糖代谢状态与非高密度脂蛋白相关性研究
|
摘要
目的探讨不同糖代谢状态与非高密度脂蛋白(non-HDL-C)的关系及其在2型糖尿病(T2DM)早期防治中的作用。方法选取2008—2017年于深圳市南山区人民医院体检中心行健康体检的584例为研究对象。根据口服葡萄糖耐量试验(OGTT)分为正常糖耐量(NGT)组、空腹血糖受损合并糖耐量异常(IGR)组、T2DM组及1 h高血糖(1 h-HG)组[负荷后1 h血糖(1 h-PG)≥11.1 mmol/L] 4组。分析不同糖代谢人群的性别、年龄、体质量指数、血压、尿酸及血脂等情况。结果与NGT组比较,1 h-HG组、IGR组及T2DM组患者的性别组成、年龄、尿酸及体质量指数水平均较高;与NGT组比较,IGR组患者的血压水平较高;与NGT组比较,T2DM组患者的舒张压水平较高,差异均有统计学意义(P<0.05)。T2DM组患者的性别组成、年龄及尿酸均明显高于1 h-HG组,差异有统计学意义(P<0.05)。与NGT组比较,1 h-HG组、IGR组及T2DM组患者的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、non-HDL-C水平均明显增高,高密度脂蛋白胆固醇(HDL-C)水平明显降低,差异均有统计学意义(P<0.05);与NGT组比较,IGR组、T2DM组患者的甘油三酯(TG)水平明显增高,差异均有统计学意义(P<0.05)。分别与1 h-HG组及IGR组相比较,T2DM组患者的TG水平明显增高,HDL-C水平明显降低,差异均有统计学意义(P<0.05)。偏相关分析结果显示,1 h-PG与TC、TG、LDL-C、non-HDL-C呈显著正相关,相关系数R值分别为0.144、0.113、0.098、0.159,差异均有统计学意义(P<0.05)。结论不同糖代谢状态人群存在不同程度的血脂异常及紊乱,其中,1 h-PG与血脂代谢异常,尤其是non-HDL-C水平密切相关,推测non-HDL-C可能是T2DM早期发生发展的危险因素。
Objective To investigate the relationship between different glucose metabolism and non-high-density lipoprotein(non-HDL-C)and its role in the early prevention and treatment of type 2 diabetes mellitus(T2 DM).Methods A retrospective study was performed on 584 patients who underwent physical examination from 2008 to 2017.According to the oral glucose tolerance test(OGTT),the patients were divided into four groups:normal glucose tolerance(NGT)group,fasting glucose impaired with abnormal glucose tolerance(IGR)group,T2 DM group and 1 hour hyperglycemia(1 hour-HG)group[1 hour plasma glucose(1 hour-PG)more than 11.1 mmol/L after load].The sex,age,body mass index,blood pressure,uric acid and blood lipid were analyzed.Results Compared with the NGT group,patients in the 1 hour-HG group,IGR group and T2 DM group had higher levels of gender composition,age,uric acid and body mass index.The blood pressure level of IGR group was higher than that of NGT group.Compared with the NGT group,the diastolic blood pressure level of patients in the T2 DM group was higher,and the differences were statistically significant(P<0.05).The gender composition,age and uric acid of patients in the T2 DM group were significantly higher than those in the 1 h-HG group(P<0.05).Compared with the NGT group,patients in the 1 hour-HG group,IGR group and T2 DM group had significantly higher levels of total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and non-HDL-C,and significantly lower levels of high-density lipoprotein cholesterol(HDL-C),with statistically significant differences(P<0.05).Compared with NGT group,triglyceride(TG)levels in IGR group and T2 DM group were significantly higher(P<0.05).Compared with the 1 hour-HG group and the IGR group,TG level and HDL-C level in the T2 DM group were significantly increased,respectively(P<0.05).Partial correlation analysis showed that 1 h-PG was significantly positively correlated with TC,TG,LDL-C and non-HDL-C,and the correlation coefficient R values were 0.144,0.113,0.098 and 0.159,respectively(P<0.05).Conclusion People with different glycometabolism states have different degrees of dyslipidemia and disorder,in which 1 hour-PG is closely related to dyslipidemia,especially the level of non-HDL-C,which is speculated to be a risk factor for the early development of T2 DM.
Objective To investigate the relationship between different glucose metabolism and non-high-density lipoprotein(non-HDL-C)and its role in the early prevention and treatment of type 2 diabetes mellitus(T2 DM).Methods A retrospective study was performed on 584 patients who underwent physical examination from 2008 to 2017.According to the oral glucose tolerance test(OGTT),the patients were divided into four groups:normal glucose tolerance(NGT)group,fasting glucose impaired with abnormal glucose tolerance(IGR)group,T2 DM group and 1 hour hyperglycemia(1 hour-HG)group[1 hour plasma glucose(1 hour-PG)more than 11.1 mmol/L after load].The sex,age,body mass index,blood pressure,uric acid and blood lipid were analyzed.Results Compared with the NGT group,patients in the 1 hour-HG group,IGR group and T2 DM group had higher levels of gender composition,age,uric acid and body mass index.The blood pressure level of IGR group was higher than that of NGT group.Compared with the NGT group,the diastolic blood pressure level of patients in the T2 DM group was higher,and the differences were statistically significant(P<0.05).The gender composition,age and uric acid of patients in the T2 DM group were significantly higher than those in the 1 h-HG group(P<0.05).Compared with the NGT group,patients in the 1 hour-HG group,IGR group and T2 DM group had significantly higher levels of total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and non-HDL-C,and significantly lower levels of high-density lipoprotein cholesterol(HDL-C),with statistically significant differences(P<0.05).Compared with NGT group,triglyceride(TG)levels in IGR group and T2 DM group were significantly higher(P<0.05).Compared with the 1 hour-HG group and the IGR group,TG level and HDL-C level in the T2 DM group were significantly increased,respectively(P<0.05).Partial correlation analysis showed that 1 h-PG was significantly positively correlated with TC,TG,LDL-C and non-HDL-C,and the correlation coefficient R values were 0.144,0.113,0.098 and 0.159,respectively(P<0.05).Conclusion People with different glycometabolism states have different degrees of dyslipidemia and disorder,in which 1 hour-PG is closely related to dyslipidemia,especially the level of non-HDL-C,which is speculated to be a risk factor for the early development of T2 DM.
引文
[1] Halcox J,Misra A.Type 2 diabetes mellitus,metabolic syndrome,and mixed dyslipidemia:how similar,how different,and how to treat[J].Metab Syndr Relat Disord,2015,13(1):1-21.
[2] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[3] 李健斋,王抒,曾平.非高密度脂蛋白胆固醇用于评估及预测冠心病危险[J].中华心血管病杂志,2004,32(11):963-966.
[4] McCoy RG,Lipska KJ,Yao X,et al.Intensive treatment and severe hypoglycemia among adults with type 2 diabetes[J].JAMA Intern Med,2016,176(7):969-978.
[5] Bianchi C,Miccoli R,Trombetta M,et al.Elevated 1-hour postload plasma glucose levels identify subjects with normal glucose tolerance but impaired β-cell function,insulin resistance,and worse cardiovascular risk profile:the GENFIEV study[J].J Clin Endocrinol Metab,2013,98(5):2100-2105.
[6] 曹永吉,师爱香,孙克德,等.口服葡萄糖耐量试验中1h血糖与胰岛β细胞功能的关系研究[J].中国医药,2013,8(S1):24-26.
[7] Pareek M,Bhatt DL,Nielsen ML,et al.Enhanced predictive capability of a 1-hour oral glucose tolerance test:a prospective population-based cohort study[J].Diabetes Care,2018,41(1):171-177.
[8] Abdul-Ghani MA,Jayyousi A,DeFronzo RA,et al.Insulin resistance the link between T2DM and CVD:basic mechanisms and clinical implications[J].Curr Vasc Pharmacol,2019,17(2):153-163.
[9] Abdul-Ghani MA,Matsuda M,Balas B,et al.Muscle and liver insulin resistance indexes derived from the oral glucose tolerance test[J].Diabetes Care,2007,30(1):89-94.
[10] Abdul-Ghani MA,Williams K,DeFronzo RA,et al.What is the best predictor of future type 2 diabetes[J].Diabetes Care,2007,30(6):1544-1548.
[11] Liu K,Dyer AR,Vu TH,et al.One-hour postload plasma glucose in middle age and Medicare expenditures in older age among nondiabetic men and women:the Chicago Heart Association Detection Project in Industry[J].Diabetes Care,2005,28(5):1057-1062.
[12] Su JB,Chen T,Xu F,et al.Glycemic variability in normal glucose regulation subjects with elevated 1-h postload plasma glucose levels[J].Endocrine,2014,46(2):241-248.
[13] Paddock E,Hohenadel MG,Piaggi P,et al.One-hour and two-hour postload plasma glucose concentrations are comparable predictors of type 2 diabetes mellitus in Southwestern Native Americans[J].Diabetologia,2017,60(9):1704-1711.
[14] Jagannathan R,Bergman M.Use of 1-h post-load plasma glucose concentration to identify individuals at high risk of developing Type 2 diabetes[J].Diabet Med,2017,34(7):877-878.
[2] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[3] 李健斋,王抒,曾平.非高密度脂蛋白胆固醇用于评估及预测冠心病危险[J].中华心血管病杂志,2004,32(11):963-966.
[4] McCoy RG,Lipska KJ,Yao X,et al.Intensive treatment and severe hypoglycemia among adults with type 2 diabetes[J].JAMA Intern Med,2016,176(7):969-978.
[5] Bianchi C,Miccoli R,Trombetta M,et al.Elevated 1-hour postload plasma glucose levels identify subjects with normal glucose tolerance but impaired β-cell function,insulin resistance,and worse cardiovascular risk profile:the GENFIEV study[J].J Clin Endocrinol Metab,2013,98(5):2100-2105.
[6] 曹永吉,师爱香,孙克德,等.口服葡萄糖耐量试验中1h血糖与胰岛β细胞功能的关系研究[J].中国医药,2013,8(S1):24-26.
[7] Pareek M,Bhatt DL,Nielsen ML,et al.Enhanced predictive capability of a 1-hour oral glucose tolerance test:a prospective population-based cohort study[J].Diabetes Care,2018,41(1):171-177.
[8] Abdul-Ghani MA,Jayyousi A,DeFronzo RA,et al.Insulin resistance the link between T2DM and CVD:basic mechanisms and clinical implications[J].Curr Vasc Pharmacol,2019,17(2):153-163.
[9] Abdul-Ghani MA,Matsuda M,Balas B,et al.Muscle and liver insulin resistance indexes derived from the oral glucose tolerance test[J].Diabetes Care,2007,30(1):89-94.
[10] Abdul-Ghani MA,Williams K,DeFronzo RA,et al.What is the best predictor of future type 2 diabetes[J].Diabetes Care,2007,30(6):1544-1548.
[11] Liu K,Dyer AR,Vu TH,et al.One-hour postload plasma glucose in middle age and Medicare expenditures in older age among nondiabetic men and women:the Chicago Heart Association Detection Project in Industry[J].Diabetes Care,2005,28(5):1057-1062.
[12] Su JB,Chen T,Xu F,et al.Glycemic variability in normal glucose regulation subjects with elevated 1-h postload plasma glucose levels[J].Endocrine,2014,46(2):241-248.
[13] Paddock E,Hohenadel MG,Piaggi P,et al.One-hour and two-hour postload plasma glucose concentrations are comparable predictors of type 2 diabetes mellitus in Southwestern Native Americans[J].Diabetologia,2017,60(9):1704-1711.
[14] Jagannathan R,Bergman M.Use of 1-h post-load plasma glucose concentration to identify individuals at high risk of developing Type 2 diabetes[J].Diabet Med,2017,34(7):877-878.