初诊2型糖尿病患者血脂和血浆致动脉硬化指数特点及不同方式短期强化降糖对其影响——附382例分析  

Characteristics of lipid profiles and atherogenic index of plasma in patients with newly diagnosed type 2 diabetes and effect of different short-term intensive hypoglycemic interventions on them

作　　者：许雯[1] 时立新[2] 朱大龙[3] 李延兵[1] 周智广[4] 田浩明[5] 罗佐杰[6] 严励[7] 曾龙驿[8] 杨立勇[9] 傅祖植[7] 程桦[7] 翁建平[8] 

机构地区：[1]中山大学附属第一医院内分泌科,510080 [2]贵阳医学院附属医院内分泌科,550004 [3]南京大学医学院附属鼓楼医院内分泌科,210093 [4]中南大学湘雅医学院附属第二医院内分泌科,410013 [5]四川大学华西医院内分泌科,610041 [6]广西医科大学第一附属医院内分泌科,530021 [7]中山大学附属第二医院内分泌科,510120 [8]中山大学附属第三医院内分泌科,510630 [9]福建医科大学第一附属医院内分泌科,350005

出　　处：《新医学》2010年第3期151-156,共6页Journal of New Medicine

基　　金：2007-2009年度卫生部部属(管)医院临床学科重点项目;广东省科技计划项目(2006A36001001)

摘　　要：目的:了解初诊2型糖尿病(T2DM)患者的血脂代谢情况与血浆致动脉硬化指数(AIP)特点,探讨不同干预方式短期强化降糖治疗对初诊T2DM患者血脂及AIP的影响。方法:382例初诊T2DM患者(T2DM组)及68名血糖正常者(对照组),检测两组血脂、空腹血糖、身高、体质量、腰围、臀围,计算体质量指数(BMI)、腰臀比、AIP。T2DM组接受静脉葡萄糖耐量试验,计算急性胰岛素反应及稳态模型评估法(HOMA)指数HOMA-B及HOMA-IR。按不同干预方式将T2DM组随机分为持续皮下胰岛素输注(CSII)组、每日多次胰岛素注射(MDI)组或口服降糖药(OHA)组,快速纠正高血糖,血糖恢复正常并维持2周后停止治疗。治疗结束后复查基线指标。结果:与对照组比较,初诊T2DM组血脂异常患者比例较高(81.7%对比67.6%,P<0.01),三酰甘油明显升高(中位数:1.75mmol/L对比1.12mmol/L,P<0.01),AIP升高(0.19±0.32对比-0.01±0.29,P<0.01)。在初诊T2DM患者中,AIP水平男性明显高于女性(0.23±0.33对比0.10±0.28,P<0.01),AIP与BMI、腰臀比、HOMA-IR、胆固醇、三酰甘油、LDL-C成正相关,与HDL-C成负相关。接受2～5周的强化降糖治疗后,不同干预组的血脂均获得明显改善,表现为胆固醇、三酰甘油、LDL-C和游离脂肪酸水平下降,AIP下降。治疗后各组间血脂及AIP改善程度一致。结论:初诊T2DM患者存在明显的血脂代谢紊乱,以三酰甘油升高为主,AIP升高明显,AIP与反映胰岛素抵抗的指标明显相关。不同干预方式的短期强化降糖治疗均能有效改善初诊T2DM患者血脂代谢紊乱及AIP。Objective： To investigate characteristic of lipid profiles and atherogenic index of plasma （AIP） in patients with newly diagnosed type 2 diabetes （T2DM）, and to explore effect of different intensive interventions on these aspects. Methods： Three hundred and eighty two patients with newly diagnosed T2DM and 68 people with normal glucose tolerance were included to assess the lipid profile, fasting plasma glucose, height, weight, waist and hip circumference. Intravenous glucose tolerance tests were carried out in patients with T2DM. Body mass index （BMI）, waist-to- hip ratio （WHR）, AIP acute insulin response （AIR）, HOMA-B and HOMA-IR were calculated. Patients in T2DM group were randomly assigned to therapy with insulin （CSII or MDI） or oral hypoglycaemic agents for initial rapid correction of hyperglycaemia. Treatment was stopped after normoglycaemia has been maintained for 2 weeks. Baseline measurements were repeated after treatment. Results： Comparing with control group, proportion of dyslipidemia was significantly higher in T2DM （81.7% VS. 67.6%, P 〈 0. 01 ） ; triglyceride （TG） increased significantly （median： 1.75 mmol/L vs. 1.12 mmol/L, P 〈0. 01 ）, so did AlP （0. 19±0. 32 vs. -0. 01 ± 0. 29, P 〈 0. 01 ）. In T2DM group, AIP was significantly higher in male than in female （0. 23 ± 0. 33 vs. 0. 10 ± 0. 28, P 〈 0. 01 ）and positively correlated with BMI, WHR, Homa-IR, total cholesterol （TC）, TG and LDL-C ; while negatively correlated with HDL-C. Lipid profiles of T2DM patients were improved after 2-5 weeks of intensive hypoglycemic therapy with no significant difference among different treatment groups. Conclusion ： There is high prevalence of dyslipidemia in patients with newly diagnosed T2DM presenting as increased TG and AIP. And AIP is positively correlated with index reflecting insulin resistance. Dyslipidemia and AIP of patients with newly diagnosed T2DM can be effectively improved by different short term intensive hypoglyce- mic inter

关 键 词：2型糖尿病 血脂 血浆致动脉硬化指数 降糖治疗 

分 类 号：R587.1[医药卫生—内分泌]