2型糖尿病与糖耐量受损人群Lp(a)、ApoB/A1与胰岛素抵抗相关性分析

目的 探讨2型糖尿病(T2DM)、糖耐量受损(IGT)患者脂蛋白aLp(a)]、载脂蛋白A1、B(ApoAl,ApoB)水平变化及其与胰岛素抵抗(IR)之间的关系.方法 536例老年患者按诊断标准分为T2DM、IGT、糖耐量正常(NGT)3组,分别测定其空腹血糖(FPG)、Lp(a)、ApoA1、ApoB水平及相关指标,同时测定空腹胰岛素(FINS)并计算胰岛素抵抗指数(HOMA-IR)作为胰岛素敏感的指标.结果 T2DM、IGT组ApoB/A1显著高于NGT组,T2DM组Lo(a)水平显著低于NGT组;HOMA-IR与Lp(a)、ApoA1水平呈负相关(r=-0.141,P=0.043;r=-0.179,P=0.003),与ApoB呈正相关(r=0.190,P=0.002).多因素回归分析显示,ApoB/A1对于胰岛素抵抗(IR)的影响高于其他脂代谢指标.结论 T2DM患者体内Lp(a)水平低于NGT人群,不应作为T2DM人群心血管疾病(CVD)的发病危险评估指标;ApoB/A1与IR显著相关.

Relationship between the level of lipoprotein(a),apolipoprotein B/A1 and insulin resistance in patients with type 2 diabetes and impaired glucose tolerance

Objective To investigate the relationships between the level of Lp(a), ApoB/A1 and insulin resistance in patients with T2DM and IGT. Methods 536 consecutive patients enrolled in the study. The level of serum Lp(a), ApoA1, ApoB, FINS and other indices were measured and HOMA-IR was calculated to evaluate IR conditions. Results Lp(a) level in T2DM was significantly lower than that in NGT. And ApoB/A ratio in DM/IGT was significantly higher than that in NGT. HOMA-IR had negative correlation with Lp(a) and Apo A1 and had positive correlation with ApoB. The multiple linear regression showed that ApoB/A1 had greater influence on insulin resistance than other indices. Conclusions Lp(a) level in T2DM patients is lower than that in NGT, so it should not be taken as the predictive marker for the future cardiovascular events in T2DM. There is significant association between ApoB/A1 and insulin resistance.