Rooney D P, Ryan M F
Department of Diabetes and Endocrinology and Biochemistry Laboratory, Antrim Area Hospital, Antrim, UK.
Diabet Med. 2006 Apr;23(4):436-40. doi: 10.1111/j.1464-5491.2006.01855.x.
The importance of adipose tissue in metabolism, as a target for insulin action and a secretor of metabolic regulatory proteins, is increasingly recognized. Lipodystrophic conditions are often associated with significant insulin resistance. The commonest acquired form occurs with highly active antiretroviral therapy (HAART) for human immunodeficiency virus infection. Other medical conditions and drugs also have the potential to cause chronic subcutaneous fat damage.
We describe an unfamiliar partial lipodystrophy in a young woman, associated with markedly insulin-resistant diabetes, acquired following allogeneic bone marrow transplantation for childhood leukaemia complicated by late sclerodermatous chronic graft vs. host disease (GVHD). Clinical examination revealed scarring and lipodystrophy affecting mainly legs, thighs, buttocks and forearms but sparing her face, neck and thorax. Her serum adiponectin level was markedly reduced.
However, although thiazolidinediones lower insulin resistance and increase subcutaneous peripheral fat in Type 2 diabetes, pioglitazone treatment had little effect on either serum adiponectin, glycaemic control or the lipoatrophy. In this case, effective glycaemic control was best achieved using a combination of metformin and highly concentrated soluble insulin injections.
脂肪组织在新陈代谢中的重要性日益得到认可，它是胰岛素作用的靶点以及代谢调节蛋白的分泌者。脂肪营养不良症常与显著的胰岛素抵抗相关。最常见的后天性形式发生在用于治疗人类免疫缺陷病毒感染的高效抗逆转录病毒疗法（HAART）中。其他病症和药物也有可能导致慢性皮下脂肪损害。
我们描述了一名年轻女性中一种不常见的部分脂肪营养不良症，其与显著的胰岛素抵抗性糖尿病相关，该病症是在因儿童白血病接受异基因骨髓移植并伴有晚期硬皮病样慢性移植物抗宿主病（GVHD）后出现的。临床检查发现瘢痕形成和脂肪营养不良，主要影响腿部、大腿、臀部和前臂，但面部、颈部和胸部未受影响。她的血清脂联素水平显著降低。
然而，尽管噻唑烷二酮类药物可降低2型糖尿病患者的胰岛素抵抗并增加皮下外周脂肪，但吡格列酮治疗对血清脂联素、血糖控制或脂肪萎缩几乎没有影响。在该病例中，使用二甲双胍和高浓度可溶性胰岛素注射联合治疗可最佳地实现有效的血糖控制。
