过氧化物酶体增殖物激活受体γ在胰岛素抵抗高脂血症中的作用

The Role of Peroxisome Proliferator-activated Receptor-gamma in Insulin-resistant Hyperlipidemia

目的探讨过氧化物酶体增殖物激活受体γ(peroxide daily proliferator- activated receptor γ,PPARγ)在阿托伐他汀治疗胰岛素抵抗高脂血症中的作用。方法选取2016年10月至2018年5月我院收治的胰岛素抵抗高脂血症患者116例,实时荧光定量PCR检测外周血单个核细胞PPARγ表达。给予阿托伐他汀降脂治疗,检测治疗前后患者血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL- C)、高密度脂蛋白胆固醇(HDL- C)、空腹血糖(FBG)、空腹胰岛素(FINS)、白介素6(IL- 6)、C反应蛋白(CRP)和肿瘤坏死因子α(TNF-α)水平并计算胰岛素抵抗指数HOMA- IR。HOMA- IR >2.69的胰岛素抵抗患者纳入研究组,对照组HOMA- IR<2.69。对比两组患者降脂效果和脂肪分泌因子IL- 6、CRP和TNF-α水平变化。结果研究组患者外周血单个核细胞PPARγ表达低于对照组;对照组阿托伐他汀降脂效果优于研究组( P <0.05);治疗后研究组IL- 6、CRP和TNF-α变化明显小于对照组( P <0.05)。结论 PPARγ在胰岛素抵抗高脂血症治疗过程中发挥重要作用,PPARγ可有效增强阿托伐他汀降脂作用并抑制脂肪因子的分泌,其作用机理有待深入研究。

Objective To explore the role of peroxisome proliferator- activated receptor γ(PPAR γ)in lipid- lowering effect of atorvastatin(ATV)in insulin- resistant hyperlipidemia. Methods One hundred and sixteen patients with insulin- resistant hyperlipidemia in our hospital from May,2016 to May,2017 were enrolled in the study.RT- PCT was performed to evaluate the level of PPAR γ in the peripheral blood mononuclear cells.The patients were treated with the lipid- lowering drug ATV.The serum levels of total cholesterol(TC),triglycerides(TG),high- density lipoprotein cholesterol(HDL- C),insulin(INS),Interleukin- 6(IL6), c- reactive protein(CRP),and tumor necrosis factor α(TNF α)were tested before and after the treatment.HOMA- IR was calculated accordingly.Patients with HOMA- IR greater than 2.69 were included into the study group,while those with HOMA- IR less than 2.69 were included into the control group.The curative effect and the levels of lipid factors in the two groups were compared. Results PPAR γ level was lowered in the study group compared with the control group.The curative effect of the control group was better than that of the study group( P <0.05).Changes of lipid factors,including IL- 6,CRP and TNF α,in the study group after the treatment were smaller than those in the control group( P <0.05). Conclusion PPAR γ plays a key role in insulin- resistant hyperlipidemia.PPAR γ could remarkably promote the lipid- lowering effect of ATV and hinder the secretion of lipid factors.The underlying mechanisms need further exploration.