2型糖尿病和葡萄糖耐量异常患者游离脂肪酸升高及其意义

Clinical implications of elevated plasma free fatty acids in type 2 diabetes mellitus and impaired glucose tolerance

目的 观察 2型糖尿病 (DM)和葡萄糖耐量异常 (IGT)患者血清游离脂肪酸 (FFA)的水平 ,探讨FFA与胰岛素(INS)、胰岛素抵抗 (IR)和甘油三酯 (TG)的关系。方法 采用酶法测定 2 0例 2型DM和 2 0例IGT患者口服葡萄糖耐量试验 (OGTT) 0和 2h血清FFA水平 ,同步测定血浆葡萄糖 (PG)、血清INS以及空腹TG和胆固醇 (TC) ,并与 2 0例正常人对照。结果 2型DM和IGT患者OGTT 0和 2hINS均显著高于正常对照组 ,且 2型DM患者INS高于IGT患者 ,P <0 .0 5 ;空腹FFA和胰岛素抵抗指数 (HOMA -IR) 2型DM患者高于IGT患者 ,IGT患者高于正常对照组 ,P <0 .0 1;TG和OGTT 2hFFA 2型DM患者高于IGT患者和正常对照组 ,P <0 .0 5 ,而IGT患者和正常对照组之间比较差异无显著性 ;多元逐步回归显示空腹FFA是HOMA -IR的独立影响因素。结论 不仅 2型DM患者而且IGT患者存在FFA异常升高 ,FFA升高与IR有关 ;2型DM和IGT患者存在IR和脂代谢紊乱 。

Objective To measure levels of free fatty acids(FFA)in patients with type 2 diabetes mellitus(2-DM)and impaired glucose tolerance(IGT),and to explore the relationship between FFA and insulin(INS),insulin resistance(IR)and triglycerides(TG). Methods The concentrations of FFA were measured by enzymatic colorimetric methods during fasting and after 2 h of 75 g oral glucose tolerance(OGTT).Fasting and 2 h after OGTT plasma glucose(PG)and INS levels were also measured by glucose oxides and RIA methods. All data were compared with 20 normal controls(NC).Results Fasting and 2 h after OGTT levels of PG and INS were significantly increased and fasting FFA, HbA1c and homeostasis insulin resistance(HOMA-IR)were also elevated significantly in patients with type 2-DM and IGT as compared with those in NC. The levels of TG and 2 h after OGTT FFA, however, were remarkably increased in type 2-DM compared with IGT and NC subjects, and no differences were found between groups of IGT and NC. In stepwise multivariate analysis, fasting FFA was the strongest predictors of HOMA-IR. Conclusion The results suggest that in patients with type 2-DM and IGT, the levels of FFA be significantly elevated, and exist IR and dyslipidemia. The elevated of FFA is correlated with IR .The levels of FFA are more sensitive than those of TG in reflected dyslipidemia.