1型糖尿病的脂质和脂蛋白紊乱与大血管及微血管并发症之间的不同关联。

Differing associations of lipid and lipoprotein disturbances with the macrovascular and microvascular complications of type 1 diabetes.

作者信息

Chaturvedi N, Fuller J H, Taskinen M R

机构信息

EURODIAB, Department of Epidemiology and Public Health, University College London, London, UK.

出版信息

Diabetes Care. 2001 Dec;24(12):2071-7. doi: 10.2337/diacare.24.12.2071.

DOI:10.2337/diacare.24.12.2071

PMID:11723085

Abstract

OBJECTIVE

Cardiovascular disease (CVD) is increased in patients with type 1 diabetes, but lipid and lipoprotein patterns remain favorable. In contrast, nephropathy is associated with an adverse distribution. We compared the associations and predictive power of lipid and lipoprotein disturbances with these complications.

RESEARCH DESIGN AND METHODS

A nested case-control study from the EURODIAB cohort of 140 case subjects with evidence of at least one complication and 84 control subjects with no complications were analyzed. Conventional and unconventional lipid and lipoprotein fractions, including apolipoprotein (apo)-A1, lipoprotein (Lp)-A1, LpA1/A2, apoB, and LDL particle size were measured centrally.

RESULTS

CVD was only associated with increased LDL cholesterol (3.6 vs. 3.0 mmol/l, P = 0.02). In contrast, albuminuria was associated with elevated cholesterol, triglyceride, LDL, and apoB and with diminished LDL particle size. No disturbances in HDL and related lipoproteins were noted. In normoalbuminuric patients, CVD was not associated with any significant changes in lipids. CVD in macroalbuminuric patients was associated with increased triglyceride level (2.37 vs. 1.07 mmol/l, P = 0.001; P = 0.02 for CVD/albuminuria interaction) and LDL cholesterol (5.4 vs. 3.3 mmol/l, P = 0.005; P = 0.004 for interaction). Independent associations were observed for total cholesterol and for LDL particle size and albuminuria.

CONCLUSIONS

Abnormalities in lipid and lipoprotein disturbances are more closely related to albuminuria than to CVD in patients with type 1 diabetes. Measurement of conventional parameters provide sufficient risk information. ApoB and LDL particle size offer limited extra information. HDL metabolism remains undisturbed in the presence of complications. These changes reflect associations with glycemic control, which is the key to understanding lipid and lipoprotein disturbances.

摘要

目的

1型糖尿病患者心血管疾病（CVD）风险增加，但血脂和脂蛋白谱仍较为有利。相比之下，肾病则与不良分布相关。我们比较了血脂和脂蛋白紊乱与这些并发症之间的关联及预测能力。

研究设计与方法

对欧洲糖尿病研究（EURODIAB）队列中的一项巢式病例对照研究进行分析，该研究纳入了140例有至少一种并发症证据的病例受试者和84例无并发症的对照受试者。对常规和非常规血脂及脂蛋白组分，包括载脂蛋白（apo）-A1、脂蛋白（Lp）-A1、LpA1/A2、apoB以及低密度脂蛋白（LDL）颗粒大小进行集中检测。

结果

CVD仅与低密度脂蛋白胆固醇升高相关（3.6 vs. 3.0 mmol/L，P = 0.02）。相比之下，蛋白尿与胆固醇、甘油三酯、低密度脂蛋白及apoB升高以及LDL颗粒大小减小相关。未发现高密度脂蛋白（HDL）及相关脂蛋白存在紊乱。在正常白蛋白尿患者中，CVD与血脂的任何显著变化均无关联。大量白蛋白尿患者的CVD与甘油三酯水平升高（2.37 vs. 1.07 mmol/L，P = 0.001；CVD/白蛋白尿交互作用P = 0.02）和低密度脂蛋白胆固醇升高（5.4 vs. 3.3 mmol/L，P = 0.005；交互作用P = 0.004）相关。观察到总胆固醇、LDL颗粒大小与白蛋白尿之间存在独立关联。