Rivellese A A, Patti L, Romano G, Innelli F, Di Marino L, Annuzzi G, Iavicoli M, Coronel G A, Riccardi G
Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy.
J Clin Endocrinol Metab. 2000 Nov;85(11):4188-92. doi: 10.1210/jcem.85.11.6956.
The aim of this study was to evaluate the effect of sc insulin (INS) compared with sulfonylurea (SUL) therapy, at the same level of blood glucose control, on the low density lipoprotein (LDL) subfraction profile in normolipidemic type 2 diabetic patients. Nine normolipidemic type 2 diabetic men (age, 56+/-3 yr; body mass index, 26.5+/-0.9 kg/m2; mean +/- SEM), after a 3-week wash-out period, were assigned to INS or SUL for 2 months in a randomized cross-over design. Doses were adjusted only during the first month and then were kept constant. At the end of the treatments, hemoglobin A1c, plasma lipids, LDL, and very low density lipoprotein (VLDL) subfraction profiles and plasma postheparin lipoprotein lipase and hepatic lipase (HL) activities were evaluated. Despite glucose control was similar at the end of both periods (hemoglobin A1c, 7.4+/-0.3% vs. 7.0+/-0.2%, INS vs. SUL), INS compared with SUL significantly reduced plasma triglyceride (0.9+/-0.1 vs. 1.1+/-0.1 mmol/L; P < 0.05). Although INS did not affect the LDL concentration, it induced a decrease in both the amount (59.0 = 9.8 vs. 76.1+/-16.8 mg/dL; P = NS) and the proportion (31.2+/-3.0% vs. 38.3+/-3.8%; P < 0.03) of small LDL. Moreover, the decrease in small LDL was positively related to the reduction of large VLDL (r = 0.67; P < 0.04) and HL (r = 0.69, P < 0.05) induced by insulin therapy. In conclusion, sc insulin therapy, independently of glucose control and even in the presence of quite low plasma triglyceride levels, is able to reduce small LDL particles in type 2 diabetic patients. This change is related to decreases in both HL activity and large VLDL particles.
本研究的目的是在血糖控制水平相同的情况下，评估皮下注射胰岛素（INS）与磺脲类药物（SUL）治疗对血脂正常的2型糖尿病患者低密度脂蛋白（LDL）亚组分谱的影响。9名血脂正常的2型糖尿病男性（年龄56±3岁；体重指数26.5±0.9kg/m²；均值±标准误），经过3周的洗脱期后，采用随机交叉设计，接受INS或SUL治疗2个月。仅在第一个月调整剂量，之后保持恒定。治疗结束时，评估糖化血红蛋白、血浆脂质、LDL和极低密度脂蛋白（VLDL）亚组分谱以及血浆肝素后脂蛋白脂肪酶和肝脂肪酶（HL）活性。尽管两个阶段结束时血糖控制情况相似（糖化血红蛋白，INS组为7.4±0.3%，SUL组为7.0±0.2%），但与SUL相比，INS显著降低了血浆甘油三酯水平（0.9±0.1 vs. 1.1±0.1mmol/L；P<0.05）。虽然INS不影响LDL浓度，但它使小LDL的量（59.0±9.8 vs. 76.1±16.8mg/dL；P=无显著性差异）和比例（31.2±3.0% vs. 38.3±3.8%；P<0.03）均有所降低。此外，小LDL的降低与胰岛素治疗引起的大VLDL降低（r=0.67；P<0.04）和HL降低（r=0.69，P<0.05）呈正相关。总之，皮下注射胰岛素治疗，独立于血糖控制，即使在血浆甘油三酯水平相当低的情况下，也能够降低2型糖尿病患者的小LDL颗粒。这种变化与HL活性和大VLDL颗粒的降低有关。
