2型糖尿病患者血清小而密低密度脂蛋白胆固醇水平与脂类代谢异常及胰岛素抵抗的关系

目的探讨2型糖尿病患者血清小而密低密度脂蛋白胆固醇（sdLDL-C）水平与脂类代谢异常及胰岛素抵抗的关系。方法 193例2型糖尿病患者按胰岛素抵抗情况分为胰岛素抵抗组144例与非胰岛素抵抗组49例。采用奥林巴斯AU2700全自动生化仪检测血清小而密低密度脂蛋白（sdLDL-C）、三酰甘油（TG）、总胆固醇（TC）、空腹血糖（FBG）等,采用化学发光法检测空腹胰岛素（FIN）、C肽,并计算胰岛素抵抗指数（HOMA-IR）等。结果 2型糖尿病患者中,与非胰岛素抵抗组相比,胰岛素抵抗组TG、TG/高密度脂蛋白（HDL）、TC/HDL、sdLDL-C水平显著升高（P〈0.05）,而HDL、载脂蛋白A（apo AⅠ）、脂蛋白（Lpa）水平显著降低（P〈0.05）;对2型糖尿病患者sdLDL-C、胰岛素抵抗指数进行多元逐步回归分析,sdLDL-C与TG（Log）、LDL-C/HDLC及TG/HDL-C（Log）呈正相比关性（r=0.638、0.601、0.290,P〈0.01）,与TG/HDL（Log）和LDL-C/apoB呈负相关关系（r=-0.589、-0.342,P〈0.01）;HOMA-IR与TG/HDL和sdLDL-C呈正相关关系（r=0.281、0.250,P〈0.01）,而与TC呈负相关（r=-0.233,P〈0.01）。结论 SdLDL-C能较好地反映2型糖尿病患者胰岛素抵抗对脂类代谢的影响,TG/HDL-C、LDL-C/HDL-C等提供的重要临床信息应在以后的临床应用中得到进一步认识和重视。

Relationship of small dense low-density lipoprotein cholesterol to dyslipidemia and insulin resistance in type 2 diabetic patients

Objective To investigate the relationship of small dense low-density lipoprotein cholesterol to dyslipidemia and insulin resistance in type 2diabetic patients.Methods 193patients with type 2diabetes mellitus were divided into insulin resistance group（n=144）and Non-insulin resistance group（n=49）according to insulin resistance index.Serum concentrations of sdLDL-C,triglyceride（TG）,total cholesterol（TC）,fasting blood glucose（FBG）and etc were measured by automatic biochemical analyzer,fasting insulin and c-peptide were measured by chemiluminesence immunoassay,HOMA index（HOMA-IR）and other parameters were calculated.Results Compared with Non-insulin resistance group,the levels of TG,TG/HDL,TC/HDL and sdLDL-C in insulin resistance group were significantly higher（P〈0.05）,the levels of HDL,apoAⅠand Lp（a）（P〈0.05）were significantly lower.Multivariate regression analysis indicated that TG（Log）,LDL-C/HDL-C and TG/HDL-C（Log）showed a positive correlation with sdLDL-C（r=0.638,0.601,0.290,P〈0.01）,yet TG/HDL（Log）and LDL-C/apoB showed negative correlation with sdLDL-C（r=-0.589,-0.342,P〈0.01）.TG/HDL,sdLDL-C showed positive correlation with HOMA-IR（r=0.281,0.250,P〈0.01）,and TC showed negative correlation with HOMA-IR（r=-0.233,P〈0.01）.Conclusion The level of sd LDL-C reflects the impact of insulin resistance in T2DM on lipoprotein metabolism more strictly than do the traditional lipid parameters.Important clinical risk information provided by TG/HDL-C and LDL-C/HDL-C ratio should be recognized and implemented in future clinical guidelines.