胰岛素抵抗讲课资料.ppt

This study evaluated the incidence of CHD mortality and all CHD events during a 3.5-year period in 1,069 elderly patients without diabetes and 229 patients with type 2 diabetes. Overall, incidence of fatal CHD and nonfatal myocardial infarction was 3.4% among those without diabetes and 14.8% among those with diabetes. The odds ratios (CI, 95%) for CHD death and nonfatal MI were 11.7 and 4.7 for women with diabetes compared with those without diabetes. In men, corresponding odds ratios were 0.43 and 1.4. This slide demonstrates the incidence of death from CHD and of all CHD events over 3.5 years in patients with diabetes according to tertiles of HbA1c. The highest tertile of HbA1c was >7.9%, middle tertile included HbA1c between 6.0% and 7.9%, and lowest tertile included HbA1c <6%. Patients in the highest HbA1c tertile had a significantly (P<0.01) higher incidence of CHD mortality than did patients in the lowest tertile. Furthermore, incidence of all CHD events was significantly (P<0.05) greater in the highest HbA1c tertile relative to the lowest tertile. The investigators concluded that poor metabolic control and the duration of type 2 diabetes are important predictors of CHD risk in elderly subjects, especially women. Those patients with poor metabolic control are at highest risk of?CHD. Kuusisto J, et al. Diabetes. 1994;43:960–967. PA1-1在纤溶系统的途径中的作用 组织纤溶酶原激活物(t-PA) 1型纤溶酶原激活物抑制剂 纤溶酶原 ˉ ˉ ˉ纤溶酶活性 --- 血栓形成 胰岛素抵抗和1型纤溶酶原激活物抑制剂(PAI-1) PAI-1在纤溶系统中起主要调节作用 在存在胰岛素抵抗的患者（如高甘油三酯血症、肥胖、冠心病、动脉粥样硬化和２型糖尿病等患者）中PAI-1的血浆水平较高 用二甲双胍治疗２型糖尿病可以恢复PAI-1水平，起到预防心血管事件的作用 颈动脉粥样硬化的危险性和PAI-1水平相关 发生动脉硬化的机率比 2nd 1.0 1.5 1.2 1.6 3rd 4th PAI-1的四种水平 1st 1.2 1.4 1.6 1.0 ARIC Study Circulation 91, 284, 1995 胰岛素抵抗综合征 高胰岛素血症 糖耐量异常和２型糖尿病 高血压 甘油三酯升高 高密度脂蛋白降低 向心性肥胖 小而密LDL 餐后脂血症 内皮功能障碍 纤溶系统异常 (↑PAI-1,↑纤维蛋白原等) 多囊卵巢综合征 “经典的”描述 “扩充后”的描述 多囊卵巢综合症的临床表现 不育和月经紊乱 月经稀发 50% 闭经 20% 雄激素增多 胰岛素抵抗综合征 ２型糖尿病（发生机率增加7倍） 心血管疾病（发生机率增加４倍） 高甘油三酯血症、血脂紊乱、高血压和中枢性肥胖 探索多囊卵巢综合征中的胰岛素抵抗 多囊卵巢综合征 不育 月经紊乱 雄激素增多 痤疮 多毛症 男性