血糖控制对新诊断的2型糖尿病患者血脂、ApoB_(100)、ApoAI及HDL亚类影响的研究

Studies of Influences of Blood Glucose Controlling on the Changes of Lipid Profiles,ApoB_(100),ApoAI and HDL Subclass of Newly Diagnosed Type 2 Diabetes

本研究目的是探讨血糖控制对新诊断糖尿病患者血脂、载脂蛋白B100(ApoB100)、ApoAI及高密度脂蛋白(HDL)亚类代谢的影响。53名新诊断的2型糖尿病患者分为4组,分别为单纯饮食和运动干预组(n=13),口服降糖药组(n=13),胰岛素多次皮下注射强化治疗组(MDI)(n=13),胰岛素泵强化治疗组(CSII)(n=14)。所有受试者均进行一个月的血糖控制治疗。分别检测受试者入组及干预结束时的空腹血糖(FPG)、糖化血红蛋白(HbA1C)、血脂、ApoB100和ApoAI,采用双向电泳免疫印迹的方法测定血浆HDL亚类的含量。共43名受试者完成该试验,结果表明:①降血糖治疗结束时,各组受试者的FPG、HbAlc、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、ApoB100的水平均明显降低,ApoAI/ApoB100比值则显著升高,而高密度脂蛋白胆固醇(HDL-C)/ApoA1、LDL-C/ApoB100无明显变化。此外,通过降血糖治疗后的受试者其血浆成熟的、大颗粒的HDL2b的含量增加,并且小颗粒的HDL3b的含量则有所下降。②单纯饮食运动组血脂及载脂蛋白改善作用不显著;但降糖药物治疗组的TC、LDL-C、ApoB100水平明显降低,ApoAI/B100比值和HDL2b的含量明显升高。③特别是在胰岛素强化治疗组(MDI、CSII),ApoB100水平的下降尤为明显。通过对新诊断的2型糖尿病患者血糖的严格控制可使患者血脂水平、ApoA1、ApoB100出现不同程度的改善,并可以使HDL亚类中相对成熟的成分增加,同时使其相对幼稚的成份减少。

This study was aimed to observe if the lipid profiles, apoprotein B100 （ApoB100）, ApoAI, high density lip- oprotein （HDL） and its subclasses could be improved by controlling the blood glucose. Fifty-three patients with newly diagnosed type 2 diabetic were divided into four groups., diet and exercise group （n= 13）, continuous subcuta- neous insulin infusion （CSII） group （n= 14）, multiple daily insulin injection group （MDI, n= 13）, and oral hypogly- eaemic agents group （n = 13）. Fasting blood glucose （FPG）, glycated hemoglobin Ale （HbAlc）, lipid profiles, ApoB100 ,ApoAI and HDL subclasses were measured at beginning and a month later. Forty-three patients finished the testing. The levels of FPG, HbAlc, triglyceride （TG）, total cholesterol （TC）, low density lipoprotein choles- terol （LDL-C）, and ApoB100 were decreased significantly （P〈0.05） in all groups, and ApoAI/ApoB100 increased ob- viously （P〈0.05）. Comparatively matured HDL subclasses such as HDL2b were increased （P〈0. 05） ,and comparativelyinfantile HDL subclasses such as HDL3b were decreased （P〈0. 05）. Therapy with hyperglycemic agents improved TG, TC, LDL-C, ApoB100, ApoA1/ApoB100, and HDL2b significantly （P〈0. 05）, but intervention with the diet and exercise group alone did not improve lipid profiles, apolipoproteins, and HDL subclasses （P〉0. 05）. Mean- while, therapy with insulin intensive therapy （MDI, CSⅡ）group had the most powerful effect on decreasing A poB100 concentration （P〈0.05）. The results suggested that lipid profiles, apolipoproteins, and quantity and quality of HDL subclasses might be improved by blood glucose controlling.