老问题新认识:对脂肪酸与肥胖和胰岛素抵抗关系的再评价  

Reevaluation of fatty acids,obesity,and insulin resistance

作　　者：钱荣立[1] 

机构地区：[1]北京大学第一医院内分泌科,100034

出　　处：《中国糖尿病杂志》2012年第9期641-642,共2页Chinese Journal of Diabetes

摘　　要：美国牛津糖尿病中心的Karpe F等近期发表的"Fatty acids,obesity,and insulin resistance:time for a reevaluation"(Diabetes,2011,60:2441)。根据他们自己的研究和文献对脂肪酸(FA)在肥胖和IR中的关系撰文提出新认识。首先,非酯化脂肪酸(NEFA)的基本功能现在认为NEFA是将储存在脂肪组织的TG转运到其利用处的转运工具,而不只是供肝、心肌等利用。第二,上身和腹部皮下脂肪堆积是NEFA主要来源,不同于普遍认为只有一小部分NEFA来自腹内脂肪组织。第三,空腹血浆NEFA几乎全部来自脂肪细胞内TG水解,但餐后血浆NEFA约40%～50%来自食物脂肪乳糜颗粒中的TG被LPL水解,脂肪利用被胰岛素抑制,在富含碳水化合物餐后NEFA浓度下降。第四,NEFA升高伴急性IR,常见于肥胖,控制不良的糖尿病患者,IR伴异位脂肪——脂肪组织以外的胰岛素效应组织如骨骼肌细胞脂质增加(细胞TG),反映脂肪清除损害甚于摄取。现撷其精要摘译并如以评论,供广大读作者参考。Fredrik Karpe, et al. from Oxford Centre for Diabetes, United States, recently reported “Fatty acids, obesity, and insulin resistance： time for a reevaluation” （ Diabetes 2011, 60： 2441） and showed another side to the fatty acids/insulin resistance story： （1） Nonesterified fatty acids （NEFA） are the vehicle by which triacylglycerol （TO） stored in adipose tissue and transported to its sites of utilization, not only used by tissues such as the liver and myocardium. （2） The abdominal subcutaneous fat depot is the dominant source of NEFA, and -- against popular belief -- only a small proportion of the systemic NEFA concentrations arises from intraabdominal adipose tissue. （3） In the fasting state, plasma NEFA a- rise almost entirely from hydrolysis of TG within the adipocyte, but fatty acids may constitute 40%-50% of the total plasma NEFA pool in the postprandial period, while suppressed during high-carbohydrate di- ets. （4） Elevated NEFA concentrations associated acutely with IR often occurred in individuals with poorly controlled type 2 diabetes, IR associated with ectopic fat deposition -- in nonadipose tissues such as in skeletal muscle, an increase in intramyocellular lipid （cellular TG）, may reflect impaired disposal of fat as much as increased uptake. Here we translate the essentials in the following article.

关 键 词：非酯化脂肪酸 肥胖 胰岛素抵抗 甘油三酯 

分 类 号：R587.1[医药卫生—内分泌]