2型糖尿病患者糖负荷后血脂变化及其与胰岛素抵抗的关系

目的 了解2型糖尿病患者口服葡萄糖耐量试验后的血脂变化情况,探讨糖负荷后血脂与胰岛素抵抗的关系.方法 记录及测定26例2型糖尿病患者年龄、病程、性别、腰围、臀围、腰臀比、身高、体质量、体质量指数、收缩压、舒张压、空腹血糖、糖化血红蛋白、空腹胰岛素,测定口服葡萄糖耐量试验60min、120 min、180 min的血糖、胰岛素、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和总胆固醇(TC),比较空腹及糖负荷后血脂变化,探讨它们与Homa胰岛素抵抗指数(Homa-IR)的关系.并对影响糖负荷后血脂曲线下面积的因素进行多元逐步回归分析.结果 糖负荷后60 min、120m in、180min的TG、HDL-C、LDL-C和TC均较空腹各指标显著降低(均P＜0.01).Homa-IR与空腹及糖负荷后60 min、120 min、180 min TG正相关(P＜0.05),与空腹及糖负荷后60 min、120 min、180 min的HDL-C负相关(P＜0.05),与空腹及糖负荷后的LDL-C、TC均无显著相关.多元逐步回归分析表明,Homa-IR是糖负荷后HDL-C曲线下面积的独立影响因素(P＜0.05).结论 糖负荷后血脂较空腹显著降低.空腹及糖负荷后TG、HDL-C与胰岛素抵抗相关.糖负荷后HDL-C受胰岛素抵抗的影响.

Changes of plasma lipoprotein concentrations after an oral glucose load and their relation to insulin resistance in Type 2 diabetic patients

Objective To observe the changes of plasma lipoprotein concentrations after an oral glucose tolerance test and research their relation to insulin resistance in Type 2 diabetic patients.Methods The age,duration of diabetes,sex,waist circumference,hip circumference,waist-hip ratio,height,body weight,body mass index（BMI）,systolic blood pressure,diastolic blood pressure,fasting plasma glucose,HbA1C,fasting insulin,and fasting and 60-,120-,180-minute post-load plasma glucose,plasma insulin,triglycerides（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C） and total cholesterol（TC） after a 75-g oral glucose tolerance test were measured in 26 Type 2 diabetic patients.Comparison of plasma fasting lipoprotein concentrations and post-load lipoprotein concentrations was made,and the relation between fasting and post-load lipoprotein concentrations and Homa-IR was researched.Stepwise multiple regression analysis was applied to investigate the areas under the lipoproteins’ curves over 180 minutes.Results The declination of post-load lipoprotein concentrations after the 75-g glucose tolerance test was statistically significant（all P〈0.01）.Plasma TG concentration both in fasting and post-load state was positively related to Homa-IR（all P〈0.05）,and plasma HDL-C concentration in fasting and post-load state was negatively related to Homa-IR（all P〈0.05）.However,the correlation between both fasting and post-load state LDL-C and TC concentration and Homa-IR had no statistical significance.Moreover,stepwise multiple regression analysis revealed Homa-IR was the independent factor capable of modulating the area of HDL-C curve over 180 minutes after the 75-g glucose tolerance test（P〈0.05）.Conclusion There was a significant declination of plasma lipoproteins after a 75-g glucose tolerance test,and plasma fasting and post-load TG and HDL-C concentrations were related to insulin resistance.Insulin resistance should play a significant role in the post-load HDL-C concentration after 75-g oral glucose tolerance test.