脂代谢紊乱对2型糖尿病患者早期胰岛素分泌和胰岛素抵抗的影响

目的:了解脂代谢紊乱对2型糖尿病患者早期胰岛素分泌功能和胰岛素抵抗的影响.方法:93例未接受调脂治疗和抗高血糖治疗的新发2型糖尿病患者根据血脂水平分为正常血脂组(B组)、单纯甘油三酯升高组(C组)和混合血脂升高组(D组),20例非糖尿病正常血脂体检者为健康对照组(A组),根据口服葡萄糖耐量试验计算和分析早期胰岛素分泌指数△I30△G30和胰岛素抵抗指数HOMA-IR.结果:与健康对照组比较,2型糖尿病各亚组的△I30△G30值(P=0.00001,＜0.05和＜0.01)和HOMA-IR值(所有P＜0.05)均明显降低;在2型糖尿病患者中,脂代谢紊乱各组(C和D组)的△I30/△G30值比正常血脂组(B组)明显降低,但是混合血脂升高组(D组)与单纯甘油三酯升高组(C组)之间差异无统计学意义(P=0.2509);在2型糖尿病患者中,与正常血脂组比较,混合血脂升高组(D组)的HOMA-IR值明显升高(P=0.0027),单纯甘油三酯升高组(C组)则无显著性差异(P=0.1841).结论:2型糖尿病患者同时存在早期胰岛素分泌缺陷和胰岛素抵抗,甘油三酯升高主要降低早期胰岛素分泌功能,而胆固醇异常主要加重胰岛素抵抗.     

首杞降脂汤对糖尿病患者血脂及内皮功能的影响

目的　研究首杞降脂汤对糖尿病患者血脂及内皮功能的影响 ,探讨中药对血脂紊乱及内皮功能障碍治疗的临床效果 ,为心脑血管病的防治提供实验依据和理论依据。方法　选择门诊筛查出的糖尿病血脂异常患者 6 0例作为研究对象 ,随机分为两组 ,每组 30例 ,1组为中药治疗组 (首杞降脂汤 ) ,中药一剂 ,水煎服 ,每日1次 ;2组为京必舒新组 ,京必舒新 10mg ,每晚 1次。疗程均为 3个月 ,治疗前后分别检测血糖、血脂、血栓调节蛋白 (TM)、肝肾功能。结果　中药治疗组和京必舒新组治疗后TC ,TG ,LDL C ,TM均低于治疗前 ,治疗前后比较的差异有高度显著性 (P <0 .0 1) ,治疗后HDL C明显升高 ,治疗前后比较的差异有显著性 (P <0 .0 5 ) ,两组之间疗效比较差异无显著性 (P >0 .0 5 )。结论　首杞降脂汤可显著降低TC ,TG ,LDL C ,TM并升高HDL C ,临床效果与京必舒新作用相似 ,但能显著改善血管内皮功能。     

血脂异常患者血清神经鞘磷脂的测定及其意义

目的:评价血脂异常患者血清神经鞘磷脂(SM)水平。方法:将血脂异常的患者分为总胆固醇(TC)升高组、三酯酰甘油(TG)升高组、低密度脂蛋白胆固醇(LDL-C)升高组和高密度脂蛋白胆固醇(HDL-C)降低组,与对照组SM水平比较。酶法测定SM、TC、TG、LDL-C、HDL-C。用单因素方差分析,Dunnett检验处理数据。结果:血脂异常患者SM水平与对照组比较有显著性差异(P<0.05);TC、LDL-C升高组SM水平与对照组比较有显著性差异(P<0.05),TG升高组、HDL-C降低组SM水平与对照组比较有极显著性差异(P<0.01)。结论:血清SM水平和已知的致动脉粥样硬化危险因子密切相关,提示SM可能是导致动脉粥样硬化发生的重要因素。     

2型糖尿病患者糖尿病性肾病不同阶段血脂谱的差异

目的:比较2型糖尿病患者糖尿病肾病不同阶段的血脂谱。方法:收集我院2型糖尿病患者144例,根据尿蛋白定量、尿微量白蛋白定量分成三组:无肾病组22例,早期肾病组78例,临床期肾病组44例。所有患者测定血甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(apoA)、载脂蛋白B(apoB)、脂蛋白a。比较三组间血脂差异。结果:HDL-C水平在无肾病组、早期肾病组、临床期肾病组依次递减(1.363±0.535,1.161±0.327,1.060±0.281),三组间两两比较,差异均有显著性。TG水平依次递增(1.359±0.485,1.581±0.827,1.963±1.626),其中临床期肾病组较早期肾病组及无肾病组增高差异有显著性,早期肾病组与无肾病组间差异无显著性。脂蛋白a水平呈递增趋势(9.252±2.920,11.368±5.954,12.333±6.354),但组间差异无显著性。3组间TC、LDL-C、apoA、apoB无差异。结论:2型糖尿病患者脂代谢紊乱与糖尿病肾病的发生有一定相关性。     

A polymorphism in the promoter of UCP2 gene modulates lipid levels in patients with type 2 diabetes

A G/A single nucleotide polymorphism (SNP) in the position -866 of the UCP2 promoter modulates UCP2 expression in adipose tissue and pancreatic beta-cell, and is associated with variations of body mass index (BMI) and insulin secretion in nondiabetic subjects. We investigated associations of this SNP with traits related to obesity, dyslipidemia, and hyperglycemia in patients with type 2 diabetes. The -866 G/A SNP in the UCP2 promoter was genotyped by PCR/RFLP in 681 type 2 diabetic patients. Increased triglyceride (> or = 1.70 mM), total cholesterol (> or = 6.0 mM) and LDL-cholesterol (> or = 3.35 mM) levels were significantly less frequent in homozygous carriers of the G-allele than in homozygous carriers of the A-allele. Odds ratios for the risk of dyslipidemia in GG vs AA carriers were 0.45, 0.57, and 0.50, for triglyceride, total cholesterol and LDL-cholesterol, respectively (all p<0.007). No genetic effects of this polymorphism on the BMI or on traits related to the severity of hyperglycemia were observed. In conclusion, a common polymorphism in the promoter region of the UCP2 gene modulates triglycerides and cholesterol levels in French Caucasian subjects with type 2 diabetes. The implications of this effect in the evolution of type 2 diabetes and its macrovascular complications deserve to be investigated.     

Carnitine supplementation improves apolipoprotein B levels in pediatric peritoneal dialysis patients

There have been conflicting reports concerning the effect of carnitine supplementation on lipid metabolism in patients on peritoneal dialysis (PD). We investigated several parameters of lipid metabolism in pediatric PD patients supplemented with carnitine. The study included 20 patients receiving PD (treatment group) aged 2–18 years and a matched healthy control group. In the treatment group, baseline triglyceride, total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, and apolipoprotein B levels were higher than in the control group. High-density lipoprotein cholesterol, free fatty acid, phospholipids, and apolipoprotein A-I levels were not different from those in the control group. The baseline plasma free carnitine level was lower and acyl-carnitine level was higher in the treatment group. No difference was found between the groups with respect to plasma total carnitine levels. Oral l-carnitine supplementation (50 mg/kg per day for 30 days) led to a significant decrease (from a baseline value of 146.6±51.8 mg/dl to 63.6±22.2 mg/dl, P<0.001) in apolipoprotein B levels, and no significant change in the other lipid parameters of the treatment group. Oral l-carnitine supplementation does not ameliorate the lipid profile in pediatric PD patients, but it causes a significant decrease in apolipoprotein B levels. Hence, carnitine supplementation may be recommended for decreasing apolipoprotein B levels in this patient population.     

Expert opinion on the metabolic complications of mTOR inhibitors

Using mTOR inhibitors (mTORi) as anticancer drugs led to hyperglycemia (12–50%) and hyperlipidemia (7–73%) in phase-III trials. These high rates require adapted treatment in cancer patients. Before initiating mTORi treatment, lipid profile screening should be systematic, with fasting glucose assay in non-diabetic patients and HbA_1C in diabetic patients. After initiation, lipid profile monitoring should be systematic, with fasting glucose assay in non-diabetic patients, every 2 weeks for the first month and then monthly. The HbA_1C target is ≤ 8%, before and after treatment initiation in known diabetic patients and in case of onset of diabetes under mTORi. LDL-cholesterol targets should be adapted to general health status and cardiovascular and oncologic prognosis. If treatment is indicated, pravastatin should be prescribed in first line; atorvastatin and simvastatin are contraindicated. Fenofibrate should be prescribed for hypertriglyceridemia > 5 g/l resisting dietary measures adapted to oncologic status. In non-controllable hypertriglyceridemia exceeding 10 g/l, mTORi treatment should be interrupted and specialist opinion should be sought.     

北京地区13 336例成人空腹血脂水平分析

目的 通过检测健康查体者空腹血脂水平来了解北京地区人群血脂水平现状及其血脂异常患病率.方法 应用日立7 170全自动生化分析仪检测北京地区13 336例成人空腹血脂,血脂指标包括甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),比较不同性别和年龄组间血脂水平差别及血脂异常患病率的差异.结果 总体血脂异常患病率59.9%,男性71.6%,女性47.2%.男性TC平均(4.89±0.87)mmol/L、LDL-C平均(3.33±0.84)mmol/L、HDL-C平均(1.28±0.30)mmol/L、TG中位数1.32 mmol/L;女性TC平均(4.79±0.94)mmol/L、LDL-C平均(2.99±0.89)mmol/L、HDL-C平均(1.53±0.34)mmol/L、TG中位数0.9mmol/L.男性和女性4种血脂成分异常患病率均随年龄增加而增高(P＜0.01).TC、LDL-C、TG水平随年龄增加而增高(P＜0.01),HDL-C水平随年龄的增加有降低趋势(P＜0.01).TC在25～44岁间男性高于女性(P＜0.01),在55岁以上女性显著高于男性(P＜0.05).LDL-C在18～44岁间男性高于女性(P＜0.01),在45～74岁女性显著高于男性(P＜0.01).HDL-C水平各年龄组女性明显高于男性(P＜0.01).TG在18～54岁男性显著高于女性(P＜0.01),在55～64岁组两性间无差异,64岁以上女性高于男性(P＜0.05).结论 北京地区成人中血脂异常患病率较高,并且随年龄增大而增高,男女性别间血脂异常患病率差异有统计学意义.