控制高甘油三酯血症对胰岛素抵抗和糖代谢影响的五年前瞻性研究  

Five-years perspective study on the effect of control of hypertriglyceridemia on insulin resistance and glucose metabolism

作　　者：周鹏[1] 朱大龙[1] 叶尔肯 陈南衡[1] 西琳 张燕 

机构地区：[1]南京大学医学院附属鼓楼医院内分泌科,210008 [2]新疆伊犁州新华医院 [3]伊犁州友谊医院

出　　处：《中华糖尿病杂志（1006-6187）》2005年第6期418-420,422,共4页

基　　金：新疆维吾尔自治区重点科技攻关课题(200340102)

摘　　要：目的探讨控制高甘油三酯(TG)血症对胰岛素抵抗(IR)和糖代谢的影响.方法将86例高TG血症患者随机分为治疗组(T组)和非治疗组(N组),在饮食控制的同时,T组给予非诺贝特0.3 g/日一次顿服,定期复查血脂,N组仅饮食控制.两组高TG血症者均连续追踪观察5年.结果(1)N组血糖、胰岛素及胰岛素抵抗指数(HOMA-IR)随血TG水平上升而上升,胰岛素敏感指数(ISI)随血TG水平上升而下降(P＜0.05～0.01).(2)T组血糖水平与治疗前无显著变化(P＞0.05),但胰岛素水平、HOMA-IR和ISI分别低于和高于治疗前(P均＜0.05).(3)N组5年期间糖代谢异常患病率为9.52%,发生率为7.14%;T组未发现糖代谢异常新增病例.N组糖代谢异常患病率与T组、正常对照组(C组)相比较,相对危险度(RR)分别为4.19和2.86.(4)血TG水平与HOMA-IR正相关(P＜0.01),与ISI负相关(P＜0.01),多元逐步回归分析结果表明,TG与HOMA-IR独立相关(P＜0.05).结论控制高TG血症能够减轻IR,使糖代谢异常和2型糖尿病的发生率降低.Objective To explore the effect of control of hypertriglyceridemia on insulin resistance （IR） and glucose metabolism. Methods 86 patients with hypertriglyceridemia were randomized into the treatment （diet control plus fenofibrate 0.3g/d） group （T group） and non-treatment （only diet control） group （N group）, and the blood lipid profile was examined periodically. Follow-up was performed for 5 years. Results 1. In N group the levels of blood glucose, insulin and insulin resistance index （HOMA-IR） raised with the increase of TG level and the insulin sensitivity index（ISI） was lowered with the increase of TG level （P〈0.05-0.01）. 2. T group had no significant change in blood glucose level （P〉0.05）, lower levels of insulin and HOMA-IR, and higher ISI （all P〈0.05） at postreatment vs pretreatment. 3. In N group the prevalence of abnormal glucose metabolism during the 5 years was 9.52%, and the occurrence rate was 7.14%, while in T group no new case with abnormal glucose metabolism was found. Compared with that in T group and normal control group （C group）, the relative risks （RR） for prevalence of abnormal glucose metabolism in N group were 4.19 and 2.86 respectively. 4. The blood TG level was correlated positively with HOMA-IR （P〈0.01） and negatively with ISI （P〈0.0l）, and the multiple stepwise regression analysis showed that TG and HOMAIR were independently correlated （P〈0.05）. Conclusion Control of hypertriglyceridemia can lessen IR and the prevalences of abnormal glucose metabolism and type 2 diabetes mellitus.

关 键 词：高甘油三酯血症 胰岛素抵抗 糖代谢异常 

分 类 号：R587.1[医药卫生—内分泌]