老年2型糖尿病患者血清胆固醇酯脂肪酸检测

  目的  探讨老年2型糖尿病(diabetes mellitus, DM)患者血清胆固醇酯脂肪酸及相关生化指标变化情况。  方法  研究纳入2012年8月至12月北京医院老年体检志愿者145例(年龄≥60岁), 包括确诊为2型DM患者(DM组)73例和健康对照者(对照组)72名, 抽取空腹静脉血。用液相色谱串联质谱法测定血清11种主要胆固醇酯脂肪酸, 计算各脂肪酸脱氢酶及脂肪酸碳链延长酶活性; 同时用自动生化分析仪测定空腹血糖(fasting plasma glucose, FPG)、总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、载脂蛋白AI(apolipoprotein AI, ApoAI)、载脂蛋白B(apolipoprotein B, ApoB)、超敏C反应蛋白(high sensitivity C-reactive protein, hsCRP)等生化指标, 用独立样本t检验、非参数检验、Logistic回归等方法对数据进行分析。  结果  DM组血清脂肪酸CE14:0、CE16:1和CE22:6显著低于对照组(P < 0.05), 其他脂肪酸成分差异不具有统计学意义; 与对照组相比, DM组Δ9-脂肪酸脱氢酶(Δ9-desaturase)活性显著降低(P=0.001);Logistic回归分析显示CE22:6和Δ9-desaturase活性对预测DM患病风险具有统计学意义(P < 0.05);校正年龄、性别、体重指数(body mass index, BMI)、TC、TG、FPG因素影响后, 与CE22:6最低四分位数(CE22:6≤0.47%)相比, 最高四分位数(CE22:6>0.68%)患DM的比值比为0.27(95%CI: 0.08~0.86, Wald值4.93, P < 0.05);与Δ9-desaturase活性最低四分位数(Δ9-desaturase活性≤0.12)相比, 最高四分位数(Δ9-desaturase活性>0.17)患DM的比值比为0.06(95%CI: 0.01~0.22, Wald值17.39, P < 0.01)。CE14:0和CE20:3与FPG呈显著负相关(r=-0.18、-0.17, P < 0.05);CE18:0与BMI、TG呈显著正相关(r=0.25、0.24, P < 0.01), 而与HDL-C和ApoAI呈显著负相关(r=-0.39、-0.35, P < 0.01);CE20:3与BMI的相关性最强(r=0.42, P < 0.01)。  结论  老年2型DM患者血清部分胆固醇酯脂肪酸降低, CE22:6和Δ9-desaturase可能对2型DM具有保护作用, 平衡脂肪酸摄入对防治2型DM具有重要意义。

Detection of Serum Cholesterol Ester Fatty Acids in the Elderly with Type 2 Diabetes Mellitus

  Objective  To evaluate the alteration of cholesterol ester fatty acids and related serum biochemicalparameters in elderly patients with type 2 diabetes mellitus(T2DM).  Methods  Totally 73 T2DM patients(T2DM group) and 72 healthy subjects(control group) (aged ≥60 years) who received health check-ups in Beijing Hospital from August to December in 2012 were recruited and blood samples were collected. Eleven main cholesterol ester fatty acids in serum were determined with liquid chromatography tandem mass spectrometry, and endogenous conversions by desaturases and elongases were estimated from product-to-precursor ratios. Fasting plasma glucose(FPG), total cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), apolipoprotein(Apo) AI(ApoAI), ApoB, and high sensitivity C-reactive protein(hsCRP) were analyzed with an automatic biochemistry analyzer and the results were statistically analyzed.  Results  CE14:0, CE16:1 and CE22:6 in T2DM group were significantly lower than those in the control group(P < 0.05), while no significant difference existed between other fatty acid compositions. Δ9-desaturase activity was lower in T2DM group compared with that in control group(P=0.001). After adjusting for age, gender, body mass index(BMI), TC, TG, and FPG, Logistic analysis showed the quartiles of CE22:6 and Δ9-desaturase activity were associated with risk of type 2 DM, and the odds ratios were 0.27(95%CI: 0.08-0.86, Wald: 4.93, P < 0.05)and 0.06(95%CI: 0.01-0.22, Wald:17.39, P < 0.01), respectively, for comparison of the top to bottom quartile. Both CE14:0 and CE20:3 negatively correlated with FPG(r=-0.18, -0.17, P < 0.05); CE18:0 positively correlated with BMI and TG(r= 0.25, 0.24, P < 0.01) and negatively correlated with HDL-C and ApoAI(r=-0.39, -0.35, P < 0.01); CE20:3 positively correlated with BMI, with a correlation coefficient of 0.42(P < 0.01).  Conclusions  Several cholesterol ester fatty acids decrease in elderly T2DM patients. CE22:6 and Δ9-desaturase may protect against T2DM. An appropriately balanced intake of fatty acids is helpful for the prevention of T2DM in the elderly population.