The metabolic syndrome -: a neuroendocrine disorder?
The metabolic syndrome -: a neuroendocrine disorder?
复制标题
DOI：
10.1017/s0007114500000957
复制
发表时间：
2000-03-01
影响因子：
3.6
通讯作者：
Rosmond, R
中科院分区：
文献类型：
--
作者：
Björntorp, P;Rosmond, R
向心性肥胖是疾病的有力预测因子。通过利用唾液皮质醇测量一整天，现在已经有可能显示在人口的基础上，感知压力相关的皮质醇分泌经常在这种情况下升高。其次是胰岛素抵抗、体内脂肪的集中积聚、血脂异常和高血压（代谢综合征）。社会经济和社会心理障碍可能是下丘脑-垂体-肾上腺（HPA）轴活动过度的主要诱因。酒精、吸烟和精神疾病的特征也与此有关。在一小部分人群中，存在HPA轴功能失调、抑制，与性类固醇和生长激素分泌减少以及交感神经系统活动增加有关。这种情况之后是一致的异常，表明代谢综合征。HPA轴的这种“烧坏”功能以前曾在长期暴露于环境压力的受试者中观察到。中枢糖皮质激素受体（GR）对HPA轴的反馈控制似乎是无效的，这与GR基因位点5 '端的多态性有关。纯合子约占瑞典男性的14%（女性待检查）。这类男性皮质醇分泌控制不良，腹部肥胖，胰岛素抵抗和高血压。此外，在GR基因的调节结构域中已经确定了与皮质醇分泌升高相关的多态性;多巴胺和瘦素受体基因的多态性分别与交感神经系统活动、血压升高和血压降低相关。这些结果表明代谢综合征的神经内分泌背景复杂，HPA轴的调节动力学起着核心作用。
Central obesity is a powerful predictor for disease. By utilizing salivary cortisol measurements throughout the day, it has now been possible to show on a population basis that perceived stress-related cortisol secretion frequently is elevated in this condition. This is followed by insulin resistance, central accumulation of body fat, dyslipidaemia and hypertension (the metabolic syndrome). Socio-economic and psychosocial handicaps are probably central inducers of hyperactivity of the hypothalamic-pituitary adrenal (HPA) axis. Alcohol, smoking and traits of psychiatric disease are also involved. In a minor part of the population a dysregulated, depressed function of the HPA axis is present, associated with low secretion of sex steroid and growth hormones, and increased activity of the sympathetic nervous system. This condition is followed by consistent abnormalities indicating the metabolic syndrome. Such 'burned-out' function of the HPA axis has previously been seen in subjects exposed to environmental stress of long duration. The feedback control of the HPA axis by central glucocorticoid receptors (GR) seems inefficient, associated with a polymorphism in the 5 ' end of the GR gene locus. Homozygotes constitute about 14 % of Swedish men (women to be examined). Such men have a poorly controlled cortisol secretion, abdominal obesity, insulin resistance and hypertension. Furthermore, polymorphisms have been identified in the regulatory domain of the GR gene that are associated with elevated cortisol secretion; polymorphisms in dopamine and leptin receptor genes are associated with sympathetic nervous system activity, with elevated and low blood pressure, respectively. These results suggest a complex neuroendocrine background to the metabolic syndrome, where the kinetics of the regulation of the HPA axis play a central role.