高脂血症患者不同血脂异常分型与糖代谢的相关性研究

Correlation study on different dyslipidemia classification and glucose metabolism in patients with hyperlipidemia

目的:探讨高脂血症患者中糖代谢异常的检出情况,对比不同血脂异常分型患者糖代谢异常的差异。方法:入选既往无糖尿病或心血管病史的单纯高脂血症患者及血脂正常者共197例,根据空腹血脂水平将受试者分为4组:高胆固醇血症组(HCh组,45例)、高甘油三酯组(HTG组,46例)、混合型血脂异常组(58例)以及正常对照组(48例)。分别测量上述受试者空腹血清胰岛素(insulin,Ins)及血糖(glucose,GLU0)水平,计算胰岛素抵抗指数(HOMA-IR),并给予受试者口服75 g葡萄糖耐量试验(oral glucose tolerance test,OGTT),检测OGTT 2 h血糖(GLU120)水平。结果:HTG组及混合型组GLU120水平分别为(10.5±3.2)mmol/L及(12.0±5.4)mmol/L,均显著高于对照组[(8.7±3.5)mmol/L,P分别为0.045和0.024];HTG组及混合型组患者糖耐量异常(impaired glucosetolerance,IGT)的比例分别为39.1%和31.0%,显著高于对照组22.9%(P分别为0.009和0.014)。在空腹血糖<6.1 mmol/L的亚组人群中,HTG组及混合型组IGT的比例分别为51.4%和43.9%,亦显著高于对照组29.7%(P分别为0.009和0.015)。结论:在尚未发生心血管事件的高脂血症患者中也存在相当比例未及时诊治的糖代谢异常患者,尤其应重视甘油三酯异常和混合型高脂血症患者,应对这部分患者进行OGTT检查,以期在更早阶段发现糖代谢异常。

Objective：To detect the impaired glucose metabolism in dyslipidemic patients and explore whether the type of dyslipidemia affects the type of impaired glucose metabolism.Methods：In our stu-dy,197 patients without diabetes or cardiovascular disease history were divided into 4 groups according to fasting serum lipid levels：hypercholesterolemic group（HCh group,45 patients）;hypertriglyceridemic group（HTG group,46 patients）;combined dyslipidemic group（58 patients） and control group（48 patients）.Serum insulin and glucose levels were detected in fasting situation.HOMA-IR was calculated.And then the patients received 75 g oral glucose tolerance test（OGTT） and their GLU120 levels were detected.Results：The GLU120 levels in HTG group [（10.5±3.2） mmol/L] and combined dyslipidemic group [（12.0±5.4） mmol/L] were significantly higher than those in control group [（8.7±3.5） mmol/L,P=0.045 and 0.024,respectively].HTG group（39.1%） and combined dyslipidemic group（31.0%） also had higher impaired glucose tolerance（IGT） incidence ratios than those in control group（22.9%,P=0.009 and 0.014,respectively）.In subgroup study of patients with fasting glucose levels below 6.1 mmol/L,the incidence ratios of IGT in HTG group and combined dyslipidemic group were 51.4% and 43.9%,respectively,which were significantly higher than those in control group（29.7%,P=0.009 and 0.015,respectively）.Conclusion：There exists a definite ratio of undiscovered impaired glucose metabolism in dyslipidemic patients who have not suffered from cardiovascular disease,especially in hypertriglyceridemic and combined dyslipidemic group.OGTT is suggested to be brought into effect in order that impaired glucose metabolism would be detected in earlier stage.