Biochem 18.01.55(เช้า)

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Biochem 18.01.55(เช้า)

  1. 1. Rx42 Fon 050 & Dew 055 1 Metabolic Disease II . 18 2555 Biochemistry Metabolic Syndrome and Related Disease Metabolic syndrome Factors 1. 2. 3. 4. factor fasting plasma glucose > 110 mg/dl > 100 mg/dl1. Obesity2. Insulin resistance3. Pro-inflammatory&Pro-thrombotic factor
  2. 2. Rx42 Fon 050 & Dew 055 2 Metabolic Disease II . 18 25551.Obesity ( ) 1. Body mass index BMI 2. Distribution of fat deposition 3. Subcutaneous fat and visceral fat deposition BMI kg) m2 Diagnosis BMI for Caucasoid BMI for Asian Underweight <18.5 <18.5 Normal 18.5-24.9 18.5-22.9 Overweight 25-29.9 23-24.9 Obesity ≥30 ≥25 Caucasoid metabolicsyndrome
  3. 3. Rx42 Fon 050 & Dew 055 3 Metabolic Disease II . 18 25551. Adominal obesity = android type -2. Gluteal-femoral obesity = gynoid type -Distribution of fat deposition Adominal obesity metabolicsyndrome adonpmal 1. Waist circumference cm (36 ) cm (32
  4. 4. Rx42 Fon 050 & Dew 055 4 Metabolic Disease II . 18 25552. Waist-height ratio(WHtR) WHtR adominal obesity3. Waist-hip ratio(WHR)
  5. 5. Rx42 Fon 050 & Dew 055 5Metabolic Disease II . 18 2555 Distribution of fat deposition adominal gluteal-femerol obesity obesity
  6. 6. Rx42 Fon 050 & Dew 055 6 Metabolic Disease II . 18 2555 Waist Waist-height circumference ratio(WHtR)Subcutaneous and Visceral fat deposition - Subcutaneous fat -- - Visceral fat Subcutaneous fat abdominal fat metabolic syndrome metabolic rate glycerol fatty acid 1. energy reservation 2.
  7. 7. Rx42 Fon 050 & Dew 055 7 Metabolic Disease II . 18 2555 energy reservation- TAG energy resource- Mobilize free fatty acid Visceral fat fatty acidvisceral fat VLDLvisceral fat insulin inhibitor : visceral fat>>> Lypolysis adipose tissue- fatty acid source of energy FFA- β-oxidation fatty acid
  8. 8. Rx42 Fon 050 & Dew 055 8 Metabolic Disease II . 18 2555- glycogen- ketogenesis substrate Lypolysis- VLDL fat VLDL VLDL LDL LDL Hormone (endocrine) metabolicsyndrome- Adiponectin- Leptin : vascular wall- Pro-inflammatory cytokine adiponectin>>> adiponectin(ApN) peptide mature adipocyte adiponectinvisceral fat visceral fat ApN
  9. 9. Rx42 Fon 050 & Dew 055 9 Metabolic Disease II . 18 2555 ApN subcutaneous fat metabolic syndrome ApN 1. endothelial inflammation Anti-inflammatory effect ApN vascular wall 2. vascular endothelial function endothelial Nitric Oxide Synthase (eNOS) Nitric oxide (NO) vasodilatation platelet aggregation 3. Sensitization of insulin glucose uptake oxidation glucose TG LDL2. Insulin resistance
  10. 10. Rx42 Fon 050 & Dew 055 10 Metabolic Disease II . 18 2555 insulin hyperinsulinemiainsulin insulin β-celldysfunction β-cell β-cell insulin β-celldysfunction insulin insulin - insulin glucose Glucose transport 1. Facilitated diffusion transport system 2. Na-monosaccharide cotransporter system insulin
  11. 11. Rx42 Fon 050 & Dew 055 11 Metabolic Disease II . 18 2555 1. Insulin-sensitive insulin glucose muscle adipose tissue glucose Facilitated diffusion transport system GLUT-4 2. Insulin-insensitive insulin glucose glucose insulin GLUT-6- 1. glycolysis glucose uptake 2. glucose-6-phosphatase 3. 4. glycogenolysis- 1. lipogenesis 2. lypolysis- protein nucleic acid metabolism 1. RNA&DNA
  12. 12. Rx42 Fon 050 & Dew 055 12 Metabolic Disease II . 18 2555 2. : insulin resistance insulin 1. hyperinsulinemia 2. glucose Diabetes MellitusDiabetes Mellitus - - 1) relative deficiency of insulin insulin insulin resistance or DM type2 2) absolute deficiency of insulin insulin -Definition of Diabetes mellitus
  13. 13. Rx42 Fon 050 & Dew 055 13 Metabolic Disease II . 18 2555 - ADA 2010 1) 8 2) HbA1C follow up A1C half life 2-3 A1C 8 - A1C 9 7% retinopathy 21-63% A1C 7 9%Categories of Diabetes Mellitus - 2 Type 1 rare case β-cell insulin virus infected Type 2 insulin resistant β-cell insulinType 2 Diabetes Mellitus
  14. 14. Rx42 Fon 050 & Dew 055 14 Metabolic Disease II . 18 25551) Insulin resistant2) Dysfunctional β-cell insulin DM 1) blood glucose 2) insulin insulin resistant glucose1) sorbitol- fructose- fructose glucose sorbitol sorbitol fructose- glucose sorbitol sorbitol fructose sorbitol- sorbitol cell cell organ2) glycosylation of protein
  15. 15. Rx42 Fon 050 & Dew 055 15 Metabolic Disease II . 18 2555 - Glucose advance glycation end- products (AGEs) - cross-linking protein extracellular matrix - atherosclerosis insulin - DNA, RNA - Fibroblast collagen fiber cell DyslipidemiaDyslipidemia - coronary heart disease - total cholesterol, triglyceride, LDL, HDLMetabolism of LDL - LDL VLDL - VLDL capillary IDL - IDL LDL
  16. 16. Rx42 Fon 050 & Dew 055 16 Metabolic Disease II . 18 2555 - LDL uptake - LDL oxidation oxidized LDL uptake - LDL uptakeMetabolism of HDL - HDL VLDL, LDL HDL Dyslipidemia 1) High risk group 2) 35 Goal of treatment
  17. 17. Rx42 Fon 050 & Dew 055 17 Metabolic Disease II . 18 2555 LDL HDL mg/dL mg/dL <70 <100 2 <130 <160 0-1 <160 <190 HypertensionHypertension - BP > 140/90 - 2 1) Essential hypertension 2) Secondary hypertensionRAAS - BP - Angiotensinogen angiotensin I angiotensin II aldosterone BP
  18. 18. Rx42 Fon 050 & Dew 055 18 Metabolic Disease II . 18 2555- Rennin Angiotensinogen angiotensin I- ACE angiotensin converting enzyme angiotensin I angiotensin II- ACEI (ACE inhibitor) ARB (angiotensin receptor blocker)- Angiotensin angiotensin I receptor (AT1) vasoconstriction BP- Angiotensin angiotensin II receptor (AT2) vasodilatation BP
  19. 19. Rx42 Fon 050 & Dew 055 19 Metabolic Disease II . 18 2555 Atherosclerosis- coronary heart disease- Occlusion of lumen- Thrombosis in lumen

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