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Impairment in the number and function of CD34+/KDR+ circulating cells in diabetes and obesity with functional improvement after thymosin &bgr;4 treatment 胸腺素治疗后功能改善的糖尿病和肥胖症患者CD34+/KDR+循环细胞数量和功能受损
Pub Date : 2016-06-01 DOI: 10.1097/XCE.0000000000000076
P. S. Lee, L. Ye, E. Khoo, T. Yeo, H. Tan, A. Richards, K. Poh
BackgroundDiabetes and obesity are associated with endothelial dysfunction and atherosclerosis. As mature endothelial cells do not regenerate, CD34+/kinase insert domain receptor (KDR+) circulating cells may be an important source of vascular repair. Thymosin &bgr;4 (T&bgr;4) has been shown to have angiogenic properties. We aim to examine the number and function of CD34+/KDR+ circulating cells from Zucker diabetic fatty (ZDF) rats and investigate the effect of T&bgr;4 on these cells compared with Zucker lean (ZL) rats. MethodsBlood was collected from ZDF (n=20) and ZL (n=21) rats. Peripheral blood mononuclear cells were isolated using Ficoll density gradient centrifugation and grown on fibronectin-coated plates. Enumeration of CD34+ and KDR+ cells was performed with flow cytometry. Colony-forming, migration, and tubule formation assays were performed to determine functionality. Cells were treated with T&bgr;4 (10 ng/ml) for 3 days. ResultsThe number and function of CD34+/KDR+ circulating cells in ZDF rats were significantly reduced compared with ZL (CD34+/KDR+: 0.025±0.002 vs. 0.034±0.003%; colony-forming unit: 1.5±0.5 vs. 3.2±0.8; migrated cell: 7.5±1.0 vs. 11.0±2.1; tubule length: 4.3±0.5 vs. 5.8±1.1 mm2; P<0.05). T&bgr;4 significantly improved the migratory and tubule formation of T&bgr;4-treated CD34+/KDR+ circulating cells from ZDF rats to levels similar to cells from ZL rats (P>0.05). ConclusionA significant impairment in the number and function of CD34+/KDR+ circulating cells in ZDF rats was observed. The use of T&bgr;4 as a potential novel therapeutic target in improving migratory and angiogenic activities may prove to be important in diabetes and obesity.
背景:糖尿病和肥胖与内皮功能障碍和动脉粥样硬化相关。由于成熟的内皮细胞不能再生,CD34+/激酶插入结构域受体(KDR+)循环细胞可能是血管修复的重要来源。胸腺素&bgr;4 (T&bgr;4)已被证明具有血管生成特性。我们旨在检测Zucker糖尿病脂肪(ZDF)大鼠CD34+/KDR+循环细胞的数量和功能,并与Zucker瘦(ZL)大鼠比较T&bgr;4对这些细胞的影响。方法采集ZDF大鼠(n=20)和ZL大鼠(n=21)的血液。采用Ficoll密度梯度离心分离外周血单个核细胞,并在纤维连接蛋白包被板上培养。流式细胞术计数CD34+和KDR+细胞。进行菌落形成、迁移和小管形成试验以确定功能。细胞用T&bgr;4 (10 ng/ml)处理3天。结果与ZL相比,ZDF大鼠CD34+/KDR+循环细胞数量和功能显著降低(CD34+/KDR+: 0.025±0.002∶0.034±0.003%;菌落形成单位:1.5±0.5 vs. 3.2±0.8;迁移细胞:7.5±1.0 vs. 11.0±2.1;小管长度:4.3±0.5 vs. 5.8±1.1 mm2;P0.05)。结论ZDF大鼠CD34+/KDR+循环细胞数量和功能明显受损。利用T&bgr;4作为一种潜在的新治疗靶点来改善迁移和血管生成活动,可能在糖尿病和肥胖症中发挥重要作用。
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引用次数: 1
Longitudinal associations between adiponectin and cardiac structure differ by hypertensive status: Coronary Artery Risk Development in Young Adults. 脂联素与心脏结构之间的纵向关联因高血压状态而异:年轻人冠状动脉风险发展
Pub Date : 2016-06-01 DOI: 10.1097/XCE.0000000000000080
Shishir Sharma, Laura A Colangelo, Donald Lloyd-Jones, David R Jacobs, Myron D Gross, Samuel S Gidding, Philip Greenland

Objective: We studied the longitudinal association between adiponectin and cardiac structure and function 10 years later stratified by hypertension status.

Methods: Multicenter longitudinal study of black and white men and women that began in 1985-1986, when participants were 18-30 years old. Adiponectin was measured at year 15(2000-2001). Echocardiograms were completed at year 25(2010-2011). Participants were stratified by the presence of hypertension. Risk factor-adjusted echocardiographic variables were compared across adiponectin quintiles. Linear and quadratic regression models were also derived for risk factor-adjusted echocardiographic variables.

Results: Relative to the lowest quintile of adiponectin, participants from the highest quintile had a 6% lower LV mass index (LVMi) among normotensives, and an 8% higher LVMi among hypertensives. Among normotensive participants, regression analysis demonstrated a linear inverse relationship between adiponectin and LV mass, LVMi, posterior wall thickness (PWT) and ventricular septal thickness (VST) (all p≤0.05). Among hypertensive participants, regression analysis demonstrated a U-shaped relationship between adiponectin and LV mass, LVMi, PWT and VST (p≤0.005 for all quadratic terms).

Conclusions: Among normotensive participants, higher adiponectin may be a useful marker of less adverse future cardiac structure. Further study is required to see if adiponectin receptor agonists may provide a benefit among these individuals. Among hypertensive participants, further study is required to assess the prognostic and therapeutic use of adiponectin.

目的:研究高血压患者10年后脂联素与心脏结构和功能的纵向关系。方法:从1985-1986年开始,对18-30岁的黑人和白人男性和女性进行多中心纵向研究。在第15年(2000-2001年)测量脂联素。超声心动图于第25年(2010-2011年)完成。参与者根据高血压的存在进行分层。通过脂联素五分位数比较危险因素调整的超声心动图变量。对危险因素调整的超声心动图变量也建立了线性和二次回归模型。结果:相对于脂联素最低的五分位数,来自最高五分位数的参与者在正常血压组中左室质量指数(LVMi)低6%,在高血压组中LVMi高8%。在正常血压的受试者中,回归分析显示脂联素与左室质量、左室心肌梗死(LVMi)、后壁厚度(PWT)和室间隔厚度(VST)呈线性负相关(均p≤0.05)。在高血压患者中,回归分析显示脂联素与左室质量、LVMi、PWT和VST呈u型关系(所有二次项p≤0.005)。结论:在血压正常的参与者中,较高的脂联素可能是未来不良心脏结构较少的有用标志。脂联素受体激动剂是否对这些个体有益还需要进一步的研究。在高血压参与者中,需要进一步的研究来评估脂联素的预后和治疗应用。
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引用次数: 0
What should the systolic blood pressure be in older diabetics treated for hypertension 老年糖尿病高血压患者的收缩压应该是多少
Pub Date : 2016-06-01 DOI: 10.1097/XCE.0000000000000079
W. Aronow
The prevalence of hypertension is common in older diabetics, with its prevalence increasing with advancing age [1]. Hypertension and diabetes mellitus are both major independent risk factors for coronary events, stroke, peripheral arterial disease, and congestive heart failure in older individuals [2–7]. Left ventricular hypertrophy associated with hypertension increases cardiovascular events [3,8]. Reduction of left ventricular hypertrophy by antihypertensive treatment of hypertension reduces cardiovascular events and mortality [9–11].
高血压在老年糖尿病患者中普遍存在,且随着年龄的增长而增加[1]。高血压和糖尿病都是老年人冠状动脉事件、中风、外周动脉疾病和充血性心力衰竭的主要独立危险因素[2-7]。与高血压相关的左心室肥厚增加心血管事件[3,8]。通过降压治疗高血压减少左心室肥厚可减少心血管事件和死亡率[9-11]。
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引用次数: 0
The emergence of frailty and sarcopaenia in diabetes mellitus: description of inter-relationships and clinical importance 糖尿病患者虚弱和肌肉萎缩的出现:相互关系和临床重要性的描述
Pub Date : 2016-06-01 DOI: 10.1097/XCE.0000000000000075
A. Sinclair, Harriet Sinclair, S. Bellary, L. Rodríguez-Mañas
Diabetes mellitus is a highly prevalent chronic disease, with an associated heavy personal and public health burden of disability, morbidity and mortality. The focus of care for older patients with diabetes is prevention of functional decline, with early intervention rather than attempting to recover function later. Diabetes doubles the risk of frailty. An important contributor towards physical frailty is sarcopaenia, which manifests as an age-related loss of skeletal muscle volume and power. Frailty is not an inevitable consequence of the ageing process; it is a dynamic and potentially reversible condition that highlights the importance of early recognition and intervention. In this review, we examine the evidence for linking diabetes to frailty and sarcopaenia and how the emergence of these conditions should lead to changes in clinician behaviour in terms of assessment of function and goal setting. High-quality, focused research in this area is now mandatory.
糖尿病是一种非常普遍的慢性疾病,与残疾、发病率和死亡率相关的沉重的个人和公共卫生负担。老年糖尿病患者的护理重点是预防功能衰退,早期干预,而不是试图在以后恢复功能。糖尿病使身体虚弱的风险加倍。骨骼肌萎缩症是导致身体虚弱的一个重要因素,它表现为骨骼肌体积和力量的减少与年龄有关。衰老并不是不可避免的结果;这是一种动态的、潜在可逆的疾病,强调了早期识别和干预的重要性。在这篇综述中,我们研究了将糖尿病与虚弱和肌肉萎缩症联系起来的证据,以及这些疾病的出现如何导致临床医生在功能评估和目标设定方面的行为改变。在这一领域进行高质量、重点突出的研究现在是必须的。
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引用次数: 3
Venus and Mars: influence of sex on diabetes and cardiometabolic disease 金星与火星:性对糖尿病和心脏代谢疾病的影响
Pub Date : 2016-06-01 DOI: 10.1097/XCE.0000000000000082
A. Krentz
The latest estimates for global diabetes prevalence will no doubt concentrate the thoughts of healthcare officials in many countries [1]. Global age-standardized diabetes prevalence increased from 4.3% (95% credible interval 2.4–7.0) in 1980 to 9.0% (7.2–11.1) in 2014 in men, and from 5.0% (2.9–7.9) to 7.9% (6.4–9.7) in women. Thus, over a quarter of a century, the prevalence of diabetes more than doubled in men. The increase seen in women was less pronounced at 60%. These data are consistent with other reports that support a shift from an excess prevalence in women in the earlier part of the 20th century to a consistently higher male prevalence [2,3]. The male predominance in type 2 diabetes has implications for cardiometabolic disease prevention strategies that extend to population screening. For example, in the Rancho Bernardo Study, more women than men had isolated postchallenge (oral glucose tolerance test) hyperglycaemia as the only evidence of diabetes; the incidence of diabetes was higher in men than in women, with higher fasting but lower postchallenge glucose levels compared with women [3]. The prevalence of prediabetes syndromes – that is, impaired fasting glucose and impaired glucose tolerance – also differs by sex, with impaired fasting glucose being more prevalent in men and impaired glucose tolerance being more frequent in women [4].
对全球糖尿病患病率的最新估计无疑会引起许多国家卫生保健官员的关注。全球年龄标准化糖尿病患病率男性从1980年的4.3%(95%可信区间2.4-7.0)增加到2014年的9.0%(7.2-11.1),女性从5.0%(2.9-7.9)增加到7.9%(6.4-9.7)。因此,在25年多的时间里,男性糖尿病患病率增加了一倍多。女性的增幅不那么明显,为60%。这些数据与其他报告一致,这些报告支持从20世纪早期女性的过度流行转变为男性的持续较高流行[2,3]。男性在2型糖尿病中的优势对扩展到人群筛查的心脏代谢疾病预防策略具有启示意义。例如,在Rancho Bernardo研究中,女性比男性更多地将单独的激发后(口服葡萄糖耐量试验)高血糖作为糖尿病的唯一证据;男性的糖尿病发病率高于女性,与女性相比,空腹血糖水平较高,但挑战后血糖水平较低。糖尿病前期综合征(即空腹血糖受损和糖耐量受损)的患病率也因性别而异,空腹血糖受损在男性中更为普遍,而糖耐量受损在女性中更为常见。
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引用次数: 0
Adiponectin levels and cardiovascular disease – symptom or a cause? 脂联素水平与心血管疾病——症状还是原因?
Pub Date : 2016-06-01 DOI: 10.1097/XCE.0000000000000081
A. Odegaard
Adiponectin is a major adipocyte-secreted protein (adipokine) and is also considered a hormone that links excess adiposity with metabolic processes central to the pathophysiology of cardiovascular disease (CVD) [1–3]. Circulating levels of adiponectin are inversely proportional to adiposity and low adiponectin levels predict the development of type 2 diabetes and CVD [1,2]. Adiponectin concentration is largely determined by adipocyte size and insulin sensitivity [2,3], but is also secreted by cardiomyocytes [4]. Thus, there is a strong biological precedent for adiponectin as a biomarker of risk for CVD and rationale for the investigation by Sharma et al. [5].
脂联素是一种主要的脂肪细胞分泌蛋白(脂肪因子),也被认为是一种将过度肥胖与心血管疾病(CVD)病理生理中心代谢过程联系起来的激素[1-3]。循环中脂联素水平与肥胖成反比,低脂联素水平可预测2型糖尿病和心血管疾病的发展[1,2]。脂联素浓度主要由脂肪细胞大小和胰岛素敏感性决定[2,3],但也由心肌细胞[4]分泌。因此,脂联素作为心血管疾病风险的生物标志物有很强的生物学先例,这也为Sharma等人的研究提供了依据。
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引用次数: 0
Blood pressure guidelines: beyond simple targets 血压指南:超越简单目标
Pub Date : 2016-03-01 DOI: 10.1097/XCE.0000000000000066
S. Harrap
Hypertension and blood pressure guidelines have developed incrementally over the years, keeping pace, and now outstripping, the clinical trials that have fuelled their opinions and recommendations. The focus has been very much on treatment thresholds and targets, so well suited to the medical model. However, the routine approach to blood pressure reduction in individuals of high cardiovascular risk, irrespective of their pressure and without a target, seem to slipped under the radar of the guidelines. It is time to rectify this significant oversight and take a broader view of treatment paradigms other than those based simply on targets. Cardiovasc Endocrinol 00:000–000 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
多年来,高血压和血压指南一直在逐步发展,与临床试验保持同步,现在已经超过了临床试验,这些临床试验为它们的观点和建议提供了支持。重点是治疗阈值和目标,因此非常适合医学模式。然而,对于心血管疾病高危人群的常规降压方法,无论他们的血压如何,也没有目标,似乎都被指南忽视了。现在是纠正这种重大疏忽的时候了,对治疗范例采取更广泛的看法,而不是仅仅以目标为基础。版权所有©2015威科集团健康有限公司版权所有。
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引用次数: 0
'Knowing what matters in diabetes: healthier below 7': results of the campaign's first 10 years (part 1): participants with known type 2 diabetes. 了解糖尿病中的重要因素:7 岁以下更健康":活动头 10 年的结果(第 1 部分):已知 2 型糖尿病患者。
Pub Date : 2016-03-01 Epub Date: 2016-01-04 DOI: 10.1097/XCE.0000000000000072
Stephan Jacob, Andrea Klimke-Hübner, Franz-Werner Dippel, Werner Hopfenmüller

Introduction: During the 'Knowing what matters in diabetes: healthier below 7' diabetes campaign, more than 30 000 randomly participating individuals underwent an occasional, voluntary diabetes risk check between 2005 and 2014.

Methods: This campaign aimed to inform individuals in Germany about diabetes mellitus and its complications, the established risk factors for development of type 2 diabetes (T2D), their prevalence and management in the real-life population, the quality of risk factor control and actual disease management in participants with a history of established diabetes mellitus [people with diabetes (PWD)]. Besides demographic characteristics (e.g. sex, age) and anamnestic information (antihypertensive treatment, history of elevated plasma glucose levels, genetic disposition), risk factor assessment included BMI, waist circumference, and lifestyle (physical activity, nutritional habits). The requested information was complemented by direct measurements of blood pressure (BP) (routine), plasma glucose, and HbA1c (voluntary). Between 2005 and 2014, more than 31 000 individuals participated in 45 single campaigns in numerous German cities. Here, we report on the results of the subgroup of participants with known diabetes mellitus.

Results: Among the 26 522 individuals with a completed questionnaire participating in the years 2006-2014, 21 055 participants (79.4%) did not have a history of diabetes and 5098 individuals (19.2%) reported being diagnosed with T2D, 369 (1.4%) with type 1 diabetes. The proportion of participants with T2D increased markedly over the years from 13.3 (2006) to 21.7% (2014). The age group older than 64 years was the largest within this subgroup (67.3%), 48.4% men and 51.6% women. The prevalence of overweight or obesity was found in 78% and 69.2% of the PWD. More than 40% of individuals with T2D had no regular physical exercise and more than 15% had unfavorable nutritional habits. In all, 69.9% of participants with T2D had elevated BP as assessed during the campaign or reported treatment with antihypertensive drugs at any time. On average, almost half of PWD (46.3%) had an HbA1c above 7.0%; a significant trend toward higher values over the 10-year period was observed.

Conclusion: The analysis of PWD participating in the 'Knowing what matters in diabetes: healthier below 7' campaign showed that despite huge efforts in the past, important aspects for progression and complications of T2D mellitus are still not well controlled. This includes lifestyle habits as well as pharmaceutical treatment. Although the participants in this study cannot be considered a representative sample of the German population and occasional measurements without standardization further limit firm conclusions, the BP, plasma glucose, and HbA1c results indicate that a major proportion of PWD have insufficient metabolic and B

简介2005 年至 2014 年间,在 "了解糖尿病:7 岁以下更健康 "活动期间,3 万多名随机参与者自愿接受了不定期的糖尿病风险检查:该活动旨在让德国人了解糖尿病及其并发症、2 型糖尿病(T2D)的既定发病风险因素、这些因素在现实人群中的发病率和管理、风险因素控制的质量以及有糖尿病病史的参与者(糖尿病患者 (PWD))的实际疾病管理情况。除了人口统计学特征(如性别、年龄)和异常信息(抗高血压治疗、血浆葡萄糖水平升高史、遗传倾向)外,风险因素评估还包括体重指数、腰围和生活方式(体育活动、营养习惯)。除所要求的信息外,还对血压(BP)(常规)、血浆葡萄糖和 HbA1c(自愿)进行了直接测量。2005 年至 2014 年间,超过 31 000 人参加了在德国多个城市举行的 45 次活动。在此,我们将报告已知患有糖尿病的参与者分组的结果:结果:在 2006 年至 2014 年期间,共有 26 522 人填写了调查问卷,其中 21 055 人(79.4%)没有糖尿病史,5098 人(19.2%)被诊断为 T2D,369 人(1.4%)被诊断为 1 型糖尿病。患有 T2D 的参与者比例逐年显著增加,从 13.3%(2006 年)增至 21.7%(2014 年)。在这一亚组中,64 岁以上的年龄组人数最多(67.3%),其中男性占 48.4%,女性占 51.6%。78%和69.2%的残疾人患有超重或肥胖症。超过 40% 的终末期糖尿病患者没有定期进行体育锻炼,超过 15% 的患者有不良的营养习惯。在所有患有终末期糖尿病的参与者中,69.9%的人在活动期间被评估为血压升高,或报告在任何时候接受过降压药物治疗。平均而言,近一半的残疾人(46.3%)的 HbA1c 超过 7.0%;在 10 年的时间里,观察到 HbA1c 值有明显升高的趋势:对参与 "了解糖尿病:7 岁以下更健康 "活动的残疾人进行的分析表明,尽管过去做出了巨大努力,但仍未能很好地控制 T2D 患者病情发展和并发症的重要方面。这包括生活习惯和药物治疗。虽然这项研究的参与者不能被视为德国人口的代表性样本,而且没有标准化的偶然测量也进一步限制了结论的可靠性,但血压、血浆葡萄糖和 HbA1c 的结果表明,很大一部分残疾人的代谢和血压控制不足。随着时间的推移,所有参与者中患 T2D 的比例明显增加,这与近几十年来世界上许多其他国家 T2D 患病率不断上升的趋势一致。我们的研究结果凸显了优化疗法对于进一步改善已确诊患有这种常见慢性进展性疾病的患者的疾病管理的重要性。
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引用次数: 0
The effect of various stages of hypothermia on the ECG 不同阶段低温对心电图的影响
Pub Date : 2016-03-01 DOI: 10.1097/XCE.0000000000000060
H. Omar, Ehab El-Khabiry, D. Mangar, E. Camporesi
Hesham R. Omar, Ehab El-Khabiry, Devanand Mangar and Enrico M. Camporesi, Department of Internal Medicine, Mercy Medical Center, Clinton, Iowa, Department of Internal Medicine, OSF Saint Anthony Medical Center, Rockford, Illinois, Department of Anesthesia, Tampa General Hospital, TEAMHealth and Department of Surgery/Anesthesiology, Molecular Pharmacology and Physiology, FGTBA and TEAMHealth, University of South Florida, Tampa, Florida, USA
Hesham R. Omar, Ehab El-Khabiry, Devanand Mangar和Enrico M. Camporesi,爱荷华州克林顿Mercy医疗中心内科,伊利诺伊州罗克福德OSF圣安东尼医疗中心内科,坦帕综合医院TEAMHealth麻醉科,美国佛罗里达州坦帕市南佛罗里达大学外科/麻醉科,分子药药学和生理学,FGTBA和TEAMHealth
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引用次数: 2
The role of lipoxins in cardiometabolic physiology and disease 脂质在心脏代谢生理和疾病中的作用
Pub Date : 2016-03-01 DOI: 10.1097/XCE.0000000000000068
Emma Börgeson
Cardiometabolic pathophysiology is increasing in prevalence as a result of the escalating obesity pandemic. The search for novel therapeutics is ongoing and the strong interrelationship between diabetes and cardiovascular disease places emphasis on the need for drugs that target both pathologies, without interlinking side effects. Impaired inflammatory resolution may be the common denominator driving metabolic syndrome, diabetes, and cardiovascular disease. An interesting therapeutic approach would therefore be to promote the inflammatory resolution to subvert cardiometabolic disease. Inflammatory resolution is regulated by specialized proresolving lipid mediators: the &ohgr;3-polyunsaturated fatty acid-derived protectins, resolvins and maresins, and the &ohgr;6-polyunsaturated fatty acid-derived lipoxin (LX) A4 and LXB4. Here, we review novel evidence of how LXs may reduce pathological features associated with cardiometabolic disease. Recent evidence shows that LXs promote the resolution of obesity-induced adipose inflammation and systemic pathology. Furthermore, LXs attenuate cardinal processes associated with atherosclerotic plaque formation, for example, neutrophil recruitment, activation, and neutrophil extracellular traps formation, while promoting a proresolving M&PHgr; phenotype and enhancing efferocytosis. Finally, LXs inhibit angiogenic pathways, including endothelial proliferation and activation, while reducing platelet-neutrophil aggregation. Collectively, LXs may have therapeutic potential in attenuating cardiometabolic pathophysiology.
随着肥胖症的流行,心脏代谢病理生理学的患病率正在上升。寻找新的治疗方法正在进行中,糖尿病和心血管疾病之间的密切相互关系强调需要针对两种病理,没有相互关联的副作用的药物。炎症消退受损可能是导致代谢综合征、糖尿病和心血管疾病的共同因素。因此,一种有趣的治疗方法是促进炎症消退,从而破坏心脏代谢疾病。炎症消退是由专门的促脂质介质调节的:3-多不饱和脂肪酸衍生的保护蛋白、resolvins和maresins以及6-多不饱和脂肪酸衍生的脂素(LX) A4和LXB4。在这里,我们回顾了LXs如何减少与心脏代谢疾病相关的病理特征的新证据。最近的证据表明,LXs促进肥胖引起的脂肪炎症和全身病理的解决。此外,LXs减弱了与动脉粥样硬化斑块形成相关的主要过程,例如中性粒细胞的募集、激活和中性粒细胞胞外陷阱的形成,同时促进了M&PHgr的进展;表型和增强efferocytosis。最后,LXs抑制血管生成途径,包括内皮细胞增殖和活化,同时减少血小板-中性粒细胞聚集。综上所述,LXs可能具有降低心脏代谢病理生理的治疗潜力。
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引用次数: 3
期刊
Cardiovascular endocrinology
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