治疗高血压到糖尿病防治代谢症候群的观点.ppt

Renin-Angiotensin System and Glucose Tolerance由治療高血壓到糖尿病防治代謝症候群觀點 國立成功大學醫學院附設醫院 內科部內分泌新陳代謝科 吳達仁 醫師 代謝症候群之回顧與前瞻 糖尿病診斷愈來愈寬鬆 糖尿病醫師人數不足 糖尿病醫師用藥未達標準 糖尿病難纏的病例增加 代謝症候群之臨床案例增加 文化因素 治療高血壓增加糖尿病 治療高血脂增加糖尿病 代謝症候群之治療: 充分、全面、圓滿 防範第2型糖尿病發生之臨床研究結果 LIFE: New-Onset Diabetes Valsartan Improves Insulin Sensitivity in Hypertensive Patients Angiotensin II in the Progression of Atherosclerosis Angiotensin-converting Enzyme (ACE) Activity and Vascular Mass are Both Increased in the Mesenteric Arteries of Diabetic Rats ACEI and Glucose Metabolism Angiotensin-converting Enzyme (ACE) 經由　Bradykinin – Nitric oxide 而增加胰島素敏感度 Skeletal Muscle Glucose Uptake: Acute Insulin Response ARBs Prevent Angiotensin II Escape Deletion of the Angiotensin Type 2 Receptor (AT2R) Reduces Adipose Cell Size and Protects From Diet-Induced Obesity and Insulin Resistance AT2Ry/– mice had a normal adiposity but displayed a striking adipose tissue phenotype characterized by small adipocytes and an increase in cell number. In muscle, the expression of several genes involved in lipid metabolism,. In response to high-fat feeding, these mice were protected against obesity and obesity-related glucose intolerance, as assessed by glucose tolerance tests. Moreover, lipid oxidation assessed by indirect calorimetry was higher in AT2R-deficient mice than in wild-type mice, irrespective of the diet. AT2R-dependent signaling exerts a direct or indirect negative control on lipid utilization in muscles. These data support the idea that AT2R-dependent Ang II signaling increases adipose cell mass and glucose intolerance and thus could participate to the deleterious effects of a high-fat diet. Angiotensin II Enhances Insulin Sensitivity in Vitro and in Vivo AII had no effect on basal glucose uptake, but significantly potentiated insulin-stimulated glucose uptake; this effect was abolished by the AT1 antagonist, losartan. AII did not alter the insulin binding capacity of adipocytes, but increased insulin-stimulated tyrosine