2型糖尿病患者血脂代谢特征和进一步脂质检测价值分析  

Features of lipid metabolism and values of advanced lipid testing in type 2 diabetes mellitus

作　　者：王益 干伟[1] 张禾 梁珊珊 兰培相[2] 杨舒羽 赵艳华[1] 马莹[1] WANG Yi;GAN Wei;ZHANG He;LIANG Shanshan;LAN Peixiang;YANG Shuyu;ZHAO Yanhua;MA Ying(Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China;the Fourth People′s Hospital of Zigong,Zigong,Sichuan 643099,China)

机构地区：[1]四川大学华西医院实验医学科,四川成都610041 [2]自贡市第四人民医院,四川自贡643099

出　　处：《国际检验医学杂志》2022年第13期1638-1643,1647,共7页International Journal of Laboratory Medicine

基　　金：成都市科技项目(2021-YF05-01382-SN)。

摘　　要：目的分析2型糖尿病(T2DM)患者在不同病程阶段以及降糖治疗前后的脂代谢特征和进一步脂质检测的价值,为临床评估提供客观依据。方法选取2021年4-10月于内分泌科就诊的T2DM患者208例作为研究对象(T2DM组),根据是否治疗分为初诊组(105例)和治疗组(103例)。筛选同一时期体检人群中无心脑血管疾病、糖尿病等表观健康成年人216例作为对照组。比较3组临床资料和糖脂代谢等生化指标。将初诊T2DM患者根据是否伴有并发症分为单纯性T2DM组(64例)和T2DM伴并发症组(40例),比较两组糖脂代谢等生化指标。分析T2DM组和对照组小而密低密度脂蛋白胆固醇(sdLDL-C)水平与其他脂代谢指标的相关性。结果除低密度脂蛋白胆固醇(LDL-C)外,T2DM组较对照组糖、脂代谢指标均异常(P<0.05)。与初诊组相比,治疗组体质量指数(BMI)、LDL-C、sdLDL-C、糖化血红蛋白(HbA1c)水平均明显降低(P<0.05),载脂蛋白B(ApoB)/LDL-C明显升高(P<0.05)。与单纯性T2DM组相比,T2DM伴并发症组血糖(GLU)、ApoB/LDL-C水平更高(P<0.05),而高密度脂蛋白胆固醇(HDL-C)水平更低(P<0.05)。T2DM组和对照组的sdLDL-C水平均与甘油三酯(TG)、LDL-C、ApoB和TG/HDL-C呈正相关(P<0.05)。结论T2DM患者普遍存在脂代谢紊乱,主要表现为TG、ApoB、非高密度脂蛋白胆固醇(nonHDL-C)以及sdLDL-C水平升高,HDL-C和载脂蛋白A-Ⅰ(ApoA-Ⅰ)水平降低,而LDL-C无明显变化,常规降糖治疗即可给血脂代谢带来益处。建议在对T2DM患者进行动脉粥样硬化性心血管疾病风险评估时,增加ApoB、nonHDL-C以及sdLDL-C等进一步脂质检测指标。Objective To analyze the features of lipid metabolism and values of advanced lipid testing in type 2 diabetes mellitus(T2DM)patients at different stages of disease and before and after hypoglycemic treatment,in order to provide evidences for clinical evaluation.Methods A total of 208 T2DM patients(T2DM group)admitted to the department of endocrinology from April to October 2021 were enrolled as the research subjects,and were divided into newly diagnosed T2DM group(105 cases)and hypoglycemic treatment group(103 cases)according to the treatment.A total of 216 apparently healthy adults without cardiovascular disease and diabetes were enrolled as the control group.General clinical characteristics and biochemical indices of glucose and lipid metabolism were compared among the three groups.The newly diagnosed T2DM patients were divided into simple T2DM group(64 cases)and T2DM with complications group(40 cases)according to whether they were accompanied by complications,and the biochemical indicators such as glucose and lipid metabolism were compared between small the two groups.The correlation between dense low density lipoprotein cholesterol(sdLDL-C)level and other lipid indicators in T2DM group and control group was analyzed.Results The indicators of glucose and lipid metabolism were abnormal in T2DM group compared with control group(P<0.05)except for LDL-C level.Compared with the newly diagnosed group,BMI,LDL-C,sdLDL-C and HbA1c in the hypoglycemic treatment group significantly decreased(P<0.05),while ApoB/LDL-C significantly increased(P<0.05).Compared with the simple T2DM group,the complications group had higher GLU and ApoB/LDL-C(P<0.05),but lower HDL-C.The level of sdLDL-C in the T2DM group and the control group were positively correlated with TG,LDL-C,ApoB and TG/HDL-C(P<0.05).Conclusion Dyslipidemia is common in patients with T2DM,which is mainly manifested as increased TG,ApoB,nonHDL-C and sdLDL-C,and decreased HDL-C and ApoA-Ⅰ,but there is no difference in LDL-C,conventional hypoglycemic treatment can bring

关 键 词：2型糖尿病 脂代谢 进一步脂质检测 小而密低密度脂蛋白胆固醇 相关性 

分 类 号：R446.11[医药卫生—诊断学]