Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine. Tokyo 142-8666, Japan.
Endocr J. 2012;59(7):561-9. doi: 10.1507/endocrj.ej11-0329. Epub 2012 May 16.
The reduced levels of high-density lipoprotein (HDL) 2-cholesterol (C) in diabetes and other metabolic disorders associated with a high risk of cardiovascular disease are well established. Few studies, however, have compared the HDL subspecies in type 1 diabetes (T1D) with those in type 2 diabetes (T2D) with or without insulin. We examined HDL subspecies in 27 T1D with insulin, 33 T2D with insulin or insulin plus oral-anti-diabetic drugs (OADs), 36 T2D with OADs or diet/exercise, and 25 non-diabetic controls. Insulin was injected four times daily in a basal-bolus manner for both T1D and T2D. Plasma levels of C, apolipoprotein (apo) AI, and AII were determined in HDL2 and HDL3 by the single precipitation method. HDL-C levels were significantly higher in T1D and lower in T2D, compared with the controls. Insulin-treated T2D had higher HDL-C than non-insulin-treated T2D. T1D had higher HDL2-C and HDL2-apo AI levels than T2D. Insulin-treated T2D had higher HDL2-C and HDL2-apo AI levels than non-insulin-treated T2D. All of these differences were more pronounced for men than for women. HDL3 levels were comparable among controls,T1D and T2D. HDL2-C levels were inversely associated with BMI, HbA1c, triglyceride, small dense LDL-C, and LDL-C. Multiple regression analysis revealed that HDL2-C was independently associated with triglyceride, LDL-C, and intensive insulin therapy but not with HbA1c. In conclusion, these results suggest that intensive insulin therapy is associated with alterations of HDL subspecies, irrespective of the type of diabetes.
高密度脂蛋白（HDL）2 胆固醇（C）水平降低与心血管疾病风险增加有关，这在糖尿病和其他代谢紊乱中已得到证实。然而，很少有研究比较过 1 型糖尿病（T1D）和 2 型糖尿病（T2D）患者的 HDL 亚类，也没有比较过使用胰岛素和/或胰岛素加口服降糖药（OAD）、使用 OAD 或饮食/运动治疗的 T2D 患者的 HDL 亚类。我们检查了 27 例使用胰岛素的 T1D、33 例使用胰岛素或胰岛素加 OAD 的 T2D、36 例使用 OAD 或饮食/运动的 T2D 和 25 例非糖尿病对照者的 HDL 亚类。T1D 和 T2D 均采用基础-餐时胰岛素注射方案，每天注射 4 次。采用单次沉淀法测定 HDL2 和 HDL3 中的 C、载脂蛋白（apo）AI 和 AII 水平。与对照组相比，T1D 的 HDL-C 水平显著升高，T2D 的 HDL-C 水平显著降低。与非胰岛素治疗的 T2D 相比，胰岛素治疗的 T2D 具有更高的 HDL-C。T1D 的 HDL2-C 和 HDL2-apo AI 水平高于 T2D。与非胰岛素治疗的 T2D 相比，胰岛素治疗的 T2D 具有更高的 HDL2-C 和 HDL2-apo AI 水平。这些差异在男性中比在女性中更为明显。对照组、T1D 和 T2D 的 HDL3 水平相当。HDL2-C 水平与 BMI、HbA1c、甘油三酯、小而密 LDL-C 和 LDL-C 呈负相关。多元回归分析显示，HDL2-C 与甘油三酯、LDL-C 和强化胰岛素治疗独立相关，而与 HbA1c 无关。总之，这些结果表明，强化胰岛素治疗与 HDL 亚类的改变有关，而与糖尿病类型无关。
