不同糖耐量人群血浆载蛋白A5与胰岛B细胞第一时相胰岛素分泌关系研究

目的探讨不同糖耐量人群血浆载脂蛋白A5(apolipoprotein A5,apoA5)与胰岛B细胞第一时相胰岛素分泌的关系。方法选取2009年2月至9月重庆医科大学附院门诊35例新诊断的2型糖尿病(T2DM组),30例糖调节受损者(IGR组),35例正常对照(NGT组)。以葡萄糖刺激后3～5 min急性胰岛素反应(AIR3-5)来表示第一时相胰岛素分泌功能指数;测空腹apoA5、游离脂肪酸(FFA)及糖负荷后2hFFA(2hFFA);稳态模型评价胰岛素抵抗指数(HOMA-IR)及胰岛B细胞功能(HOMA-β)。探讨apoA5与AIR3-5、血脂、血糖、HOMA-B及HOMA-IR等关系。结果(1)T2DM组、IGR组的apoA5、AIR3-5、HDL-C、HOMA-B显著低于NGT组(P<0.05),且T2DM组显著低于IGR组(P<0.05);(2)T2DM组、IGR组TG、FFA、2hFFA、LDL-C、FPG、2hPG、FINS、BMI、WHR和HOMA-IR明显高于NGT组(P<0.05),T2DM组显著高于IGR组(P<0.05);(3)apoA5与AIR3-5、HOMA-B、HDL-C均呈正相关,与TG、FFA、2hFFA、LDL-C、FPG、2hPG、FINS、HOMA-IR、BMI、WHR均呈负相关;(4)多元逐步回归分析显示,AIR3-5、TG、FFA、WHR、HOMA-IR是apoA5的独立影响因素。结论从NGT到IGR到T2DM发病进程中,低apoA5血症可能通过升高FFA而导致高甘油三酯血症,使B细胞第一时相胰岛素分泌受损,故推测升高apoA5水平,可能会降低TG,从而改善和恢复第一时相胰岛素分泌,延缓T2DM的进程。

The plasma apolipoprotein-A5 and the first-phase insulin secretion of islet beta cells in people with different glucose tolerance:a correlation study

Objective To investigate the correlation between apolipoprotein A5(apoA5) and the first-phase insulin secretion of islet beta cells in people with different glucose tolerance.Methods 35 patients newly diagnosed with type 2 diabetes mellitus(T2DM group) and 30 patients with impaired glucose regulation(IGR group) were selected,with 35 people with normal glucose tolerance(NGT group) assigned as normal controls.3~5 minutes acute insulin response(AIR3-5) was used to reflect the function indexes of the first-phase insulin secretion;Fasting apoA5,free fatty acid of 2 hours post glucose-load(2hFFA) were determined;Homeostasis model assessment for insulin resistance(HOMA-IR) andβ-cell function(HOMA-β)were calculated.Thereafter,the correlations between apoA5 and AIR3-5,bloodfat,glucose,HOMA-B and HOMA-IR were studied.Results(1)T2DM group and IGR group had a significantly lower levels of apoA5,AIR3-5,HDL-C and HOMA-B than NGT group(P<0.05),with T2DM group lower than IGR group(P<0.05).(2)T2DM group and IGR group had a significantly higher levels of TG,FFA,2hFFA,LDL-C,FPG,2hPG,FINS,BMI,WHR and HOMA-IR than NGT group(P<0.05),with T2DM group obviously higher than IGR group(P<0.05).(3)apoA5 was positively correlated with AIR3-5,HOMA-B and HDL-C but negatively with TG,FFA,2hFFA,LDL-C,FPG,2hPG,FINS,HOMA-IR,BMI and WHR.(4)Stepwise multiple regression analysis showed that AIR3-5,TG,FFA,WHR and HOMA-IR were independent factors to affect apoA5.Conclusion In the progression from NGT to IGR and then T2DM,the low apoA5 might lead to hypertriglyceridemia(HTG) by increasing FFA levels hence damage of the first-phase insulin secretion of islet beta cells.Thus,the increased apoA5 level might decrease TG so as to improve and recover the first-phase insulin secretion,which might appear promising to delay the progression of T2DM.