Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
Expert Opin Pharmacother. 2011 Aug;12(12):1887-1900. doi: 10.1517/14656566.2011.585462.
Metabolic syndrome (MetS) defines the clustering in an individual of multiple metabolic abnormalities, based on central obesity and insulin resistance. In addition to its five components, prothrombotic and proinflammatory states are essential features. The significance of MetS lies in its close association with the risk of type 2 diabetes and cardiovascular disease (CVD). This field being an evolving one necessitated the current review.
The areas covered in this review include the so far unproven concept that enhanced low-grade inflammation often leads to dysfunction of the anti-inflammatory and atheroprotective properties of apolipoprotein A-I (apoA-I) and HDL particles, which further increases the risk of diabetes and CVD. It was emphasized that lifestyle modification is essential in the prevention and management of MetS, which includes maintenance of optimal weight by caloric restriction, adherence to a diet that minimizes postprandial glucose and triglyceride fluctuations, restricting alcohol consumption, smoking cessation and engaging in regular exercise. Drug therapy should target the dyslipoproteinemia and the often associated hypertension or dysglycemia.Statins are the drugs of first choice, to be initiated in patients with MetS at high 10-year cardiovascular risk. Such treatment is inadequate if fasting serum triglycerides remain at > 150 mg/dl, when niacin should be combined. Fibrates, omega 3 fatty acids, metformin, angiotensin-converting enzyme inhibitors and pioglitazone are additional options in drug therapy.
Research on MetS in subpopulations prone to impaired glucose tolerance and insulin resistance has indicated that proinflammatory state and oxidative stress are often prominently involved in MetS, to the extent that evidence of impaired function of HDL and apo A-I particles is discernible by biological evidence of functional defectiveness via outcomes studies and/or correlations with inflammatory and anti-inflammatory biomarkers. A sex difference has been clear in this development.
代谢综合征（MetS）定义为个体中多种代谢异常的聚集，基于中心性肥胖和胰岛素抵抗。除了其五个组成部分外，促血栓形成和促炎状态是基本特征。MetS 的重要性在于它与 2 型糖尿病和心血管疾病（CVD）的风险密切相关。由于这一领域是一个不断发展的领域，因此需要进行当前的综述。
本综述涵盖的领域包括目前尚未得到证实的概念，即增强的低度炎症通常导致载脂蛋白 A-I（apoA-I）和高密度脂蛋白（HDL）颗粒的抗炎和抗动脉粥样硬化特性的功能障碍，这进一步增加了糖尿病和 CVD 的风险。强调生活方式的改变对于预防和管理 MetS 至关重要，包括通过热量限制维持最佳体重，遵循最大限度减少餐后血糖和甘油三酯波动的饮食，限制酒精摄入，戒烟和定期运动。药物治疗应针对脂蛋白异常血症以及通常相关的高血压或糖代谢异常。他汀类药物是首选药物，应在高 10 年心血管风险的 MetS 患者中启动治疗。如果空腹血清甘油三酯仍> 150mg/dl，则治疗不足，此时应联合使用烟酸。贝特类药物、ω-3 脂肪酸、二甲双胍、血管紧张素转换酶抑制剂和吡格列酮是药物治疗的其他选择。
在易发生糖耐量受损和胰岛素抵抗的亚人群中对 MetS 的研究表明，促炎状态和氧化应激通常与 MetS 密切相关，以至于通过功能缺陷的生物学证据可以看出 HDL 和 apoA-I 颗粒的功能受损的证据通过结局研究和/或与炎症和抗炎生物标志物的相关性。在这一发展过程中，性别差异明显。
