Nauck M A, Meier J J, Wolfersdorff A V, Tillil H, Creutzfeldt W, Köbberling J
Diabetes Center Bad Lauterberg, Kirchberg 21, D-37431 Bad Lauterberg in Harz, Germany.
Acta Diabetol. 2003 Dec;40(4):163-72. doi: 10.1007/s00592-003-0106-y.
A follow-up study of first-degree relatives of type 2 diabetic patients presented the opportunity to study the association of components of the metabolic syndrome with oral glucose tolerance in these subjects. In 1992, 25 years after the first analysis of the cohort, we performed 75-g oral glucose tolerance tests and measured anthropometric data (body mass index, waist-hip ratio), insulin and C-peptide concentrations, and parameters of lipoprotein metabolism (free fatty acids, triglycerides, cholesterol, HDL cholesterol). Of 135 participants, 71 had normal glucose tolerance (GT), 22 had impaired GT, and 42 had diabetic GT (WHO 1985 criteria). Impaired glucose tolerance and diabetes were significantly (Kruskal-Wallis test) associated with advanced age (p=0.001), higher body mass index (p=0.005) and waist-hip ratio (p=0.027), systolic hypertension (p=0.031), elevated basal insulin concentrations (p<0.001), higher free fatty acids (p<0.001) and triglycerides (p=0.017), and lower HDL cholesterol (p=0.003); no associations were found with total and LDL cholesterol levels (Friedewald's formula, p=0.25). Abnormalities (obesity, hypertriglyceridemia, low HDL cholesterol, hypertension, pathological oral glucose tolerance) were associated with significant deterioriations in all other components of the metabolic syndrome, if their number exceeded three. Disturbances of oral glucose tolerance are present in a high percentage of first-degree relatives after 25 years of follow-up (51% of those tested). Impaired or diabetic glucose tolerance in such a cohort was associated with overweight, hypertension and disturbances of lipoprotein metabolism characteristic of the metabolic syndrome. Hypercholesterolemia (LDL-cholesterol) is not a component of the metabolic syndrome in a German population with a high hereditary burden regarding type 2 diabetes. A metabolic syndrome should certainly be diagnosed if three components are present, although even in the presence of only two components, an elevated risk is evident.
对2型糖尿病患者的一级亲属进行的一项随访研究提供了一个机会，来研究这些受试者中代谢综合征各组分与口服葡萄糖耐量之间的关联。1992年，即对该队列进行首次分析的25年后，我们进行了75克口服葡萄糖耐量试验，并测量了人体测量数据（体重指数、腰臀比）、胰岛素和C肽浓度以及脂蛋白代谢参数（游离脂肪酸、甘油三酯、胆固醇、高密度脂蛋白胆固醇）。在135名参与者中，71人葡萄糖耐量正常（GT），22人葡萄糖耐量受损，42人患有糖尿病性GT（根据世界卫生组织1985年标准）。葡萄糖耐量受损和糖尿病与高龄（p=0.001）、较高的体重指数（p=0.005）和腰臀比（p=0.027）、收缩期高血压（p=0.031）、基础胰岛素浓度升高（p<0.001）、较高的游离脂肪酸（p<0.001）和甘油三酯（p=0.017）以及较低的高密度脂蛋白胆固醇（p=0.003）显著相关（Kruskal-Wallis检验）；未发现与总胆固醇和低密度脂蛋白胆固醇水平相关（Friedewald公式，p=0.25）。如果异常情况（肥胖、高甘油三酯血症、低高密度脂蛋白胆固醇、高血压、病理性口服葡萄糖耐量）的数量超过三个，则与代谢综合征所有其他组分的显著恶化相关。经过25年的随访，高比例（51%的受测者）的一级亲属存在口服葡萄糖耐量异常。在这样一个队列中，葡萄糖耐量受损或糖尿病与超重、高血压以及代谢综合征特有的脂蛋白代谢紊乱相关。在2型糖尿病遗传负担较高的德国人群中，高胆固醇血症（低密度脂蛋白胆固醇）并非代谢综合征的组分。如果存在三个组分，当然应该诊断为代谢综合征，不过即使仅存在两个组分，风险也明显升高。
