胰岛素抵抗危险因素的探讨

目的　研究 2型糖尿病胰岛素抵抗的危险因素及其内在变化关系。方法　对 83例初诊 2型糖尿病患者 [正常体质量组 34例 ,超重和 (或 )肥胖组 4 9例 ]胰岛素抵抗的 8种危险因素 ,包括空腹血糖、空腹胰岛素、三酰甘油、胆固醇、高密度脂蛋白胆固醇、收缩压、舒张压和体质量指数 ,进行了测定 ,并与 32例正常对照组比较。结果　 2型糖尿病组空腹血糖、空腹胰岛素、三酰甘油、血压较对照组高 (P <0 .0 1～ 0 .0 5 ) ,高密度脂蛋白胆固醇较对照组低 ;2型糖尿病正常体质量组与超重和 (或 )肥胖组间血糖、血脂、血压比较差异无统计学意义 ,但超重和 (或 )肥胖组空腹胰岛素水平高于正常体质量组 (P <0 .0 1)。结论　 2型糖尿病一旦诊断 ,多存在一定程度的胰岛素抵抗 ,这种抵抗与体质量增加、三酰甘油升高有关 ,且易形成高血压 ,直接影响糖尿病多种慢性并发症及其预后     

Low incidence of vascular complications in patients with diabetes mellitus associated with liver cirrhosis as compared with type 2 diabetes mellitus

We compared clinical features and vascular complications of patients with diabetes mellitus associated with liver cirrhosis versus patients with type 2 diabetes mellitus. Subjects were 19 patients (LC-DM group) in whom diabetes was diagnosed after development of liver cirrhosis. Control consisted of 38 patients with type 2 diabetes (T2DM group) matched for sex, age, duration of diabetes, body mass index, treatment, and degree of glycemic control, which was determined by glycoalbumin. The LC-DM group had significantly more smokers, higher serum insulin levels, more insulin resistance calculated by homeostasis model assessment, lower blood counts (white and red blood cells, hemoglobin, and platelets), and lower serum levels of total cholesterol, triglyceride, low density lipoprotein cholesterol and lipoprotein (Lp)(a) than the T2DM group. The incidence of diabetic retinopathy and cerebrovascular disease was significantly lower in the LC-DM group compared to the T2DM group. Logistic regression analysis indicated that Lp(a) and the diabetes duration were significant predictors for the retinopathy, while Lp(a) was a significant predictor for the cerebrovascular complication. In diabetes associated with liver cirrhosis, the incidence of diabetic retinopathy and cerebrovascular disease is lower than in type 2 diabetes mellitus in this study, probably because of lower levels of serum Lp(a).     

Improvement of the plasma lipoprotein pattern after institution of insulin treatment in diabetes mellitus

Plasma lipids and lipoproteins were studied in 26 nonobese diabetic patients, either newly diagnosed or unsatisfactorily controlled by oral antidiabetic treatment. Measurements were performed before and 3-4 mo after the institution of insulin treatment. In a subgroup of seven patients, the activities of lipoprotein lipase (LPL) and hepatic lipase (HL) in postheparin plasma and the elimination rate of exogenous triglyceride were also monitored. After beginning insulin treatment, diabetic control was improved as demonstrated by decreasing levels of HbA1. Mean plasma cholesterol and triglyceride levels decreased by about 10% (P less than 0.01) and 40% (P less than 0.05), respectively. The decrease in plasma cholesterol was largely accounted for by a fall in LDL cholesterol levels (-8%, P less than 0.05), while plasma HDL cholesterol concentrations increased by about 12% (P less than 0.01). The elimination rate of exogenous triglycerides increased significantly. There was a suggestive, but not significant, increase in LPL activity while the HL activity remained unchanged. It is concluded that the improved diabetic control after institution of insulin treatment results in a significant improvement of the plasma lipoprotein profile. Since the improvement of the lipoprotein pattern is not strictly correlated to the amelioration of indices reflecting glucose transport, we suggest that the plasma lipoprotein pattern may provide an additional tool for monitoring the degree of control in diabetes mellitus.     

罗格列酮治疗2型糖尿病45例临床观察

目的观察马来酸罗格列酮治疗2型糖尿病（T2DM）前后血清高敏C反应蛋白（hsCRP）的变化,探讨其可能的药物作用。方法86例双胍类和磺脲类药物治疗3个月以上的T2DM病人随机分为罗格列酮组与对照组,进行为期16周的临床观察。结果罗格列酮组治疗前后比较空腹血糖（FPG）、餐后2h血糖（PPG）及糖化血红蛋白（HbA1c）均明显下降（P〈0．01）,胰岛素抵抗指数（IRI）明显下降（P〈0．05）,高密度脂蛋白胆固醇（HDL-C）明显升高（P〈0．01）,低密度脂蛋白胆固醇（LDL-C）明显下降（P〈0．01）,胆固醇（CH）和甘油三酯（TG）无明显变化,收缩压（SBP）平均下降9．6mmHg（P〈0．01）,舒张压（DBP）平均下降6．1mmHg（P〈0．01）,体重指数（BMI）无明显变化,hsCRP明显下降（P〈0．01）。而对照组各观察指标无明显变化。结论T2DM患者慢性高血糖状态与炎症关系密切。罗格列酮治疗在改善胰岛素敏感性的同时,还具有抗炎、调脂、降压等作用,长期使用可预防T2DM心血管疾病的发生。     

Lipids and lipoproteins in patients with type 2 diabetes

Insulin resistance and type 2 diabetes are associated with a clustering of interrelated plasma lipid and lipoprotein abnormalities, which include reduced HDL cholesterol, a predominance of small dense LDL particles, and elevated triglyceride levels. Each of these dyslipidemic features is associated with an increased risk of cardiovascular disease. Increased hepatic secretion of large triglyceride-rich VLDL and impaired clearance of VLDL appears to be of central importance in the pathophysiology of this dyslipidemia. Small dense LDL particles arise from the intravascular processing of specific larger VLDL precursors. Typically, reduced plasma HDL levels in type 2 diabetes are manifest as reductions in the HDL(2b) subspecies and relative or absolute increases in smaller denser HDL(3b) and HDL(3c). Although behavioral interventions such as diet and exercise can improve diabetic dyslipidemia, for most patients, pharmacological therapy is needed to reach treatment goals. There are several classes of medications that can be used to treat lipid and lipoprotein abnormalities associated with insulin resistance and type 2 diabetes, including statins, fibrates, niacin, and thiazolidinediones. Clinical trials have shown significant improvement in coronary artery disease after diabetic dyslipidemia treatment.     

2型糖尿病大鼠不同药物治疗后内皮脂肪酶的表达变化

目的:检测2型糖尿病大鼠血浆中内皮脂肪酶(endothelial lipase,EL)水平,以及经不同降糖药物治疗后EL水平变化.探讨EL与2型糖尿病的相关性,评价不同降糖药物对EL水平的影响.方法:成年雄性SD大鼠60只,随机抽取15只作为正常对照组(CTL组),另外45只采取高脂高糖饲料喂养+链脲佐菌素诱导的方法制备2型糖尿病大鼠模型,而后将成模大鼠39只随机分为3组:2型糖尿病组(n=13,DM组)、胰岛素治疗组(n=13,IDM组)和格列齐特治疗组(n=13,GDM组),分别于1、9和13周末测体重、空腹血糖、空腹胰岛素水平、胰岛素敏感指数、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、C-反应蛋白和EL.结果:13周末测各组血糖,DM组较CTL组、GDM组、IDM组升高(P＜0.05).其中IDM组、GDM组与CTL纽无明显差异(P＞0.05).13周末测各组血浆EL水平,DM组EL表达较CTL组和IDM组明显升高(P＜0.05),与GDM组无明显差异(P＞0.05).IDM组EL表达较DM组明显降低(P＜0.05),与CTL组无明显差异(P＞0.05).结论:2型糖尿病大鼠中EL表达明显增高,经胰岛素治疗和格列齐特治疗后EL的表达并不一致.胰岛素在降低血糖的同时降低EL水平,而格列齐特降低血糖并不降低EL水平.这种不一致可能是由于胰岛素与格列齐特对EL的调节作用不同引起的.     

实验性2型糖尿病肾病大鼠模型研究

目的建立2型糖尿病肾病大鼠模型。方法雄性Wistar大鼠高糖高脂喂养8周后,腹腔注射链脲佐菌素（STZ,30mg／kg）诱导糖尿病大鼠。通过葡萄糖耐量试验和胰岛素抵抗指数判断胰岛素抵抗情况。结果在注射STZ之前,高糖高脂喂养大鼠和对照组血糖基本相似,而血清胰岛素水平明显高于对照组。在注射STZ之后,高糖高脂大鼠血糖明显增高,血清胰岛素降至对照组水平。在第10周末,2型糖尿病大鼠体重、血压、胆固醇、甘油三酯、24小时尿蛋白定量和肾重指数较对照组存在差异而肾功无明显差异。。肾脏病理显示2型糖尿病大鼠具有典型2型糖尿病肾病的病理改变。结论联合高糖高脂饮食和小剂量STZ方法建立的动物模型可以用于2型糖尿病肾病的研究。     

Effects of Endurance Training on Lipid Metabolism and Glycosylated Hemoglobin Levels in Streptozotocin-induced Type 2 Diabetic Rats on a High-fat Diet

[Purpose] Exercise has been recognized as a simple and economical therapeutic modality that effectively benefits patients with diabetes, for instance, increasing insulin sensitivity in type 2 diabetes. However, thus far, no studies have examined the effect of endurance training exercises on type 2 diabetes. Therefore, this study examined the effect of endurance training exercise regimens on body weight, glucose and insulin levels, lipid profiles, and HbA_1c levels in STZ-induced type 2 diabetic rats on a high-fat diet. HbA_1c was considered an indicator of glucose control during endurance training. [Methods] A total of 36 rats were included in this study. Diabetes was induced by administering STZ to 2 groups of 12 rats each, and, the remaining 12 rats were classified as the normal group. Biochemical parameters were measured 28 days later, and included: serum total cholesterol, triglyceride, high-density lipoprotein, glycosylated hemoglobin, glucose, and insulin levels. [Results] A significant decrease in serum TC and TG levels, and an increase in HDL cholesterol level were observed in the endurance training group. Moreover, blood glucose and HbA_1c levels after 28 days of exercising were significantly lower in the endurance training group than in the control group (p<0.05). [Conclusion] These results indicate that endurance training affects body weight and, lipid profiles, as well as fasting blood glucose, HbA_1c, and insulin levels, in STZ-induced type 2 diabetic rats on a high- fat diet. We suggest that endurance training exercises may exhibit therapeutic, preventative, and protective effects against diabetes mellitus through improving lipid metabolism, glycemic control, and HbA_1c levels.Key words: Diabetic mellitus, Endurance training, Glycosylated hemoglobin     

老年2型糖尿病合并无症状性脑梗死患者血清尿酸与血脂及胰岛素敏感指数的改变

目的探讨2型糖尿病(T2DM)并发无症状性脑梗死(SCI)与血清尿酸(SUA)、血脂、胰岛素(Ins)水平的关系。方法122例T2DM患者,分为T2DM合并SCI组、单纯SCI组和单纯糖尿病(DM)组,分别进行SUA、血胆固醇(TC)、血甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、极低密度脂蛋白胆固醇(VLDLC)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)及脂蛋白LP(a)测定,对DM患者均做馒头餐试验和Ins水平测定并计算胰岛素敏感性指数(IAI)。结果T2DM合并SCI组的血TC、TG、LDLC、VLDLC及ApoB水平均比单纯SCI组高;T2DM合并SCI组的SUA水平比单纯SCI组和单纯DM组增高(P<0.05);T2DM合并SCI组与单纯DM组相比较,血Lp(a)及Ins水平升高(P<0.05),而HDLC、ApoA降低(P<0.01),同时IAI降低。结论DM合并高尿酸血症、低HDL血症等脂代谢异常及胰岛素抵抗在DM合并SCI的发病中可能起重要作用。     

Renoprotective effect of JinQi-JiangTang tablet on high-fat diet and low-dose streptozotocin-induced type 2 diabetic rats

JinQi-JiangTang tablet (JQ), a traditional Chinese patent medicine, have been commonly applied to clinical therapy in type 2 diabetic patients. The present study was undertaken to investigate the renoprotective effect of JQ on type 2 diabetic rats. The type 2 diabetic rat model was successfully induced by a high-fat and high-sugar diet combined with a single low-dose of streptozotocin. Intervention with JQ could significantly diminish the body weight loss, reduce the levels of fasting blood glucose, 24 hour urinary protein, blood urea nitrogen and serum creatinine in STZ-induced diabetic rats. JQ improved the creatinine clearance in diabetic rats. What''s more, the levels of total cholesterol, triglyceride and low-density lipoprotein cholesterol were markedly reduced following JQ treatment, while the level of high-density lipoprotein cholesterol was elevated. Moreover, JQ significantly improved the activity of superoxide dismutase, catalase and glutathione peroxidase, whereas decreased the level of lipid peroxidation malondialdehyde in renal tissue of diabetic rats. Furthermore, immunohistochemical analysis showed that JQ significantly downregulated the expression of Bax, Caspase-3 and Cytochrome c and upregulated Bcl-2 protein expression in the renal tissue of diabetic rats, which was considered as the major pathogeneses of apoptosis. These data demonstrated that JQ exhibited a renoprotective effect through blood glucose control, alleviating lipid metabolism, anti-oxidative stress and anti-apoptosis activities.

JinQi-JiangTang tablet (JQ), a traditional Chinese patent medicine, have been commonly applied to clinical therapy in type 2 diabetic patients.     

Lipoprotein physiology in nondiabetic and diabetic states. Relationship to atherogenesis

Abnormalities of plasma lipid and lipoprotein concentrations are common in both insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus. In general, individuals with IDDM who are untreated or inadequately treated have elevations in both postprandial and fasting triglyceride levels in association with reduced activity of lipoprotein lipase. Low-density lipoprotein (LDL) cholesterol levels can rise when insulin deficiency impacts on LDL-receptor function. When patients with IDDM are treated and plasma glucose levels well controlled, plasma very-low-density lipoprotein (VLDL) triglyceride and LDL cholesterol levels are usually normal. In addition, plasma high-density lipoprotein (HDL) cholesterol levels are normal or elevated in well-controlled IDDM subjects. In NIDDM, increased VLDL triglyceride and reduced HDL cholesterol concentrations are common and are only partially related to glycemic control. Overproduction of VLDL leads to hypertriglyceridemia, which can be exacerbated if lipoprotein lipase activity is also reduced. The regulation of LDL levels is complex; catabolism can be reduced if significant insulin deficiency exists or increased if significant hypertriglyceridemia is present. The reduced levels of HDL cholesterol in NIDDM appear to be related to increased exchange of HDL cholesteryl esters for VLDL triglycerides, although other mechanisms may exist. The roles of insulin resistance, obesity, and independently inherited abnormalities of lipoprotein metabolism in the etiology of dyslipidemia of NIDDM are complex and require further investigation. Finally, the effects of diabetes on glycosylation of apoproteins; on other lipid enzymes, particularly hepatic triglyceride lipase; on lipoprotein surface lipids; and on hepatic uptake of remnants have only just begun to be defined. In view of the marked increase in atherosclerotic cardiovascular disease in individuals with diabetes mellitus, prompt attention to and aggressive therapy for dyslipidemia should be a central component of care for these patients.     

Lipoproteins and apolipoproteins in young nonobese Arab women with NIDDM treated with insulin

The effects of insulin on the lipid values of nonobese non-insulin-dependent diabetic (NIDDM) Arab women requiring insulin was investigated to find whether these patients have the same coronary artery risk factor related to lipid levels. In this study, 55 NIDDM women on insulin therapy (mean age 28 +/- 8.1 yr and duration of disease 5 +/- 1.2 yr) and 70 control subjects (matched for sex, age, and body mass index) were studied for their plasma levels of lipids, lipoproteins, and apolipoproteins. Concentrations of total cholesterol, very-low-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride (TG), LDL TG, high-density lipoprotein triglyceride (HDL TG), phospholipid, glucose, glycosylated hemoglobin (HbAtc), apolipoprotein B (apoB), LDL-apoB, and apoB/apoAl were significantly elevated in diabetic women compared with control subjects. There was no significant change in the levels of apoAll in plasma and lipoprotein fractions. Concentrations of HDL cholesterol (chol), HDL2-chol, HDL3-chol, plasma apoAl, HDL2-apoAl, HDL3-apoAl, and HDL-apoAl were significantly lower in diabetic women than in control subjects. There was no significant correlation between glucose or HbAtc and most of the lipids, lipoprotein lipids, and apolipoproteins measured. Despite normal body weight and insulin therapy, abnormalities in lipids, lipoprotein lipids, and apoB persisted in NIDDM patients compared with control subjects. Our data may favor an enhanced affinity toward atherosclerosis in these patients.     

冠心病合并2型糖尿病患者不稳定动脉粥样硬化斑块的评估及影响因素的分析

目的研究合并2型糖尿病的冠状动脉粥样硬化性心脏病（冠心病）患者与非2型糖尿病冠心病患者的不稳定动脉粥样硬化斑块的差别。方法在行冠脉造影术时,通过血管内超声（IVUS）对146例冠心病患者病变血管进行检测,测定是否有不稳定粥样硬化斑块,并评估冠脉狭窄程度。根据患者是否存在糖尿病,分为2组进行对比,同时定量分析患者相关冠心病危险因素：性别、年龄、体质指数（BMI）、高血压、甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平等。结果糖尿病组的不稳定冠状动脉钙化斑块数量显著多于非糖尿病组（P〈0.05）,糖尿病组的低密度脂蛋白胆固醇水平显著大于非糖尿病组（P〈0.05）。结论合并2型糖尿病患者冠脉形成不稳定斑块较非2型糖尿病患者的风险更大,同时2型糖尿病患者的低密度脂蛋白胆固醇水平更高于非2型糖尿病患者。对于同时合并有2型糖尿病的患者在积极控制血糖水平的同时,应积极进行调整血脂治疗,使不稳定斑块向稳定型斑块转化,降低冠脉事件的发生。     

舒洛地特对链脲佐菌素诱导的糖尿病大鼠胰岛B细胞功能的影响

目的 探讨低分子肝素类抗凝药物舒洛地特对链脲佐菌素诱导的糖尿病大鼠胰岛B细胞功能的影响.方法 将造模成功的33只SD大鼠分为3组:正常对照11只(对照组)、糖尿病模型组11只(模型组,后有3只死亡)、舒洛地特治疗组11只(舒洛地特组,后有1只死亡);糖尿病大鼠模型经单剂量腹腔注射链脲佐菌素(STZ)制成,舒洛地特组大鼠每天以舒洛地特10 mg/(kg·d)灌胃,对照组和模型组大鼠每天给予等量生理盐水灌胃.12周末检测所有试验大鼠空腹血糖(FPG)、空腹胰岛素(FINS)、活化部分凝血活酶时间(AFTT)、凝血酶原时间(PT)、凝血酶时间(TT)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、血肌酐(SCr)及丙氨酸氨基转移酶(ALT),同时计算出胰岛素敏感指数(ISI)和胰岛素抵抗指数(HOMA-IR).结果 12周末,模型组和舒洛地特组TG、LDL-C及ALT水平之间无明显差异,但均较对照组明显升高(P均<0.05);血SCr水平3组间差异无统计学意义(P均>0.05).与对照组相比,模型组和舒洛地特组APTT、PT和TT显著降低,胰岛素敏感指数(ISI)明显降低,胰岛素抵抗指数(HOMA-IR)明显增高(P均<0.05);舒洛地特组与模型组相比,APTT、PT和TT明显增加[(76.18±3.96)s与(65.85±3.15)s,(24.25±3.64)s与(20.34±2.97)s,(34.56±9.13)s与(25.87±8.86)s],胰岛素敏感指数(ISI)显著升高(-4.75±0.10与-5.86±0.11),胰岛素抵抗指数(HOMA-IR)显著减低(2.46±0.76与3.37±0.68,P均<0.01).结论 舒洛地特能改善链脲佐菌素诱导的糖尿病大鼠胰岛素抵抗,增加胰岛素敏感性,对糖尿病大鼠的血液高凝状态有改善作用,但时糖尿病大鼠血脂及肝肾功能的改变未见显著影响.     

Elevated plasma glucose and lowered triglyceride levels from omega-3 fatty acid supplementation in type II diabetes

We studied the effect of omega-3 fatty acids (omega 3FA) on glucose homeostasis and lipoprotein levels in eight type II (non-insulin-dependent)-diabetic subjects ingesting 8 g/day omega 3FA for 8 wk as marine-lipid concentrate capsules. After omega 3FA supplementation, fasting plasma glucose levels increased 22% (P = .005) and meal-stimulated glucose increased 35% (P = .036). The percentage of glucose elevation correlated with percentage ideal body weight (r = .73, P = .04). No significant changes were seen in fasting or meal-stimulated plasma insulin, glucose disposal, or insulin-to-glucagon ratios. Very-low-density lipoprotein cholesterol and triglyceride (TG) levels showed consistent reductions of 56% (P less than .001) and 42% (P less than .001), respectively, after omega 3FA supplementation. Total cholesterol levels decreased 7% (P less than .05) without alteration in low- or high-density lipoprotein cholesterol. Thus, omega 3FA supplementation at a dose of 8 g/day significantly improves plasma TG levels but increases fasting and meal-stimulated glucose concentrations in the type II diabetic patient not treated with insulin or sulfonylurea agents. Marine-lipid concentrate capsules supplying large amounts of omega 3FAs should be used cautiously in the type II diabetic patient.     

Remnant-like particle cholesterol, triglycerides, and insulin resistance in nonobese Japanese type 2 diabetic patients

OBJECTIVE: The aim of the study was to investigate the relationships between remnant-like particle (RLP) cholesterol, triglycerides, and insulin resistance in nonobese Japanese type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A total of 86 nonobese Japanese type 2 diabetic patients (72 men and 14 women, aged 40-83 years, BMI 20.1-26.6 kg/m2) were studied. BMI, HbA1c levels, and fasting concentrations of plasma glucose, serum lipids (RLP cholesterol, total cholesterol, HDL cholesterol, and triglycerides), and serum insulin were measured. Insulin resistance was estimated by the homeostasis model assessment (HOMA-IR). The subjects were divided into two groups according to the value of HOMA-IR. Values >2.5 were indicative of the insulin-resistant state, and values <2.5 were indicative of the insulin-sensitive state. RESULTS: The insulin-resistant group had significantly higher RLP cholesterol and triglyceride levels and lower HDL cholesterol levels compared with the insulin-sensitive group. Univariate regression analysis showed that insulin resistance was positively correlated with BMI (r = 0.254, P = 0.019), HbA1c levels (r = 0.278, P = 0.011), RLP cholesterol levels (r = 0.315, P = 0.004), and triglyceride levels (r = 0.332, P = 0.002) and was negatively correlated with HDL cholesterol levels (r = -0.301, P = 0.006) in our diabetic patients. Multiple regression analysis showed that insulin resistance was independently associated with serum triglyceride levels, which explained 13.5% of the variability of insulin resistance in our nonobese Japanese type 2 diabetic patients. CONCLUSIONS: These results indicate that 1) nonobese Japanese type 2 diabetic patients with insulin resistance are characterized by high RLP cholesterol and triglyceride levels, and low HDL cholesterol levels; and 2) the level of serum triglycerides is an independent predictor of insulin resistance in these patients.     

Concentrations of lipids and apolipoproteins in patients with clinically well-controlled insulin-dependent and non-insulin-dependent diabetes

The triglyceride and cholesterol content of total, very-low-, intermediate-, low-, and high-density lipoproteins, and of apolipoproteins (apo) Al, All, B, Cll, Clll, and E were determined in plasma from 107 patients with clinically well-controlled diabetes and from 66 age- and weight-matched healthy normal subjects. The diabetic patients were separated into two groups: those with insulin-dependent diabetes mellitus (IDDM, type 1, n = 24) and those with non-insulin-dependent diabetes mellitus (NIDDM, type 2, n = 83). The latter group contained two subgroups: those treated by diet (type 2d, n = 42) or by insulin (type 2i, n = 41). High-density lipoprotein cholesterol was increased in IDDM patients, and decreased in NIDDM patients relative to control subjects. Mean apo Al values in IDDM patients were higher than in their respective controls and in NIDDM patients. Concentrations of apo B, Clll, and E were higher in all diabetic patients than in the healthy controls, but those of apo Cll did not differ statistically between diabetics and nondiabetics. Although total plasma cholesterol and triglyceride concentrations were apparently near normal values in patients with good glycemic control, we found a persistent increase of intermediate-density lipoproteins (remnants) in all the diabetic groups studied. This factor may be related to the perceived increased cardiovascular risk in these individuals.     

Implications of decreased serum adiponectin for type IIb hyperlipidaemia and increased cholesterol levels of very-low-density lipoprotein in type II diabetic patients

The present study was performed to investigate the relevance of cholesterol levels of plasma lipoproteins [HDL (high-density lipoprotein), LDL (low-density lipoprotein), IDL (immediate-density lipoprotein), VLDL (very-LDL) and chylomicrons] determined by a novel HPLC method, with adiponectin, which is decreased in Type II diabetes and assumed to be involved in dysregulated metabolism and atherogenesis. Type II diabetic patients who were not treated with insulin, statins and fibrates were enrolled. Study subjects included Type II diabetic patients with normolipidaemia (DM-NL; n=15), type 4 hyperlipidaemia (DM-T4HL; n=13), Type IIa hyperlipidaemia (DM-T2aHL; n=15) and Type IIb hyperlipidaemia (DM-T2bHL; n=13). Fasting blood samples were collected. The serum adiponectin level was lower in DM-T2bHL than in any of the other groups. Cholesterol levels of each lipoprotein fraction, serum triacylglycerol (triglyceride), remnant-like particle-cholesterol, fasting plasma glucose, HbA1c (glycated haemoglobin), age, gender difference and BMI (body mass index) were incorporated into a stepwise regression analysis as independent variables. VLDL-cholesterol correlated inversely with adiponectin independently of age, BMI, gender difference and glycaemic control. Although the mechanisms remain to be explored, serum adiponectin was reduced particularly in Type II diabetics with type IIb hyperlipidaemia and correlated inversely with VLDL-cholesterol. Measuring VLDL-cholesterol may be helpful for understanding the pathological features of diabetic dyslipidaemia.     

Homocysteine and other biochemical parameters in Type 2 diabetes mellitus with different diabetic duration or diabetic retinopathy

BACKGROUND: Cardiovascular risk-related markers in type 2 diabetes mellitus (DM) have not been well understood. METHODS: Serum and urine samples for biochemical and immunologic analysis were collected from 204 normal subjects and 257 type 2 DM patients, the latter of which were further classified by different diabetic duration with or without retinopathy. RESULTS: Glycosylated hemoglobin A1c, triglyceride, lipase, free fatty acid, albumin creatinine ratio (ACR), lactate dehydrogenase (LDH) and homocysteine were significantly increased in DM patients, whereas high density lipoprotein cholesterol and bilirubin were significantly decreased in DM patients, compared with normal subjects. Lipid profiles, ACR, bilirubin, uric acid, creatine kinase, and hsCRP were not changed in DM patients with different diabetic duration or diabetic retinopathy. Lactate dehydrogenase in DM patients with duration >20 years and homocysteine in patients with duration >10 years was significantly higher than those with duration <5 years. Homocysteine was significantly increased in DM patients with retinopathy, compared with DM patients without retinopathy. CONCLUSION: The increased triglyceride, lipase, free fatty acid, albumin creatinine ratio, lactate dehydrogenase and homocysteine as well as decreased high density lipoprotein cholesterol and anti-oxidative bilirubin in DM patients should be cautious and considered as risks for increasing DM complication. Homocysteine might be associated with longer diabetic duration and microvascular complication of retinopathy in diabetes.     

来氟米特对糖尿病大鼠肾组织中P-选择素表达的影响

目的探讨P-选择素在糖尿病大鼠肾组织中的表达及来氟米特对其影响。方法高糖高脂饮食联合小剂量腹腔注射链脲佐菌素(streptozotocin,STZ)建立2型糖尿病动物模型。随机分为糖尿病组(B组)和来氟米特干预组(C组),另设鼠龄匹配的正常对照组(A组)。第8、9、12、16周,监测各组血糖(FBG)、糖化血红蛋白A1(HbA1c)、血脂、血肌酐(Scr)、尿素氮(BUN)、胰岛素(Insulin)及24小时尿蛋白定量。第9、16周各组随机处死6只大鼠,测量肾重指数。另外观察肾脏病理情况。用半定量RT-PCR方法检测肾皮质P-选择素(P-selectin)mRNA表达水平。结果大鼠肾脏病理符合2型糖尿病肾病的改变。与A组相比,第16周时B组血肌酐、尿素氮明显升高(P0.01),24小时尿蛋白定量自糖尿病成模后即开始高于对照组(P0.05),并于12、16周时仍持续增加(P0.01,P0.01)。与B组相比,C组大鼠BUN和Scr第16周时降低,差异有统计学意义(P0.05,P0.01),24小时尿蛋白定量12、16周时较B组降低(P0.05,P0.01)。糖尿病大鼠肾组织中P-selectin表达明显高于对照组(P0.01),来氟米特干预后其表达降低(P0.05)。结论来氟米特可能通过抑制糖尿病大鼠肾组织中P-选择素的表达发挥对肾脏的保护作用。