[长期血糖控制对1型糖尿病儿童及青少年血脂谱变化的影响]

Kostolanská J, Jakus V, Barák L', Staníková A

I. Detská klinika Lekárskej fbakulty UKa DFNsP Bratislava, Slovenská republika.

Vnitr Lek. 2011 Jun;57(6):533-9.

INTRODUCTION

Abnormalities in lipid metabolism contribute significantly to the increased occurrence of cardiovascular events in individuals with T1DM compared to healthy subjects. Disorder of lipid metabolism in T1DM is heavily dependent on maintaining of blood glucose values near the physiological range. DCCT study confirmed that patients with well compensated diabetes have similar lipid spectrum to the healthy subjects one.

AIMS

We aimed to study relations of lipid profile parameters (cholesterol of high density HDL, cholesterol of low density LDL, total cholesterol - TC, triglycerides - TAG) to age, duration of T1DM (DD), blood glucose, HbA1c and if the blood pressure (BP), BMI corrected for age (BMIc) and daily insulin doses per kilogram (DI) in 30 patients with T1DM with good long-term glycemic compensation. We aimed also to find mathematical models of lipid profile parameters dependence of the parameters of glycemic control, age, duration of DM1T, blood pressure (systolic and diastolic BPs, BPd, respectively) BMIc and DI.

RESULTS

HbA1c levels were significantly higher in diabetic patients compared to controls (p < 0.01), HDL were higher in diabetics than in controls (not significantly). LDL levels were in diabetics similar to controls. TAG was significantly lower in diabetics than in controls (p < 0.01). HDL significantly positively correlated with HbA1c (r = 0.372, p < 0.05) and negatively with BPs (r = -0.373, p < 0.05), TAG correlated with age (r = 0.546, p < 0.01), DD (r = 0.577, p < 0.001) and BPs (r = 0.407, p < 0.05). We also found a statistically appropriate mathematical models of the relationship of HDL and TAG with the parameters: age, DD, glucose, HbA1c, BP, BMIc, DI (r = 0.785, r2 = 0.616, p < 0.01, R = 0.758; r2 = 0.574, p < 0.05, respectively).

CONCLUSION

The changes in HDL and TAG values in juvenile diabetics are significantly affected by particularly long-term glycemic control and insulin therapy.

引言

与健康受试者相比，脂质代谢异常在很大程度上导致1型糖尿病（T1DM）患者心血管事件发生率增加。T1DM患者的脂质代谢紊乱在很大程度上取决于血糖值维持在生理范围内。糖尿病控制和并发症试验（DCCT）研究证实，血糖得到良好控制的糖尿病患者的血脂谱与健康受试者相似。

目的

我们旨在研究30例长期血糖控制良好的T1DM患者的血脂谱参数（高密度脂蛋白胆固醇HDL、低密度脂蛋白胆固醇LDL、总胆固醇 - TC、甘油三酯 - TAG）与年龄、T1DM病程（DD）、血糖、糖化血红蛋白（HbA1c）的关系，以及血压（BP）、年龄校正体重指数（BMIc）和每千克每日胰岛素剂量（DI）之间的关系。我们还旨在找到血脂谱参数与血糖控制参数、年龄、DM1T病程、血压（收缩压和舒张压，分别为BPd）、BMIc和DI之间依赖关系的数学模型。

结果

糖尿病患者的HbA1c水平显著高于对照组（p < 0.01），糖尿病患者的HDL高于对照组（无显著差异）。糖尿病患者的LDL水平与对照组相似。糖尿病患者的TAG显著低于对照组（p < 0.01）。HDL与HbA1c显著正相关（r = 0.372，p < 0.05），与血压显著负相关（r = -0.373，p < 0.05），TAG与年龄（r = 0.546，p < 0.01）、病程（r = 0.577，p < 0.001）和血压（r = 0.407，p < 0.05）相关。我们还发现了HDL和TAG与以下参数之间关系的统计学上合适的数学模型：年龄、病程、血糖、HbA1c、血压、BMIc、DI（r = 0.785，r2 = 0.616，p < 0.01，R = 0.758；r2 = 0.574，p < 0.05，分别）。