2型糖尿病患者高密度脂蛋白亚型分子组分的变化

Alterations and Significance of Particle Components of High Density Lipoprotein Subspecies in Type 2 Diabetic Patients

目的研究2型糖尿病患者高密度脂蛋白亚型分子构成成分含量、代谢关键酶活性变化及与血糖等指标的相关关系。方法 26例新发2型糖尿病患者与25例健康对照者留取血浆检测血糖、胰岛素和血脂谱。以改良一步沉淀法分离高密度脂蛋白3并检测其组分含量,并计算高密度脂蛋白2的主要组分含量。以荧光酶法测定胆固醇酯转运蛋白和磷脂转运蛋白活性。结果 (1)2型糖尿病组血高密度脂蛋白胆固醇与对照组无显著差异(P=0.579)。(2)2型糖尿病组与对照组的胆固醇酯转运蛋白和磷脂转运蛋白活性均无明显差异。(3)2型糖尿病组高密度脂蛋白3以下组分含量较对照组明显减少(均P<0.01):胆固醇为0.60±0.17 mmol/L比0.75±0.22mmol/L,磷脂为1.14±0.19 mmol/L比1.29±0.22 mmol/L,游离胆固醇为0.021±0.012 mmol/L比0.033±0.012mmol/L,胆固醇酯为0.97±0.28 mmol/L比1.19±0.36 mmol/L。其中游离胆固醇和胆固醇酯含量与餐后血糖、糖化血红蛋白、胰岛素抵抗指数呈显著负相关(P<0.05)。(4)2型糖尿病组高密度脂蛋白2的载脂蛋白AI含量较对照组显著降低(604.8±233.3 mg/L比755.4±198.0 mg/L,P<0.05),并与胰岛素抵抗指数、餐后血糖、血甘油三酯呈显著负相关(P<0.05)。结论 2型糖尿病患者高密度脂蛋白3和高密度脂蛋白2颗粒主要组分含量明显减少,并与血糖水平及胰岛素抵抗程度相关。

Aim To study alterations in particle components of high density lipoprotein subspecies and activities of the key lipid transfer proteins for its metabolism in type 2 diabetic patients, the correlation between these alterations and related blood glucose indicators were also explored. Methods 26 new-onset type 2 diabetic patients （T2DM group） and 25 healthy subjects （control group） were recruited. Plasma was both fasting and postprandial sampled for all sub- jects, then blood glucose, insulin and lipid spectrum were determined. High density lipoprotein 3 was separated by mod- ified one-step precipitation method and the compositions were measured, then the major compositions of high density lipo2 protein 2 were calculated. Activities of cholesterol ester transfer protein and phospholipid transfer protein was determined by enzyme fluorescence assay kits. Results （ 1 ） There were no differences in plasma high density hpoprotein choles- terol （HDLC） between T2DM group and control group （P = 0. 579 ）. （2）There were no significant differences in either cholesterol ester transfer protein or phospholipid transfer protein activity between T2DM group and control group （P 〉 0. 5）. （3） The following particle components of high density lipoprotein 3 （ HDL3 ） in T2DM group were decreased sig- nificantly than those in control group （ P 〈 O. 01 ） ： HDL3 C （0. 60 ± 0. 17 mmol/L vs 0. 75 ±0. 22 mmol/L）, phospholipids （ PL, 1.14± O. 19 mmol/L vs 1.29 ±O. 22 mmol/L） , free cholesterol （ FC, O. 021 ± O. 012 mmolfL vs O. 033 ± O. 012 mmol/L）, cholesterol ester （ CE, 0. 97 ± 0. 28 mmol/L vs 1.19 ± 0. 36 mmol/L）. All the subjects＇ FC and CE from HDL3 were significantly and negatively correlated with the following indicators （ P 〈 0. 05 ） ： postprandial blood glucose （PBG）, glycosylated hemoglobin （HbAlc）, home-ostasis model assessment of insulin resistance （HOMA-IR）. （4） The apolipoprotein AI （Apo AI） of HDL2 in T2DM group was significantly decreased than those in control group （604. 8 ± 233.3 mg/L vs 755.4 ± 198.0 mg/L, P 〈0. 05）, and the Apo AI of HDL2 in all subjects was significantly and negatively correlated with PBG, HOMA-IR and plasma triglycerides （TG） （ P 〈 0. 05 ）. Conclusions The major components of HDL3 and HDL2 were decreased significantly in T2DM group than that in control group. We speculate that the size of HDL3 and HDL2 particle shrinks and might relate to hyperglycemia and insulin resistance.