的胰岛功能指数、空腹C肽、血清钙、促甲状腺激素(TSH)差异无统计学意义(P>0.05)。Logistic回归分析显示,糖化血红蛋白(OR=1.776,P<0.05)、胰岛素抵抗指数(OR=1.289,P<0.05)是新发T2DM患者维生素D缺乏的危险因素。结论新发T2DM患者25(OH)D_(3)水平低于对照组。较高的糖化血红蛋白和胰岛素抵抗指数是T2DM合并维生素D缺乏的危险因素。

体质指数正常的多囊卵巢综合征女性发生高脂血症的影响因素研究

背景近年来多囊卵巢综合征(PCOS)女性的脂质代谢紊乱发生率较高,与肥胖、胰岛素抵抗(IR)的关系密切。BMI正常的PCOS女性也有较高的脂质代谢水平,但目前对该类人群中血脂异常的研究较少。目的探讨BMI正常的PCOS女性发生高脂血症的影响因素。方法基于“针刺和克罗米芬对多囊卵巢综合征妇女活产率的影响(PCOSAct)”临床试验数据,选取基线较完整且符合研究标准的受试者428例。判断高脂血症的评价标准:总胆固醇(TC)≥6.22 mmol/L和/或三酰甘油(TG)≥2.26 mmol/L和/或低密度脂蛋白(LDL)≥4.14 mmol/L和/或高密度脂蛋白(HDL)<1.04 mmol/L,并据此进行分组。比较两组患者在人体测量学、性激素、糖脂代谢以及心肌酶、肝功能方面的差异,采用多因素Logistic回归分析探究BMI正常的PCOS女性高脂血症的影响因素。结果BMI正常的PCOS女性合并高脂血症的发生率为32.24%(138/428),最常见的血脂异常类型是HDL水平降低;单一表型异常率较高[21.73%(93/428)]。高脂血症组138例、无高脂血症组290例。高脂血症组年龄、糖尿病家族史占比、体质量、腰围、BMI、腰臀比(WHR)较大,尝试妊娠时间较长,游离雄激素指数、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、LDL、TC、TG、载脂蛋白B、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、乳酸脱氢酶(LDH)水平比无高脂血症组高,性激素结合球蛋白、抗米勒管激素、HDL、载脂蛋白A、总胆红素、直接胆红素水平较无高脂血症组低(P<0.05)。多因素Logistic回归分析发现年龄、BMI、HOMA-IR、LDH是正常BMI的PCOS患者发生高脂血症的独立危险因素(OR=1.170、1.348、1.172、1.009),性激素结合球蛋白是独立保护因素(OR=0.979,P<0.05)。结论BMI正常的PCOS女性合并高脂血症发生率为32.24%,年龄、BMI、HOMA-IR、LDH、SHBG均是PCOS女性发生高脂血症的影响因素,临床上应该根据各诱因采取相应措施防治及延缓PCOS女性高脂血症的发生与发展。

不同强度训练方式对2型糖尿病超重或肥胖者体成分及糖代谢影响的Meta分析

目的:系统评价高强度间歇训练(high-intensity interval training,HIIT)与中等强度持续性训练(moderate-intensity continuous training,MICT)对2型糖尿病超重或肥胖患者体成分、糖代谢相关指标干预效果,对比两种运动方式的改善效果,为2型糖尿病超重或肥胖患者运动处方的制定提供参考依据。方法:检索The Cochrane Library、PubMed、EMbase、Web of Science、中国知网、中国生物医学文献数据库(CBM)、万方及美国临床试验注册中心数据库,搜集HIIT与MICT对2型糖尿病超重或肥胖患者体成分和糖代谢相关指标干预效果比较的随机对照试验,检索时间为各数据库建库至2022年6月。由2名研究者对所纳入的研究进行筛选、质量评价和数据提取,采用RevMan 5.4软件对结局指标进行Meta分析。结果:①共纳入13项随机对照试验,包括371例患者,所纳入研究整体质量较高。②HIIT组与MICT组对体成分改善效果无显著性差异(体质量:WMD=2.44,95%CI:-3.01-7.89,P>0.05;体质量指数:WMD=0.28,95%CI:-1.21-1.77,P>0.05;腰围:WMD=2.16,95%CI:-2.04-6.35,P>0.05;体脂百分比:WMD=0.47,95%CI:-2.11-3.05,P>0.05);③两组体质量与体质量指数指标“训练周期≥12周”亚组“训练频率≤3次/周”亚组差异有显著性意义(训练周期≥12周亚组:WMD=4.25,95%CI:0.90-7.59,P=0.01;WMD=2.71,95%CI:1.92-3.51,P<0.00001;训练频率≤3次/周亚组:WMD=5.14,95%CI:1.7-8.57,P=0.003;WMD=1.67,95%CI:0.66-2.67,P=0.001);④敏感性分析结果显示,HIIT组与MICT组体脂百分比指标差异有显著性意义(WMD=2.17,95%CI:1.20-3.14,P<0.0001),两组对糖代谢改善效果无显著性差异(空腹血糖:WMD=0.31,95%CI:-0.17-0.79,P>0.05;糖化血红蛋白:WMD=0.01,95%CI:-0.19-0.20,P>0.05;胰岛素抵抗指数:WMD=-0.14,95%CI:-0.71-0.42,P>0.05);⑤亚组分析结果显示,空腹血糖指标在“训练频率≤3次/周”亚组分析中差异有显著性意义(WMD=0.92,95%CI:0.25-1.60,P=0.007);糖化血红蛋白在“训练频率>3次/周”亚组分析中差异有显著性意义(WMD=-0.2,95%CI:-0.3至-0.1,P<0.0001)。结论:①整体而言,HIIT与MICT对改善2型糖尿病超重或肥胖患者体质量、体质量指数、腰围及体脂百分比等体成分和空腹血糖、糖化血红蛋白及胰岛素抵抗指数等糖代谢指标无显著差异;②当训练周期≥12周、训练频率≤3次/周时,MICT对体质量以及体质量指数的改善效果具有一定优势。

甘油三酯-葡萄糖乘积指数与女性非糖尿病高血压左心室肥厚的相关性探讨

目的:探讨女性非糖尿病高血压患者甘油三酯-葡萄糖乘积(TyG)指数与左心室肥厚(LVH)的相关性。方法:回顾分析133名女性非糖尿病高血压患者,采用Pearson相关性分析与左室质量指数(LVMI)相关的因素,通过二元logistic回归分析获得LVH的影响因素,并通过ROC曲线分析TyG指数预测LVH的最佳截断值以及灵敏度和特异度。结果:在女性非糖尿病高血压患者中,与TyG指数低值组比较,TyG指数高值组其LVMI也较高。Pearson相关性分析发现LVMI与TyG指数、收缩压及夜间舒张压呈正相关(P<0.05)。二元Logistic回归分析显示,TyG指数和夜间收缩压是LVH的预测因素(OR=3.486,95%CI:1.417~8.577;OR=1.048,95%CI:1.019~1.077)。TyG指数与夜间收缩压联合预测LVH的AUC为0.75(95%CI:0.659~0.847),灵敏度为64.7%,特异度为76.8%。结论:在女性非糖尿病高血压患者中,TyG指数和夜间收缩压与左室质量指数呈正相关,可以作为左心室肥厚的预测因子。

益气化聚方与硫辛酸治疗2型糖尿病的血糖、代谢及神经病变分析

目的:观察益气化聚方联合硫辛酸对2型糖尿病(T2DM)患者血糖、代谢指标及周围神经病变的影响。方法:选取2020年8月至2022年12月上海中医药大学附属岳阳中西医结合医院收治的T2DM患者120例作为研究对象,采用随机数字表法分为对照组和观察组,每组60例。对照组给予硫辛酸治疗,观察组在对照组基础上加用益气化聚方治疗。比较2组患者在治疗后的临床疗效、血糖变化、代谢相关指标、周围神经病变及治疗期间不良反应发生情况。结果:治疗后,观察组患者治疗总有效率高于对照组,且高低密度脂蛋白胆固醇(HDL-C)水平、总神经运动神经传导速度(MNCV)及感觉神经传导速度(SNCV)评分(正中神经和腓总神经)显著升高,差异有统计学意义(P<0.05),空腹血糖(FPG)、餐后2 h血糖(2 h PG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、胰岛素抵抗指数(HOMA-IR)与对照组比较显著降低(P<0.05)。观察组治疗期间出现血小板功能异常2例、脸色苍白1例,对照组治疗期间出现血小板功能异常2例、脸色苍白2例,2组治疗后不良反应发生情况差异无统计学意义。结论:采用益气化聚方联合硫辛酸治疗T2DM可更明显改善周围神经病变,降低血糖,控制血脂,且安全性良好。

甘油三酯葡萄糖指数与心血管疾病相关性的研究进展

胰岛素抵抗是心血管疾病的危险因素之一,目前用于评价胰岛素抵抗的传统方法大多较为复杂且价格昂贵,临床应用较为局限。甘油三酯葡萄糖指数是一种新兴反映胰岛素抵抗水平的指标,被大量实验证实与心血管疾病相关。本文就胰岛素抵抗在心血管疾病中的作用机制以及甘油三酯葡萄糖指数与心血管疾病相关性的研究进展展开综述,旨在为早期发现和预防心血管疾病提供有力的指导。

三酰甘油-葡萄糖指数与冠状动脉慢血流的相关性研究

目的分析冠状动脉慢血流(CSF)相关风险因素,使用限制性立方样条(RCS)模型探究三酰甘油-葡萄糖(TyG)指数与CSF之间剂量-反应关系,进一步了解胰岛素抵抗(IR)与CSF发生间的关系。方法回顾性选取2021年6月至2023年5月就诊于新疆医科大学第五附属医院完善冠状动脉造影检查明确诊断为CSF的115例患者作为CSF组,另选取同期健康体检的121例无冠状动脉血流异常者作为正常血流组进行研究。运用多因素logistic回归分析发生CSF的相关风险因素,对TyG指数进行分组,运用RCS模型明确TyG指数与CSF之间的剂量-反应关系。结果多因素logistic回归分析结果表示,吸烟史(β=1.538,OR=4.655,95%CI:2.332~9.681)、收缩压(β=0.077,OR=1.080,95%CI:1.051~1.113)、低密度脂蛋白胆固醇(β=0.552,OR=1.737,95%CI:1.156~2.676)和TyG指数(β=1.072,OR=2.922,95%CI:1.629~5.475)为CSF的危险因素,淋巴细胞计数(β=-0.941,OR=0.390,95%CI:0.218~0.680)和左室射血分数(β=-0.126,OR=0.881,95%CI:0.813~0.944)为CSF的保护因素。RCS模型结果表示,TyG指数与CSF之间存在剂量-反应关系(P-overall<0.001,P-non-linear=0.001)。结论TyG指数为CSF的独立危险因素,二者之间存在非线性剂量-反应关系,IR可能与CSF的发生机制相关。

腹腔镜术前口服高糖溶液对结直肠癌患者的影响

目的探讨结直肠癌患者腹腔镜术前口服高糖溶液对术后胃肠功能、炎症水平及胰岛素抵抗的影响。方法选择2020年5月至2022年7月南京中医药大学附属连云港市中医院收治的78例结直肠癌患者为研究对象,利用随机数字表法将其分为两组,观察组39例,对照组39例。观察组男20例、女19例,年龄38~75(56.65±8.43)岁,Dukes分期:Ⅰ期21例,Ⅱ期18例;对照组男19例、女20例,年龄39~74(55.79±8.39)岁,Dukes分期:Ⅰ期22例,Ⅱ期17例。对照组采用常规治疗,观察组术前采用高糖溶液口服。比较两组患者的术后胃肠功能、炎症水平、胰岛素抵抗指数及并发症情况。采用独立样本t检验、配对t检验和χ^(2)检验。结果治疗后,观察组术后肛门排气时间、术后首次排便时间、住院时间分别为(23.97±2.85)h、(14.35±5.43)h、(5.69±0.87)d,均短于对照组(34.68±3.94)h、(21.06±7.47)h、(9.52±1.14)d,差异均有统计学意义(均P<0.05);治疗后,观察组患者肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平分别是(141.85±30.29)ng/L、(8.69±2.05)mg/L、(7.34±0.93)ng/L,均低于对照组(182.46±33.37)ng/L、(15.33±2.78)mg/L、(9.97±1.54)ng/L,差异均有统计学意义(均P<0.05);治疗后,观察组胰岛素抵抗指数(5.14±0.31),低于对照组(7.75±0.96),差异有统计学意义(P<0.05);治疗后,观察组并发症总发生率为10.25%(4/39),低于对照组的28.21%(11/39),差异有统计学意义(P<0.05)。结论腹腔镜术前口服高糖溶液能有效改善结直肠癌患者术后的胃肠功能,降低患者炎症水平,改善患者胰岛素抵抗,降低并发症发生率,值得推广。