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年龄偏大的成年人负荷后高血糖与心血管风险增加相关

Post-Challenge Hyperglycemia in Older Adults Is Associated with Increased Cardiovascular Risk Profile

Crandall JP, Shamoon H, Cohen HW 2010/6/1 17:19:30

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J Clin Endocrinol Metab, 2009,

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Context:
Post-challenge hyperglycemia (PCH) is common in older adults and is associated with increased cardiovascular disease (CVD) risk and total mortality. However, PCH is rarely recognized in clinical settings, and the glycemic exposure and CVD risk profile of elderly individuals with PCH has not been defined.

Objective:
The aim of the study was to characterize metabolic and CVD risk profile of elderly subjects with PCH and to determine the effect of acute postprandial metabolic changes on vascular biomarkers.

Design:
We conducted a cross-sectional study with a standard meal challenge protocol.

Participants:
Older adults with normal glucose tolerance (n=30) or PCH (fasting glucose <126mg/dl and 2-h glucose ≥170mg/dl; n=28) participated in the study.

Main Outcome Measures:
We assessed fasting and postprandial levels of glucose, insulin, lipids, high sensitivity C-reactive protein, plasminogen activator inhibitor-1, and adiponectin and endothelial function using reactive hyperemia peripheral arterial tonometry.

Results:
Normal glucose tolerance and PCH subjects were matched for age, sex, body mass index, and ethnicity. Fasting glucose (102±3 vs. 93±2mg/dl; P<0.001) and glycosylated hemoglobin (5.7 vs. 5.4%; P=0.01) were modestly higher in the PCH group, which was also more insulin resistant (homeostasis model assessment for insulin resistance, 7.0±1.3 vs. 4.1±0.6; P=0.03). Fasting high sensitivity C-reactive protein was higher (2.6±0.5 vs. 1.3±0.2mg/dl; P=0.05), and adiponectin was lower (11.6±1.6 vs. 14.0±1.3μg/ml; P=0.03) in subjects with PCH. Peak and 6-h postprandial area under the curve glucose, insulin, and lipids were higher in PCH subjects, who also had higher fasting and postprandial levels of plasminogen activator inhibitor-1. Reactive hyperemia peripheral arterial tonometry declined postprandially only in PCH.

Conclusions:
Older adults with PCH experience significant fasting and postprandial metabolic dysregulation, which is accompanied by a proatherosclerotic and prothrombotic vascular profile.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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