中老年人餐后高甘油三酯血症的临床干预

The clinical intervention on postprandial hypertriglyceridemia in middle and elderly people

目的了解噻唑烷二酮类药物马来酸罗格列酮对餐后高甘油三酯(TG)血症中老年患者的疗效。方法采用改良脂肪餐负荷试验,以餐后4 h血清TG水平(TG 4 h)>2 mmol/L确定为餐后高TG血症患者39例,随机分为非诺贝特组12例(口服微粒化非诺贝特200 mg,每晚1次顿服,共8周),罗格列酮组27例(口服马来酸罗格列酮4 mg,每天1次晨服,共8周),两组于治疗前、治疗后4周和8周进行脂肪餐负荷试验,同时测定空腹血糖(FPG)和空腹胰岛素(FIns),以胰岛素敏感指数(ISI)作为胰岛素敏感性判断指标,进行对比分析。结果在不同时段两组内脂肪餐负荷试验前后比较,TG4h水平较同组餐前空腹TG水平比较升高(P<0.05),而脂肪餐后HDL-C水平较同组餐前空腹HDL-C水平明显下降(P<0.05),TC、LDL-C均未见明显变化;非诺贝特组治疗8周后,空腹TG、TG4h均呈明显下降(P<0.05),HDL-C、餐后4h HDL-C呈明显升高(P<0.05);罗格列酮组治疗8周后,空腹TG、TG4h、ISI绝对值均呈明显下降(P<0.05),HDL-C、餐后4hHDL-C呈明显升高(P<0.05)。结论短期应用马来酸罗格列酮不仅可以改善胰岛素敏感性,还可以有效地降低餐后高TG血症患者的餐后TG水平,升高HDL-C水平。

Objective To evaluate the clinical effect of the rosiglitazone （RSG） on the middle and elderly patients with postprandial hypertriglyeeridemia. Methods Thirty-nine patients who had TG4h more than 2 mmol/L were selected according to the improved fat diet burden test. The subjects were randomly divided into two groups, the group C （n = 12 ）and RSG group（ n = 27 ）. The former group were given mieroeapsule 200mg/day orally in the evening for 8 weeks,the later group were given 4mg/day orally in the morning for 8 weeks. The serum TG,TC ,HDL-C and LDL-C were measured as a reference index, at same time, the FPG,FIns were measured. Insulin sensitivity index （ISI） calculated. The parameters above were measured again at the 4th week and the 8th week after treatment. Results The postprandial TG4h levels were higher than that of the preprandial TG in the two groups at different periods （P 〈0.05）, but the postprandial HDL-C reduced dramatically （P 〈 0.05 ）, the serum TC and LDL-C showed no change（P 〉 0.05 ） ; In the group C, both fasting TG and TG4h were reduced obviously 8 weeks after treatment （ P 〈 0.05 ） , HDL-C and postprandial HDL-C 4 hours after fat diet were elevated obviously （ P 〈 0.05 ） ; ]in the RSG group,the absolute serum TG,TG4h and ISI were reduced obviously （P 〈 0.05 ）, HDL-C and postprandial HDL-C 4 hours after fat diet were elevated obviously （ P 〈 0.05 ）. Conclusion The short-term administration of rosiglitazone （RSG） can not only improve the insulin sensitivity ,but reduce effectively the level of the postprandial serum TG and increase level of serum HDL-C.