Lipid Metabolism Disorders

脂质代谢紊乱
  • 文章类型: Journal Article
    脂质代谢是维持体内平衡和健康的关键组成部分,和脂质是参与生物能量代谢的重要化学物质。近年来随着人们对脂质代谢的兴趣日益浓厚,越来越多的研究表明,脂质代谢异常与许多人类疾病的发展密切相关,包括癌症,心血管,神经学,和内分泌系统疾病。因此,了解异常脂质代谢如何促进相关疾病的发展及其作用机制,为治疗和预防相关疾病提供了理论基础,也为相关疾病的靶向治疗提供了新的途径。因此,在这篇综述中,我们讨论了各种人类疾病中异常脂质代谢的过程,包括心血管系统疾病,神经退行性疾病,内分泌系统疾病(如肥胖和2型糖尿病),和其他疾病,包括癌症。
    Lipid metabolism is a critical component in preserving homeostasis and health, and lipids are significant chemicals involved in energy metabolism in living things. With the growing interest in lipid metabolism in recent years, an increasing number of studies have demonstrated the close relationship between abnormalities in lipid metabolism and the development of numerous human diseases, including cancer, cardiovascular, neurological, and endocrine system diseases. Thus, understanding how aberrant lipid metabolism contributes to the development of related diseases and how it works offers a theoretical foundation for treating and preventing related human diseases as well as new avenues for the targeted treatment of related diseases. Therefore, we discuss the processes of aberrant lipid metabolism in various human diseases in this review, including diseases of the cardiovascular system, neurodegenerative diseases, endocrine system diseases (such as obesity and type 2 diabetes mellitus), and other diseases including cancer.
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  • 文章类型: Journal Article
    背景:脂质代谢紊乱与多个组织和器官的变性有关,但是,脂质代谢紊乱与椎间盘退变(IDD)之间的串扰机制尚未完全阐明。本研究旨在探讨脂质代谢异常信号对椎间盘终板软骨细胞(EPC)衰老和钙化的调控机制。
    方法:人椎间盘软骨终板组织,本研究建立了细胞模型和大鼠高脂血症模型。组织学和免疫组织化学用于人EPC组织检测。TMT标记的定量蛋白质组学用于检测差异蛋白,MRI,Micro-CT,采用银绿染色和免疫荧光法观察大鼠尾椎间盘的形态和退变。流式细胞术,衰老相关β-半乳糖苷酶染色,茜素红染色,碱性磷酸酶染色,DCFH-DA荧光探针,和Westernblot检测EPC细胞衰老的表达,衰老相关分泌表型,钙化相关蛋白和细胞衰老相关信号通路的激活。
    结果:我们的研究发现,人退行性EPC中高表达的氧化低密度脂蛋白(ox-LDL)和凝集素样氧化低密度脂蛋白受体1(LOX-1)与高脂血症(HLP)有关。TMT标记的定量蛋白质组学揭示了细胞周期调控等富集途径,软骨内骨形态发生和炎症。大鼠模型显示HLP能诱导ox-LDL,LOX-1、衰老和钙化标志物在EPC中高表达。此外,我们证明ox-LDL诱导的EPCs衰老和钙化依赖于LOX-1受体,ROS/P38-MAPK/NF-κB信号通路参与了ox-LDL/LOX-1诱导细胞衰老的调控。
    结论:因此,我们的研究表明ox-LDL/LOX-1通过ROS/P38-MAPK/NF-κB信号通路诱导EPCs衰老和钙化,提供有关了解脂质代谢紊乱与IDD之间联系的信息。
    BACKGROUND: Lipid metabolism disorders are associated with degeneration of multiple tissues and organs, but the mechanism of crosstalk between lipid metabolism disorder and intervertebral disc degeneration (IDD) has not been fully elucidated. In this study we aim to investigate the regulatory mechanism of abnormal signal of lipid metabolism disorder on intervertebral disc endplate chondrocyte (EPC) senescence and calcification.
    METHODS: Human intervertebral disc cartilage endplate tissue, cell model and rat hyperlipemia model were performed in this study. Histology and immunohistochemistry were used to human EPC tissue detection. TMT-labelled quantitative proteomics was used to detect differential proteins, and MRI, micro-CT, safranin green staining and immunofluorescence were performed to observe the morphology and degeneration of rat tail intervertebral discs. Flow cytometry, senescence-associated β-galactosidase staining, alizarin red staining, alkaline phosphatase staining, DCFH-DA fluorescent probe, and western blot were performed to detect the expression of EPC cell senescence, senescence-associated secretory phenotype, calcification-related proteins and the activation of cell senescence-related signaling pathways.
    RESULTS: Our study found that the highly expressed oxidized low-density lipoprotein (ox-LDL) and Lectin-like oxidized low-density lipoprotein receptor 1 (LOX-1) in human degenerative EPC was associated with hyperlipidemia (HLP). TMT-labelled quantitative proteomics revealed enriched pathways such as cell cycle regulation, endochondral bone morphogenesis and inflammation. The rat model revealed that HLP could induce ox-LDL, LOX-1, senescence and calcification markers high expression in EPC. Moreover, we demonstrated that ox-LDL-induced EPCs senescence and calcification were dependent on the LOX-1 receptor, and the ROS/P38-MAPK/NF-κB signaling pathway was implicated in the regulation of senescence induced by ox-LDL/LOX-1 in cell model.
    CONCLUSIONS: So our study revealed that ox-LDL/LOX-1-induced EPCs senescence and calcification through ROS/P38-MAPK/NF-κB signaling pathway, providing information on understanding the link between lipid metabolism disorders and IDD.
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  • 文章类型: Journal Article
    背景:桥本甲状腺炎(HT),甲状腺功能减退的常见原因,近年来发病率呈上升趋势,尤其是在女性中。除了常见的并发症,如脂代谢紊乱,HT患者也可能会出现一些严重的并发症,例如急性肾损伤和严重的肌肉损伤。本文探讨左甲状腺素钠片(L-T4)替代治疗甲状腺功能减退症严重并发症的疗效,包括治疗剂量,并发症恢复的持续时间,以及是否需要额外的治疗。
    我们描述了一例52岁的HT患者,她表现出肾脏损伤,肌肉损伤,和脂质代谢紊乱。血清肌酐水平升高,肌酸激酶,胆固醇,甘油三酯,低密度脂蛋白胆固醇,高密度脂蛋白胆固醇,肾小球滤过率估计值明显下降。该患者开始使用L-T4(75和100µg,alternate).
    经过两个月的治疗,血清肌酸激酶水平降至正常范围。估计的肾小球滤过率水平恢复,血清肌酐水平下调,虽然略高于正常范围。L-T4部分逆转HT诱导的肌肉疾病,肾功能,和该患者的血脂状况,并显着缓解了她的HT相关症状。
    BACKGROUND: Hashimoto thyroiditis (HT), a common cause of hypothyroidism, has shown an increasing incidence in recent years, particularly among women. In addition to the common complications such as lipid metabolism disorders, patients with HT may also experience some serious complications, acute kidney injury and severe muscle damage for instance. This article explored the effectiveness of levothyroxine sodium tablets (L-T4) replacement therapy in severe complications of hypothyroidism, including treatment dosage, duration of complication recovery, and whether additional treatment is needed.
    UNASSIGNED: We described a case of a 52-year-old woman with HT who exhibited kidney injury, muscle injury, and lipid metabolism disorders. The increased levels of serum creatinine, creatine kinase, cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and the decreased levels of estimated glomerular filtration rate were obviously observed. This patient was started on L-T4 (75 and 100 µg, alternate).
    UNASSIGNED: Following a two-month treatment, the serum creatine kinase level decreased to within normal range. The estimated glomerular filtration rate level was restored, and the serum creatinine level was down-regulated, although slightly higher than the normal range. L-T4 partially reversed HT-induced the disorders of muscle, renal function, and lipid profile of this patient and remarkably alleviated her HT-related symptoms.
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  • 文章类型: Journal Article
    背景:老年重度抑郁症(MDD)患者的临床症状更复杂,脂质代谢异常(ALM)发生率更高。这项研究旨在比较老年首发药物初治(FEDN)患者样本中有和没有ALM的患者之间的临床差异。
    方法:我们招募了266名老年MDD患者。社会人口统计学变量,临床资料,并获得脂质参数。汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HAMA),并采用阳性和阴性综合征量表(PANSS-P)的阳性子量表评估患者的抑郁,焦虑和精神病症状,分别。
    结果:在这项研究中,我们发现,老年MDD患者中ALM合并症的患病率为86.1%.与非异常脂质代谢(NALM)组相比,ALM组的患病时间较长,更高的临床总体严重程度量表(CGI-S)和HAMD评分,较高的促甲状腺激素(TSH)和葡萄糖水平。Logistic回归分析显示,老年MDD患者病程(OR=1.11,P=0.023,95CI=1.015~1.216)和CGI-S评分(OR=2.28,P=0.014,95CI=1.18~4.39)与ALM相关。
    结论:需要考虑老年MDD患者定期血脂评估的重要性。
    BACKGROUND: Older major depressive disorder (MDD) patients have more complex clinical symptoms and higher abnormal lipid metabolism (ALM) rates. This study aimed to compare clinical differences between those with and without ALM in a sample of older first-episode drug naïve (FEDN) patients.
    METHODS: We recruited 266 older MDD patients. Socio-demographic variables, clinical data, and lipid parameters were obtained. The Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and the positive subscale of the Positive and Negative Syndrome Scale (PANSS-P) were conducted to evaluate patients\' depression, anxiety and psychotic symptoms, respectively.
    RESULTS: In this study, we found that the prevalence of comorbid ALM was 86.1% in older MDD patients. Compared with the non-abnormal lipid metabolism (NALM) group, the ALM group had a higher duration of illness, higher clinical global impression of severity scale (CGI-S) and HAMD scores, higher thyroid stimulating hormone (TSH) and glucose levels. Logistic regression analysis indicated that duration of illness (OR = 1.11, P = 0.023, 95%CI = 1.015-1.216) and CGI-S score (OR = 2.28, P = 0.014, 95%CI = 1.18-4.39) were associated with ALM in older MDD patients.
    CONCLUSIONS: The importance of regular lipid assessment in older MDD patients needs to be taken into account.
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  • 文章类型: Journal Article
    甲状腺癌(TC)是全球发病率不断上升的肿瘤。其病因是复杂的,基于因素的多层相互作用。其中,脂质代谢紊乱已成为一个重要的研究领域。癌细胞通过代谢重新编程来促进它们的快速生长,扩散,和生存。这种重编程与脂质水平的显着变化有关,主要是脂肪酸(FA),因为它们在维持细胞结构中起着关键作用,促进信号通路,并提供能量。这些与脂质相关的变化有助于癌细胞满足持续生长和分裂的增加的需求,同时适应肿瘤微环境。在这次审查中,我们检查不同阶段的脂质代谢,包括合成,运输,和氧化,在TC的背景下,肥胖和激素对TC发育的影响。最近的科学努力揭示了甲状腺癌特有的脂质稳态紊乱,为早期发现和有针对性的治疗干预开辟了潜在的途径。了解FA代谢中涉及的复杂代谢途径可以提供对预防癌症进展和减轻其对周围组织的影响的潜在干预措施的见解。
    Thyroid cancer (TC) is a neoplasm with an increasing incidence worldwide. Its etiology is complex and based on a multi-layered interplay of factors. Among these, disorders of lipid metabolism have emerged as an important area of investigation. Cancer cells are metabolically reprogrammed to promote their rapid growth, proliferation, and survival. This reprogramming is associated with significant changes at the level of lipids, mainly fatty acids (FA), as they play a critical role in maintaining cell structure, facilitating signaling pathways, and providing energy. These lipid-related changes help cancer cells meet the increased demands of continued growth and division while adapting to the tumor microenvironment. In this review, we examine lipid metabolism at different stages, including synthesis, transport, and oxidation, in the context of TC and the effects of obesity and hormones on TC development. Recent scientific efforts have revealed disturbances in lipid homeostasis that are specific to thyroid cancer, opening up potential avenues for early detection and targeted therapeutic interventions. Understanding the intricate metabolic pathways involved in FA metabolism may provide insights into potential interventions to prevent cancer progression and mitigate its effects on surrounding tissues.
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  • 文章类型: Journal Article
    脂质代谢紊乱是几种严重影响公众健康的慢性代谢性疾病的主要原因。Salusin-α,血管活性肽,已被证明可以减轻脂质代谢紊乱,尽管其作用机制尚未报道。为了研究Salusin-α对脂质代谢的影响和潜在机制,使用慢病毒载体过表达或敲低Salusin-α。慢病毒转染HepG2细胞后,游离脂肪酸(FFA)诱导肝细胞脂肪变性。使用油红O染色并通过测量几种生化指标来评估脂质积累的程度。随后,生物信息学用于分析可能参与脂质代谢紊乱的信号通路。最后,半定量PCR和免疫印迹用于验证肝激酶B1(LKB1)/AMPK通路的参与。化合物C,AMPK的抑制剂,被用来进一步证实这种机制的参与。结果表明,Salusin-α显着减弱脂质积累,炎症和氧化应激。此外,Salusin-α增加了LKB1和AMPK的水平,抑制固醇调节元件结合蛋白-1c的表达,脂肪酸合成酶和乙酰辅酶A羧化酶。化合物C的添加消除了Salusin-α介导的AMPK对下游信号分子的调节。总之,Salusin-α的过表达激活了LKB1/AMPK途径,这反过来又抑制了HepG2细胞中的脂质积累。这提供了对Salusin‑α改善脂质代谢紊乱的潜在机制的见解,同时确定了潜在的治疗靶标。
    Lipid metabolism disorders are a major cause of several chronic metabolic diseases which seriously affect public health. Salusin‑α, a vasoactive peptide, has been shown to attenuate lipid metabolism disorders, although its mechanism of action has not been reported. To investigate the effects and potential mechanisms of Salusin‑α on lipid metabolism, Salusin‑α was overexpressed or knocked down using lentiviral vectors. Hepatocyte steatosis was induced by free fatty acid (FFA) after lentiviral transfection into HepG2 cells. The degree of lipid accumulation was assessed using Oil Red O staining and by measuring several biochemical indices. Subsequently, bioinformatics was used to analyze the signaling pathways that may have been involved in lipid metabolism disorders. Finally, semi‑quantitative PCR and western blotting were used to verify the involvement of the liver kinase B1 (LKB1)/AMPK pathway. Compound C, an inhibitor of AMPK, was used to confirm this mechanism\'s involvement further. The results showed that Salusin‑α significantly attenuated lipid accumulation, inflammation and oxidative stress. In addition, Salusin‑α increased the levels of LKB1 and AMPK, which inhibited the expression of sterol regulatory element binding protein‑1c, fatty acid synthase and acetyl‑CoA carboxylase. The addition of Compound C abrogated the Salusin‑α‑mediated regulation of AMPK on downstream signaling molecules. In summary, overexpression of Salusin‑α activated the LKB1/AMPK pathway, which in turn inhibited lipid accumulation in HepG2 cells. This provides insights into the potential mechanism underlying the mechanism by which Salusin‑α ameliorates lipid metabolism disorders while identifying a potential therapeutic target.
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  • 文章类型: Journal Article
    APOA1/C3/A4/A5簇是调节脂蛋白代谢和维持血浆脂质稳态的重要组成部分。全基因组关联分析和孟德尔随机化揭示了该集群内的遗传变异与脂质代谢紊乱之间的潜在关联。包括高脂血症和心血管事件。对基因调控复杂性的增强理解已导致对表观遗传变异在调节APOA1/C3/A4/A5基因表达中的作用的日益认识。对APOA1/C3/A4/A5簇的表观遗传调控模式的深入研究将有助于增加我们对脂质代谢紊乱的发病机理的理解,并促进新的治疗方法的发展。这篇综述讨论了APOA1/C3/A4/A5簇如何影响循环脂蛋白的生物学以及APOA1/C3/A4/A5簇的表观遗传调控的当前进展。
    The APOA1/C3/A4/A5 cluster is an essential component in regulating lipoprotein metabolism and maintaining plasma lipid homeostasis. A genome-wide association analysis and Mendelian randomization have revealed potential associations between genetic variants within this cluster and lipid metabolism disorders, including hyperlipidemia and cardiovascular events. An enhanced understanding of the complexity of gene regulation has led to growing recognition regarding the role of epigenetic variation in modulating APOA1/C3/A4/A5 gene expression. Intensive research into the epigenetic regulatory patterns of the APOA1/C3/A4/A5 cluster will help increase our understanding of the pathogenesis of lipid metabolism disorders and facilitate the development of new therapeutic approaches. This review discusses the biology of how the APOA1/C3/A4/A5 cluster affects circulating lipoproteins and the current progress in the epigenetic regulation of the APOA1/C3/A4/A5 cluster.
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  • 文章类型: Journal Article
    长期暴露于微重力被认为会导致肝脏脂质积聚,从而增加宇航员非酒精性脂肪性肝病(NAFLD)的风险。然而,症状持续存在的原因仍未得到充分研究.在这项研究中,我们使用了基于串联质量标签(TMT)的定量蛋白质组学技术,以及基于液相色谱-串联质谱(LC-MS/MS)的非靶向代谢组学技术,综合分析模拟微重力条件下大鼠肝脏组织中与脂质积累相关的蛋白质相对表达水平和代谢产物丰度。差异分析显示模拟微重力组和对照组之间有63种蛋白质和150种代谢物。通过整合差异表达的蛋白质和代谢物并进行途径富集分析,我们揭示了在模拟微重力条件下主要代谢途径的失调,包括不饱和脂肪酸的生物合成,亚油酸代谢,类固醇激素的生物合成和丁酸代谢,表明失重导致大鼠肝脏代谢中断。最后,我们研究了暴露于微重力刺激下的大鼠肝脏中与脂质代谢相关的差异表达蛋白。这些发现有助于确定受微重力影响的关键分子,并可以指导为宇航员设计合理的营养或药理对策。
    Long-term exposure to microgravity is considered to cause liver lipid accumulation, thereby increasing the risk of non-alcoholic fatty liver disease (NAFLD) among astronauts. However, the reasons for this persistence of symptoms remain insufficiently investigated. In this study, we used tandem mass tag (TMT)-based quantitative proteomics techniques, as well as non-targeted metabolomics techniques based on liquid chromatography-tandem mass spectrometry (LC-MS/MS), to comprehensively analyse the relative expression levels of proteins and the abundance of metabolites associated with lipid accumulation in rat liver tissues under simulated microgravity conditions. The differential analysis revealed 63 proteins and 150 metabolites between the simulated microgravity group and the control group. By integrating differentially expressed proteins and metabolites and performing pathway enrichment analysis, we revealed the dysregulation of major metabolic pathways under simulated microgravity conditions, including the biosynthesis of unsaturated fatty acids, linoleic acid metabolism, steroid hormone biosynthesis and butanoate metabolism, indicating disrupted liver metabolism in rats due to weightlessness. Finally, we examined differentially expressed proteins associated with lipid metabolism in the liver of rats exposed to stimulated microgravity. These findings contribute to identifying the key molecules affected by microgravity and could guide the design of rational nutritional or pharmacological countermeasures for astronauts.
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  • 文章类型: Case Reports
    我们介绍了一个诊断为纯合子家族性高胆固醇血症的小男孩,该男孩表现为他汀类药物和依泽替米贝耐药。患者在6岁时接受了脂蛋白单采术。他的低密度脂蛋白胆固醇水平显着降低通过添加lomitapide和evinacumab,他的颈动脉斑块开始消退.
    We present a young boy with a diagnosis of homozygous familial hypercholesterolemia who presented with statin and ezetimibe resistance. The patient received lipoprotein apheresis at 6 years of age. His low-density lipoprotein cholesterol levels significantly were reduced by adding lomitapide and evinacumab, and his carotid plaque started to regress.
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  • 文章类型: Journal Article
    目的:阻塞性睡眠呼吸暂停(OSA)与糖脂代谢异常有关。然而,睡眠呼吸暂停特异性低氧负担(SASHB)与OSA患者糖脂代谢紊乱之间是否存在独立关联尚不清楚.
    方法:在这项研究中,我们从2019年1月至2023年7月招募了2,173名疑似OSA的参与者。多导睡眠图变量,生化指标,并收集每位参与者的身体测量值.多元线性回归分析用于评估SASHB,AHI,CT90和葡萄糖以及脂质分布。此外,逻辑回归用于确定各种SASHB中异常葡萄糖和脂质代谢的比值比(OR),AHI,CT90四分位数。
    结果:SASHB与空腹血糖(FBG)独立相关(β=0.058,P=0.016),空腹胰岛素(FIN)(β=0.073,P<0.001),胰岛素抵抗的稳态模型评估(HOMA-IR)(β=0.058,P=0.011),总胆固醇(TC)(β=0.100,P<0.001),总甘油三酯(TG)(β=0.063,P=0.011),低密度脂蛋白胆固醇(LDL-C)(β=0.075,P=0.003),载脂蛋白A-I(apoA-I)(β=0.051,P=0.049),载脂蛋白B(apoB)(β=0.136,P<0.001),校正混杂因素后的载脂蛋白E(apoE)(β=0.088,P<0.001)。此外,在较高的SASHB四分位数中,高胰岛素血症的OR分别为1.527、1.545和2.024,与最低四分位数相比(线性趋势P<0.001);与最低四分位数相比,高SASHB四分位数中高总胆固醇血症的OR分别为1.762、1.998和2.708(线性趋势P<0.001),与低四分位数相比,高SASHB四分位数中高LDL胆固醇血症的OR分别为1.663、1.695和2.值得注意的是,高甘油三酯血症的OR{1.471,1.773,2.099}和异常HOMA-IR{1.510,1.492,1.937}在SASHB四分位数中保持了一致的趋势。
    结论:我们发现SASHB与高胰岛素血症独立相关,异常HOMA-IR,高总胆固醇血症,中国汉族人群高甘油三酯血症和高LDL胆固醇血症。需要进一步的前瞻性研究来证实SASHB可以作为OSA患者糖脂代谢异常的预测因子。
    背景:ChiCTR1900025714{http://www.chictr.org.cn/};2019年9月6日提前注册;中国。
    OBJECTIVE: Obstructive sleep apnea (OSA) is associated with abnormal glucose and lipid metabolism. However, whether there is an independent association between Sleep Apnea-Specific Hypoxic Burden (SASHB) and glycolipid metabolism disorders in patients with OSA is unknown.
    METHODS: We enrolled 2,173 participants with suspected OSA from January 2019 to July 2023 in this study. Polysomnographic variables, biochemical indicators, and physical measurements were collected from each participant. Multiple linear regression analyses were used to evaluate independent associations between SASHB, AHI, CT90 and glucose as well as lipid profile. Furthermore, logistic regressions were used to determine the odds ratios (ORs) for abnormal glucose and lipid metabolism across various SASHB, AHI, CT90 quartiles.
    RESULTS: The SASHB was independently associated with fasting blood glucose (FBG) (β = 0.058, P = 0.016), fasting insulin (FIN) (β = 0.073, P < 0.001), homeostasis model assessment of insulin resistance (HOMA-IR) (β = 0.058, P = 0.011), total cholesterol (TC) (β = 0.100, P < 0.001), total triglycerides (TG) (β = 0.063, P = 0.011), low-density lipoprotein cholesterol (LDL-C) (β = 0.075, P = 0.003), apolipoprotein A-I (apoA-I) (β = 0.051, P = 0.049), apolipoprotein B (apoB) (β = 0.136, P < 0.001), apolipoprotein E (apoE) (β = 0.088, P < 0.001) after adjustments for confounding factors. Furthermore, the ORs for hyperinsulinemia across the higher SASHB quartiles were 1.527, 1.545, and 2.024 respectively, compared with the lowest quartile (P < 0.001 for a linear trend); the ORs for hyper-total cholesterolemia across the higher SASHB quartiles were 1.762, 1.998, and 2.708, compared with the lowest quartile (P < 0.001 for a linear trend) and the ORs for hyper-LDL cholesterolemia across the higher SASHB quartiles were 1.663, 1.695, and 2.316, compared with the lowest quartile (P < 0.001 for a linear trend). Notably, the ORs for hyper-triglyceridemia{1.471, 1.773, 2.099} and abnormal HOMA-IR{1.510, 1.492, 1.937} maintained a consistent trend across the SASHB quartiles.
    CONCLUSIONS: We found SASHB was independently associated with hyperinsulinemia, abnormal HOMA-IR, hyper-total cholesterolemia, hyper-triglyceridemia and hyper-LDL cholesterolemia in Chinese Han population. Further prospective studies are needed to confirm that SASHB can be used as a predictor of abnormal glycolipid metabolism disorders in patients with OSA.
    BACKGROUND: ChiCTR1900025714 { http://www.chictr.org.cn/ }; Prospectively registered on 6 September 2019; China.
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