Valdivielso Pedro, Hidalgo Ana, Rioja José, Aguilar Isabel, Ariza María José, González-Alegre Teresa, González-Santos Pedro
Unidad de Lípidos, Departamento de Medicina Interna, Hospital Virgen de la Victoria, Málaga, Spain.
Atherosclerosis. 2007 Oct;194(2):391-6. doi: 10.1016/j.atherosclerosis.2006.08.006. Epub 2006 Sep 22.
To determine whether postprandial lipid levels are markers of clinical and subclinical macrovascular disease in a select group of patients with type 2 diabetes.
We recruited 119 local patients with type 2 diabetes and moderate metabolic control (HbA1c <8%). The patients were being treated with dietary measures and/or oral antihyperglycemic therapy. No patient was receiving lipid-lowering therapy. A history of cardiovascular events was recorded and the ankle-arm index was measured to assess subclinical peripheral artery disease. The patients underwent a lipid analysis after a 12-h fast and 4h after a mixed breakfast (50 g of fat, 40 g of carbohydrates).
The patients with clinical and subclinical macrovascular disease had a greater history of smoking, a longer disease duration, and higher serum creatinine levels. The groups with macroangiopathy had lower postprandial concentrations of HDL cholesterol (p<0.05) and a trend towards lower fasting levels of HDL cholesterol (p=0.08) and higher fasting and postprandial levels of triglycerides (p=0.07). Multivariate analysis showed the presence of vascular (both clinical and subclinical) disease to be significantly associated with smoking (OR 3.06; 95% CI, 1.15-8.4), disease duration (for each year, OR 1.12; 95% CI, 1.03-1.22) and postprandial levels of triglycerides (for each 50mg, OR 1.73; 95% CI, 1.13-2.65).
In our diabetic patients, the postprandial level of triglycerides 4h after a fatty breakfast, though not fasting lipids, plus smoking and disease duration were independently associated to clinical and subclinical macrovascular disease.
确定在一组特定的2型糖尿病患者中，餐后血脂水平是否为临床和亚临床大血管疾病的标志物。
我们招募了119名当地2型糖尿病患者，其代谢控制处于中等水平（糖化血红蛋白<8%）。这些患者接受饮食措施和/或口服降糖治疗。没有患者接受降脂治疗。记录心血管事件病史，并测量踝臂指数以评估亚临床外周动脉疾病。患者在禁食12小时后及混合早餐（50克脂肪、40克碳水化合物）后4小时进行血脂分析。
患有临床和亚临床大血管疾病的患者有更多的吸烟史、更长的病程以及更高的血清肌酐水平。患有大血管病变的组餐后高密度脂蛋白胆固醇浓度较低（p<0.05），空腹高密度脂蛋白胆固醇水平有降低趋势（p=0.08），空腹和餐后甘油三酯水平较高（p=0.07）。多变量分析显示，血管疾病（临床和亚临床）的存在与吸烟（比值比3.06；95%置信区间，1.15 - 8.4）、病程（每年，比值比1.12；95%置信区间，1.03 - 1.22）以及餐后甘油三酯水平（每50毫克，比值比1.73；95%置信区间，1.13 - 2.65）显著相关。
在我们的糖尿病患者中，富含脂肪早餐后4小时的餐后甘油三酯水平，而非空腹血脂水平，加上吸烟和病程与临床和亚临床大血管疾病独立相关。
