文档介绍：胰岛素抵抗和代谢综合征
内容
胰岛素抵抗概念和发生机制
胰岛素抵抗评估方法
代谢综合征
改善胰岛素抵抗的药物介绍
胰岛素抵抗概念
胰岛素敏感性
胰岛素降低游离葡萄糖浓度的能力
刺激葡萄糖的利用: 肌肉与脂肪
抑制葡萄糖生成: 肝脏
胰岛素敏感性降低
胰岛素抵抗
肌肉与脂肪
肝脏
胰岛素对葡萄糖代谢的主要作用
肝脏:
通过抑制糖异生和糖原分解而阻止肝脏对葡萄糖的合成和肝糖输出。
肌肉与脂肪:
促进葡萄糖在外周组织转运,主要是在骨骼肌,而其他组织相对较少,脂肪仅占外周组织葡萄糖摄取量的1%。胰岛素刺激葡萄糖摄取作用是通过肌肉与脂肪细胞膜上的特殊葡萄糖转运蛋白(GluT-4)介导的。
Underlying causes of insulin-resistant states (1)
Prereceptor
Abnormal insulin (mutations) /Anti-insulin antibodies
Receptor
Decreased number of receptors (mainly, failure to activate tyrosine kinase) /Reduced binding of insulin /Insulin receptor mutations /Insulin receptor – blocking antibodies
Postreceptor
Defective signal transduction
Mutations of GLUT4 (In theory, these mutations could cause insulin resistance, but polymorphisms in the GLUT4 gene are rare.)
Combinations of defects - binations mon. Obesity is associated mainly with postreceptor abnormality and is also associated with a decreased number of insulin receptors. Obesity is the mon cause of insulin resistance.
Underlying causes of insulin-resistant states (2)
Other conditions that are categorized as receptor or postreceptor insulin-resistant states
Type A syndrome /Type B syndrome /Leprechaunism Lipodystrophic states /Ataxia-telangiectasia
Werner syndrome /Rabson-Mendenhall syndrome
Pineal hypertrophic syndrome
Aging - This may cause insulin resistance through a decreased production of GLUT-4
Increased production of insulin antagonists - A number of disorders are associated with increased production of insulin antagonists, such as Cushing syndrome, acromegaly, and stress states, such as trauma, surgery, diabetes ketoacidosis, severe infection, uremia, and liver cirrhosis.
Underlying causes of insulin-resistant states (3)
Medications associated with insulin resistance syndrome - These include glucocorticoids (Cushing syndrome), cyclosporine, niacin, and protease inhibitors.
Human immunodeficiency virus (HIV)17 - Protease inhibitor – associated lipodystrophy is a recognized  Nucleo