糖尿病前期患者的磁共振脂蛋白异常——来自胰岛素抵抗动脉粥样硬化研究

作     者：Festa A. Williams K. Hanley A. J. G. S. M. Haffner 张步升 

作者机构：Department of Medicine University of Texas Health Science Center MC 7873 7703 Floyd Curl Dr San Antonio TX 78229-3900 United States Dr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第11期

页      面：45-46页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：糖尿病前期 胰岛素抵抗 甘油三酯水平 VLDL 化学法测定 前动脉 人口统计学 测量结果 研究成果 

摘      要：Background-Subjects with type 2 diabetes have smaller LDL and HDL particles in addition to higher levels of triglycerides and lower HDL cholesterol. Elevated insulin resistance, blood pressure, and dyslipidemia(including small dense LDL) predicted incident diabetes. In the Insulin Resistance Atherosclerosis Study(IRAS) we studied nuclear magnetic resonance(NMR) lipoprotein particle measures in prediabetic individuals, considering potentially modifying covariates, including insulin resistance, as directly measured using a frequently sampled intravenous glucose tolerance test. Methods and Results-Of 830 subjects who were nondiabetic at baseline, 130(15.7%) developed diabetes after a mean followup of 5.2 years. Various lipoprotein abnormalities were found in prediabetic subjects compared with subjects who stayed nondiabetic at follow-up. In logistic regression analyses(demographically adjusted), VLDL particles, large VLDL, LDL particles, small LDL, large HDL, small HDL, VLDL size, LDL size, and HDL size were related to incident diabetes. The relation of VLDL size and small HDL to incident diabetes was independent of waist(odds ratio OR 95%CI , 1.43 1.18 to 1.73 and 1.23 1.01 to 1.51 for VLDL size and small HDL, respectively) and independent of conventionally(chemically)measured triglycerides and HDL cholesterol(OR 95%CI , 1.45 1.18 to 1.78 and 1.30 1.06 to 1.60 , respectively). Insulin sensitivity attenuated the relation to incident diabetes of VLDL size(OR 95%CI , 1.25 1.01 to 1.53 ) but not of small HDL particles(OR 95%CI , 1.25 1.02 to 1.54 ). Conclusions-We have shown a range of lipoprotein abnormalities in prediabetic individuals, including compositional changes in HDL and VLDL. These findings extend previous work indicating a proatherogenic state in healthy, nondiabetic subjects who subsequently develop diabetes.