在诊断和未诊断的糖尿病、糖尿病前期和血糖正常的成年人中，血脂和载脂蛋白 B 浓度的时间变化：1988-1991 年至 2005-2008 年全国健康和营养调查的结果。
Temporal changes in concentrations of lipids and apolipoprotein B among adults with diagnosed and undiagnosed diabetes, prediabetes, and normoglycemia: findings from the National Health and Nutrition Examination Survey 1988-1991 to 2005-2008.
机构信息
Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
出版信息
Cardiovasc Diabetol. 2013 Jan 30;12:26. doi: 10.1186/1475-2840-12-26.
BACKGROUND
Diabetes is characterized by profound lipid abnormalities. The objective of this study was to examine changes in concentrations of lipids and apolipoprotein B among participants stratified by glycemic status (diabetes, undiagnosed diabetes, prediabetes, and normoglycemia) in the United States from 1988-1991 to 2005-2008.
METHODS
We used data from 3202 participants aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) III (1988-1991) and 3949 participants aged ≥20 years from NHANES 2005-2008.
RESULTS
Among participants of all four groups, unadjusted and adjusted mean concentrations of total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B, but not triglycerides, decreased significantly. Among participants with prediabetes and normoglycemia, unadjusted and adjusted mean concentrations of high-density lipoprotein cholesterol increased significantly. Adjusted mean log-transformed concentrations of triglycerides decreased in adults with undiagnosed diabetes and prediabetes. During 2005-2008, unadjusted concentrations of apolipoprotein B ≥80 mg/dl were observed in 72.8% of participants with diagnosed diabetes, 87.9% of participants with undiagnosed diabetes, 86.6% of participants with prediabetes, and 77.2% of participants with normoglycemia. The unadjusted use of cholesterol-lowering medications rose rapidly, especially among participants with diabetes (from ~1% to ~49%, P <0.001). The use of fenofibrate, gemfibrozil, and niacin rose significantly only among adults with diagnosed diabetes (from ~2% to ~8%, P = 0.011).
CONCLUSION
Lipid profiles of adults with diabetes improved during the approximately 16-year study period. Nevertheless, large percentages of adults continue to have elevated concentrations of apolipoprotein B.
背景
糖尿病的特点是脂质严重异常。本研究的目的是在美国人群中，按血糖状态（糖尿病、未诊断的糖尿病、糖尿病前期和血糖正常）对 1988-1991 年至 2005-2008 年期间的参与者进行分组，观察脂质和载脂蛋白 B 浓度的变化。
方法
我们使用了来自国家健康和营养调查（NHANES）III（1988-1991 年）的 3202 名年龄≥20 岁的参与者和来自 NHANES 2005-2008 年的 3949 名年龄≥20 岁的参与者的数据。
结果
在所有四组参与者中，未经调整和调整后的总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇和载脂蛋白 B（但不包括甘油三酯）的平均浓度均显著降低。在糖尿病前期和血糖正常的参与者中，未经调整和调整后的高密度脂蛋白胆固醇平均浓度显著升高。未经调整和调整后的甘油三酯对数转换平均浓度在未诊断的糖尿病和糖尿病前期的成年人中均降低。在 2005-2008 年期间，诊断为糖尿病的参与者中有 72.8%、未诊断为糖尿病的参与者中有 87.9%、糖尿病前期的参与者中有 86.6%、血糖正常的参与者中有 77.2%的人存在载脂蛋白 B≥80mg/dl。降胆固醇药物的未调整使用率迅速上升，尤其是在糖尿病患者中（从约 1%上升至约 49%，P<0.001）。仅在诊断为糖尿病的成年人中，使用非诺贝特、吉非贝齐和烟酸的比例显著上升（从约 2%上升至约 8%，P=0.011）。
结论
在大约 16 年的研究期间，糖尿病患者的血脂谱得到改善。然而，仍有很大比例的成年人存在载脂蛋白 B 浓度升高的情况。
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