中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2010, Vol. 32 ›› Issue (1): 7-12.doi: 10.3881/j.issn.1000-503X.2010.01.003

• 肥胖综合治疗论坛 • 上一篇    下一篇

肥胖致胰岛素抵抗和高血糖的机制、治疗及评测

赵维纲;朱惠娟   

  1. 中国医学科学院 北京协和医学院 北京协和医院内分泌科卫生部重点内分泌实验室,北京 100730
  • 收稿日期:2009-12-30 修回日期:1900-01-01 出版日期:2010-02-28 发布日期:2010-02-28
  • 通讯作者: 朱惠娟

Mechanism, Treatment, and Evaluation of Obesity-induced Insulin Resistance and Type 2 Diabetes

ZHAO Wei-gang; ZHU Hui-juan   

  1. Key Laboratory of Endocrinology of Ministry of Health, Department of Endocrinology,
    PUMC Hospital, CAMS and PUMC, Beijing 100730, China
  • Received:2009-12-30 Revised:1900-01-01 Online:2010-02-28 Published:2010-02-28
  • Contact: ZHU Hui-juan

摘要: 摘要:肥胖是2型糖尿病的主要原因。葡萄糖稳态异常由胰岛素信号蛋白信号传导缺欠引起,可导致肌肉葡萄糖摄取减少、脂质生成异常和肝糖输出增加。这一胰岛素信号紊乱与慢性炎性状态有关,该状态能诱发可诱导型一氧化氮合酶并升高一氧化氮和反应性氮簇水平,共同引起信号蛋白翻译后修饰作用。在肝脏和肌肉的胰岛素抵抗的分子机制间存在着差异。脂肪细胞来源的激素和细胞因子可增强或抑制葡萄糖感应和胰岛素信号传导。在葡萄糖稳态中存在着中枢神经系统调节。针对纠正肥胖引起的中枢神经系统和周围组织异常的多项治疗将证明是有效的。胰岛素抵抗机制研究、临床干预评测离不开胰岛素敏感性的精确评价方法,正常血糖葡萄糖钳夹技术是公认的金标准。

关键词: 肥胖, 胰岛素抵抗:2型糖尿病

Abstract: ABSTRACT:Obesity is a major cause of insulin resistance and type 2 diabetes. The altered glucose homeostasis is caused by faulty insulin signal transduction, which results in decreased glucose uptake by the muscle, altered lipogenesis, and increased glucose output by the liver. The etiology of this derangement in insulin signaling is related to a chronic inflammatory state, leading to the induction of inducible nitric oxide synthase and release of high levels of nitric oxide and reactive nitrogen species, which together cause posttranslational modifications in the signaling proteins. There are substantial differences in the molecular mechanisms of insulin resistance in muscle versus liver. Hormones and cytokines from adipocytes can enhance or inhibit both glycemic sensing and insulin signaling. The role of the central nervous system in glucose homeostasis also has been well established. Multi-pronged therapies aimed at rectifying obesity induced anomalies in both central nervous system and peripheral tissues may prove to be beneficial. The golden standard method to evaluate the insulin sensitivity is hyperinsulinemic euglycemic clamp.

Key words: obesity, insulin resistance, type 2 diabetes