Avogaro A
Unit of Metabolic Diseases, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy.
Panminerva Med. 2006 Mar;48(1):3-12.
The metabolic syndrome (MS) is a cluster of metabolic abnormalities with insulin resistance as a major characteristic. The main adverse consequence of the MS is cardiovascular disease (CVD). Complex, mutually reinforcing interactions between obesity and insulin resistance largely account for the pathogenesis of MS. Central pathophysiologic features include: insulin resistance, atherogenic dyslipidemia, chiefly present as low HDL-C together with increases in triglycerides and small dense, low density lipoprotein particles, hypertension, a proinflammatory state, with increases in acute-phase reactants, and a prothrombotic state. Although lifestyle and overeating seem to be the triggering pathogenic factors, genetic elements are also involved in the pathogenesis of MS. When present, insulin resistance results in impaired insulin action in insulin-sensitive tissues such as muscle, fat, and liver. Insulin resistance results in abnormalities of glucose metabolism, with reduced peripheral disposal of glucose in muscle and increased hepatic glucose output in the fasting state. But, most importantly, the progressively increasing concentration in circulating glucose leads to various abnormalities in insulin secretion. Elevated insulin levels themselves are atherogenic by inducing an oxidative stress and by stimulating sympathetic-nerve activity. Ectopic fat deposition, stress, proinflammatory state, and a maladaptive response of innate immunity may together concur to the development of the MS. When this condition is acknowledged, substantial modification of life style and correction of each single risk factor should be pursued without uncertainties and without hierarchical approach; this means that each risk factor should be treated and brought to target.
代谢综合征（MS）是一组以胰岛素抵抗为主要特征的代谢异常。MS的主要不良后果是心血管疾病（CVD）。肥胖与胰岛素抵抗之间复杂且相互强化的相互作用在很大程度上解释了MS的发病机制。主要的病理生理特征包括：胰岛素抵抗、致动脉粥样硬化性血脂异常，主要表现为高密度脂蛋白胆固醇（HDL-C）降低，同时甘油三酯升高以及小而密的低密度脂蛋白颗粒增加、高血压、促炎状态，表现为急性期反应物增加，以及血栓前状态。尽管生活方式和暴饮暴食似乎是触发致病因素，但遗传因素也参与了MS的发病机制。当存在胰岛素抵抗时，会导致胰岛素在肌肉、脂肪和肝脏等胰岛素敏感组织中的作用受损。胰岛素抵抗导致葡萄糖代谢异常，肌肉中葡萄糖的外周处置减少，空腹状态下肝脏葡萄糖输出增加。但最重要的是，循环葡萄糖浓度的逐渐升高会导致胰岛素分泌出现各种异常。胰岛素水平升高本身通过诱导氧化应激和刺激交感神经活动而具有致动脉粥样硬化作用。异位脂肪沉积、应激、促炎状态和先天免疫的适应性不良反应可能共同促成MS的发展。当认识到这种情况时，应毫无疑虑且不采取分级方法地对生活方式进行实质性改变并纠正每一个单一危险因素；这意味着应对每个危险因素进行治疗并使其达到目标。
