老年2型糖尿病患者血脂与胰岛素抵抗及胰岛β细胞功能的关系
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摘要
目的探讨老年2型糖尿病患者血脂与胰岛素抵抗及胰岛β细胞功能的关系。方法选择2016年4月～2018年3月期间在北京积水潭医院住院的老年糖尿病患者(年龄≥65岁)120例,测定空腹血糖(fasting plasma glucose,FBG)、空腹胰岛素(fasting insulin, FINS)及总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)水平。用稳态模型评估法(homeostasis model aseessment,HOMA)计算胰岛β细胞功能(homa islet beta cell function index,HOMA-β)及胰岛素抵抗(homa insulin-resistance,HOMA-IR)相关指数,评估血脂与HOMA-β及HOMA-IR指数的关系。结果 TC与体重指数(body mass index,BMI)及FBG相关;LDL-C与BMI、FBG及HOMA-IR相关;LDL-C≥2.6mmol/L的患者BMI、FBG及HOMA-IR明显高于LDL-C<2.6mmol/L组。校正性别、年龄、糖尿病病程、BMI的影响后,LDL-C与HOMA-IR的相关性差异有统计学意义。结论在非胰岛素治疗的老年2型糖尿病患者中,LDL-C与肥胖及胰岛素抵抗相关,但未发现血脂成分与胰岛β细胞功能相关。
Objective To explore the relationship between lipid and insulin resistance and islet β cell function in advanced age patients with type 2 diabetes. Methods A total of 120 patients with type 2 diabetes(older than 65 years old) admitted in our hospital from April 2016 to March 2018 were recruited in this study. Selected objects are measured fasting plasma glucose, fasting insulin, total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Homeostasis model assessment of secretory function of islet β cell and insulin resistance were evaluated. The relationship between lipid and insulin resistance and islet β cell function were evaluated. Results Triglyceride was related to body mass index and fasting plasma glucose. Low-density lipoprotein cholesterol was related to body mass index, fasting plasma glucose and HOMA-IR. Body mass index, fasting plasma glucose and HOMA-IR in patients with LDL-C≥2.6 mmol/L were significantly higher than patients with LDL-C<2.6 mmol/L. There was significant relationship between LDL-C and HOMA-IR after adjusting sex, age, course of diabetes and body mass index. Conclusion LDL-C is related to obesity and HOMA-IR in non-insulin treatment of diabetic elderly patients. However, no relationship was found between blood lipids and islet beta cell function.
Objective To explore the relationship between lipid and insulin resistance and islet β cell function in advanced age patients with type 2 diabetes. Methods A total of 120 patients with type 2 diabetes(older than 65 years old) admitted in our hospital from April 2016 to March 2018 were recruited in this study. Selected objects are measured fasting plasma glucose, fasting insulin, total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Homeostasis model assessment of secretory function of islet β cell and insulin resistance were evaluated. The relationship between lipid and insulin resistance and islet β cell function were evaluated. Results Triglyceride was related to body mass index and fasting plasma glucose. Low-density lipoprotein cholesterol was related to body mass index, fasting plasma glucose and HOMA-IR. Body mass index, fasting plasma glucose and HOMA-IR in patients with LDL-C≥2.6 mmol/L were significantly higher than patients with LDL-C<2.6 mmol/L. There was significant relationship between LDL-C and HOMA-IR after adjusting sex, age, course of diabetes and body mass index. Conclusion LDL-C is related to obesity and HOMA-IR in non-insulin treatment of diabetic elderly patients. However, no relationship was found between blood lipids and islet beta cell function.
引文
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9 Chen ZY,Liu SN,Li CN,et al.Atorvastatin helps preserve pancreatic β cell function in obese C57BL/6 J mice and the effect is related to increased pancreas proliferation and amelioration of endoplasmic-reticulum stress[J].Lipids Health Dis,2014,13(98):1-10
10 Rütti S,Ehses JA,Sibler RA,et al.A low and high density lipoproteins modulate function,apoptosis and proliferation of primary human and murine pancreatic beta cells[J].Endocrinology,2009,150(10):4521-4530
11 中华医学会糖尿病学会.中国2型糖尿病防治指南[J].中华内分泌代谢杂志,2014,30(10):893-942
12 Plaisance V,Brajkovic S,Tenenbaum M,et al.Endoplasmic reticulum stress links oxidative stress to impaired pancreatic beta-cell function caused by human oxidized LDL[J].PLoS One,2016,11(9):1-14
13 McAuleg KA,William SM,Mann JI,et al.Diagnosing insulin resistance in the general population[J].Diabetes care,2011,24(5):460-464
14 郭毅飞,李雪锋,曾玉琴,等.血清 sP-selectin、sE-selectin水平与糖尿病患者胰岛素抵抗的关系[J].河北医药,2018,40(3):352-355
15 范丽,杜鑫.2 型糖尿病 700 例低密度脂蛋白与并发症关系分析[J].中华临床医师杂志,2013,7(19):8645-8648
16 李伟,张晨鑫,王玲,等.2 型糖尿病合并肥胖患者腹部脂肪分布与胰岛素抵抗的相关性研究 [J].重庆医学,2017,46(26):3632-3634
17 刘小位,王养维,庞雅玲,等.TG/HDL‐C与新诊断T2DM 患者胰岛素抵抗的相关性研究[J].陕西医学杂志,2017,1(46):61-62
18 Bardini G,Dicembrini I,Rotella CM,et al.Correlation between HDL cholesterol levels and beta-cell function in subjects with various degree of glucose tolerance[J].Acta Diabetol,2013,50(2):277-281
19 Andrew LS,Sarah EH,Bronwyn A.et al.HDL and glucose metabolism:current evidence and therapeutic potential[J].Front Pharmacol,2015,6(11):258-265
2 侯鹏高.动脉粥样硬化与脂代谢紊乱研究进展[J].齐齐哈尔医学院学报,2015,36(7):1039-1040
3 Zhou M,Zhu L,Cui X,et al.The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as a predictor of insulin resistance but not of β cell function in a Chinese population with different glucose tolerance status[J].Lipids Health Dis,2016,15(10):104-112
4 李雷,蒲青,华丽萍,等.2 型糖尿病患者血脂水平与胰岛素抵抗的相关性研究[J].实用糖尿病杂志,2014,10(4) :49-50
5 谢义平,罗金琼.二甲双胍治疗2型糖尿病的效果分析[J].中国现代医生,2016,54(21):114-116
6 季方圆,逄曙光,田玉玲.血糖控制不同阶段2型糖尿病患者的血脂水平[J].中国老年学杂志,2015,35(6):1445-1446
7 Collins R,Reith C,Emberson J,et al.Interpretation of the evidence for the efficacy and safety of statin therapy[J].Lancet,2016,388(10059):2532-2561
8 马校芬,金秀平.脂代谢紊乱对2型糖尿病患者胰岛素抵抗及分泌功能的影响[J].河北联合大学学报,2016,18(2):107-109
9 Chen ZY,Liu SN,Li CN,et al.Atorvastatin helps preserve pancreatic β cell function in obese C57BL/6 J mice and the effect is related to increased pancreas proliferation and amelioration of endoplasmic-reticulum stress[J].Lipids Health Dis,2014,13(98):1-10
10 Rütti S,Ehses JA,Sibler RA,et al.A low and high density lipoproteins modulate function,apoptosis and proliferation of primary human and murine pancreatic beta cells[J].Endocrinology,2009,150(10):4521-4530
11 中华医学会糖尿病学会.中国2型糖尿病防治指南[J].中华内分泌代谢杂志,2014,30(10):893-942
12 Plaisance V,Brajkovic S,Tenenbaum M,et al.Endoplasmic reticulum stress links oxidative stress to impaired pancreatic beta-cell function caused by human oxidized LDL[J].PLoS One,2016,11(9):1-14
13 McAuleg KA,William SM,Mann JI,et al.Diagnosing insulin resistance in the general population[J].Diabetes care,2011,24(5):460-464
14 郭毅飞,李雪锋,曾玉琴,等.血清 sP-selectin、sE-selectin水平与糖尿病患者胰岛素抵抗的关系[J].河北医药,2018,40(3):352-355
15 范丽,杜鑫.2 型糖尿病 700 例低密度脂蛋白与并发症关系分析[J].中华临床医师杂志,2013,7(19):8645-8648
16 李伟,张晨鑫,王玲,等.2 型糖尿病合并肥胖患者腹部脂肪分布与胰岛素抵抗的相关性研究 [J].重庆医学,2017,46(26):3632-3634
17 刘小位,王养维,庞雅玲,等.TG/HDL‐C与新诊断T2DM 患者胰岛素抵抗的相关性研究[J].陕西医学杂志,2017,1(46):61-62
18 Bardini G,Dicembrini I,Rotella CM,et al.Correlation between HDL cholesterol levels and beta-cell function in subjects with various degree of glucose tolerance[J].Acta Diabetol,2013,50(2):277-281
19 Andrew LS,Sarah EH,Bronwyn A.et al.HDL and glucose metabolism:current evidence and therapeutic potential[J].Front Pharmacol,2015,6(11):258-265