Shen D C, Fuh M M, Shieh S M, Chen Y D, Reaven G M
Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan, Republic of China.
J Clin Endocrinol Metab. 1991 Sep;73(3):503-10. doi: 10.1210/jcem-73-3-503.
This study was initiated to 1) assess gemfibrozil's ability to lower plasma triglyceride (TG) concentration in patients with NIDDM, and 2) determine whether this effect was associated with any changes in glycemic control. Measurements were made of mean hourly plasma glucose, insulin, TG, and FFA concentrations from 1200-1600 h in response to a test meal; hepatic glucose production (HGP); insulin-stimulated glucose uptake during a hyperinsulinemic glucose clamp study (MCR); and fasting plasma lipoprotein TG and cholesterol concentrations in 12 patients with NIDDM before and 3 months after gemfibrozil treatment. Although ambient plasma TG and FFA concentrations fell significantly, plasma glucose, insulin, HGP, concentrations fell significantly, plasma glucose, insulin, HGP, and glucose MCR did not change. However, when patients were divided into two groups, those with fasting plasma glucose levels above 9 mmol/L (fair control) and those with levels below 9 mmol/L (good control), a different phenomenon was observed. Patients in fair control had significant decreases in mean hourly plasma concentrations of glucose (15.1 +/- 1.7 to 12.6 +/- 0.9 mmol/L; P less than 0.001), insulin (523 +/- 59 to 471 +/- 75 pmol/L; P less than 0.001), FFA (652 +/- 150 to 504 +/- 76 mumol/L), and HGP (9.5 0.4 to 8.1 +/- 0.4 mumol/kg.min; P less than 0.005), and an increase in glucose MCR (2.63 +/- 0.49 to 3.72 +/- 0.54 mL/kg.min; P less than 0.07) in association with a fall in TG from 6.9 +/- 1.3 to 3.5 +/- 0.9 mmol/L (P less than 0.001). Although fasting low density lipoprotein cholesterol increased (1.8 +/- 0.2 to 2.7 +/- 0.2 mmol/L; P less than 0.05), the ratio of total to high density lipoprotein cholesterol decreased (6.84 +/- 0.88 to 5.80 +/- 1.05; P less than 0.02). Despite a significant fall in mean hourly TG concentration (4.6 +/- 0.7 to 3.8 +/- 0.7 mmol/L; P less than 0.001), neither insulin, FFA, HGP, nor glucose MCR changed in patients in good control. Furthermore, the mean hourly plasma glucose concentration increased from 9.2 +/- 0.7 to 11.7 +/- 1.4 mmol/L (P less than 0.001). Low density lipoprotein cholesterol also increased in this group (1.9 +/- 0.2 to 2.7 +/- 0.2 mmol/L; P less than 0.02), but, as before, the ratio of total to high density lipoprotein cholesterol decreased (8.15 +/- 1.93 to 6.36 +/- 1.03; P less than 0.02).
1）评估吉非贝齐降低非胰岛素依赖型糖尿病（NIDDM）患者血浆甘油三酯（TG）浓度的能力；2）确定该效应是否与血糖控制的任何变化相关。针对一顿试验餐，测量了1200 - 1600 h期间每小时的平均血浆葡萄糖、胰岛素、TG和游离脂肪酸（FFA）浓度；肝葡萄糖生成（HGP）；在高胰岛素血糖钳夹研究期间胰岛素刺激的葡萄糖摄取（MCR）；以及12例NIDDM患者在吉非贝齐治疗前及治疗3个月后的空腹血浆脂蛋白TG和胆固醇浓度。尽管空腹血浆TG和FFA浓度显著下降，但血浆葡萄糖、胰岛素、HGP浓度显著下降，血浆葡萄糖、胰岛素、HGP和葡萄糖MCR并未改变。然而，当将患者分为两组时，即空腹血浆葡萄糖水平高于9 mmol/L（控制不佳）的患者和低于9 mmol/L（控制良好）的患者，观察到了不同的现象。控制不佳的患者每小时平均血浆葡萄糖浓度（15.1±1.7至12.6±0.9 mmol/L；P＜0.001）、胰岛素浓度（523±59至471±75 pmol/L；P＜0.001）、FFA浓度（6,52±150至504±76 μmol/L）和HGP浓度（9.5±0.4至8.1±0.4 μmol/kg.min；P＜0.005）显著下降，葡萄糖MCR增加（2.63±0.49至3.72±0.54 mL/kg.min；P＜0.07），同时TG从6.9±1.3降至3.5±0.9 mmol/L（P＜0.001）。尽管空腹低密度脂蛋白胆固醇升高（1.8±0.2至2.7±0.2 mmol/L；P＜0.05），但总胆固醇与高密度脂蛋白胆固醇的比值下降（6.84±0.88至5.80±1.05；P＜0.02）。尽管控制良好的患者每小时平均TG浓度显著下降（4.6±0.7至3.8±0.7 mmol/L；P＜0.001），但胰岛素、FFA、HGP和葡萄糖MCR均未改变。此外该组患者每小时平均血浆葡萄糖浓度从9.2±0.7升至11.7±1.4 mmol/L（P＜0.001）。该组低密度脂蛋白胆固醇也升高（1. = 0.2至2.7±0.2 mmol/L；P＜0.02），但与之前一样，总胆固醇与高密度脂蛋白胆固醇的比值下降（8.15±1.93至6.36±1.03；P＜0.02）。
