1 型糖尿病患者的先进脂蛋白谱紊乱：重点关注 LDL 颗粒。
Advanced lipoprotein profile disturbances in type 1 diabetes mellitus: a focus on LDL particles.
机构信息
Department of Endocrinology & Nutrition, Diabetes Unit, Hospital Clínic de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
Institut d'investigacions biomèdiques August Pi i Sunyer, Barcelona, Spain.
出版信息
Cardiovasc Diabetol. 2020 Aug 9;19(1):126. doi: 10.1186/s12933-020-01099-0.
BACKGROUND
Lipoprotein disturbances have been associated with increased cardiovascular disease (CVD) risk in type 1 diabetes mellitus (T1DM). We assessed the advanced lipoprotein profile in T1DM individuals, and analysed differences with non-diabetic counterparts.
METHODS
This cross-sectional study involved 508 adults with T1DM and 347 controls, recruited from institutions in a Mediterranean region of Spain. Conventional and advanced (assessed by nuclear magnetic resonance [NMR] spectroscopy) lipoprotein profiles were analysed. Crude and adjusted (by age, sex, statin use, body mass index and leukocyte count) comparisons were performed.
RESULTS
The median (interquartile range) age of the study participants was 45 (38-53) years, 48.2% were men. In the T1DM group, the median diabetes duration was 23 (16-31) years, and 8.1% and 40.2% of individuals had nephropathy and retinopathy, respectively. The proportion of participants with hypertension (29.5 vs. 9.2%), and statin use (45.7% vs. 8.1%) was higher in the T1DM vs. controls (p < 0.001). The T1DM group had a better conventional (all parameters, p < 0.001) and NMR-lipid profile than the control group. Thus, T1DM individuals showed lower concentrations of atherogenic lipoproteins (VLDL-particles and LDL-particles) and higher concentrations of anti-atherogenic lipoproteins (HDL-particles) vs. controls, even after adjusting for several confounders (p < 0.001 for all). While non-diabetic women had a more favourable lipid profile than non-diabetic men, women with T1DM had a similar concentration of LDL-particles compared to men with T1DM (1231 [1125-1383] vs. 1257 [1128-1383] nmol/L, p = 0.849), and a similar concentration of small-LDL-particles to non-diabetic women (672.8 [614.2-733.9] vs. 671.2 [593.5-761.4] nmol/L, respectively; p = 0.790). Finally, T1DM individuals showed higher discrepancies between NMR-LDL-particles and conventional LDL-cholesterol than non-diabetic subjects (prevalence of LDL-cholesterol < 100 mg/dL & LDL-particles > 1000 nmol/L: 38 vs. 21.2%; p < 0.001). All these differences were largely unchanged in participants without lipid-lowering drugs (T1DM, n = 275; controls, n = 317).
CONCLUSIONS
Overall, T1DM participants showed a more favourable conventional and NMR-lipid profile than controls. However, the NMR-assessment identified several lipoprotein derangements in LDL-particles among the T1DM population (higher discrepancies in NMR-LDL-particles vs. conventional LDL-cholesterol; a worse profile in T1DM women) that were overlooked in the conventional analysis. Further studies are needed to elucidate their role in the development of CVD in this population.
背景
脂蛋白紊乱与 1 型糖尿病（T1DM）患者的心血管疾病（CVD）风险增加有关。我们评估了 T1DM 个体的先进脂蛋白谱，并分析了与非糖尿病个体的差异。
方法
这项横断面研究纳入了来自西班牙地中海地区的机构中 508 名 T1DM 患者和 347 名对照者。分析了常规和先进（通过核磁共振 [NMR] 光谱评估）脂蛋白谱。进行了未校正和校正（按年龄、性别、他汀类药物使用、体重指数和白细胞计数）比较。
结果
研究参与者的中位（四分位间距）年龄为 45（38-53）岁，48.2%为男性。在 T1DM 组中，中位糖尿病病程为 23（16-31）年，分别有 8.1%和 40.2%的患者患有肾病和视网膜病变。T1DM 组高血压（29.5% vs. 9.2%）和他汀类药物使用（45.7% vs. 8.1%）的比例高于对照组（均 p<0.001）。与对照组相比，T1DM 组具有更好的常规（所有参数，p<0.001）和 NMR 脂质谱。因此，即使在调整了多个混杂因素后（所有参数 p<0.001），T1DM 个体的致动脉粥样硬化脂蛋白（VLDL-颗粒和 LDL-颗粒）浓度较低，而抗动脉粥样硬化脂蛋白（HDL-颗粒）浓度较高（p<0.001）。尽管非糖尿病女性的血脂谱比非糖尿病男性更有利，但与 T1DM 男性相比，T1DM 女性的 LDL-颗粒浓度相似（1231 [1125-1383] vs. 1257 [1128-1383] nmol/L，p=0.849），与非糖尿病女性的小 LDL-颗粒浓度相似（672.8 [614.2-733.9] vs. 671.2 [593.5-761.4] nmol/L，p=0.790）。最后，与非糖尿病患者相比，T1DM 患者的 NMR-LDL-颗粒与常规 LDL-胆固醇之间的差异更大（LDL-胆固醇<100mg/dL 和 LDL-颗粒>1000nmol/L 的患病率：38% vs. 21.2%；p<0.001）。在没有降脂药物的参与者中（T1DM，n=275；对照组，n=317），所有这些差异基本保持不变。
结论
总体而言，与对照组相比，T1DM 患者具有更有利的常规和 NMR 脂质谱。然而，NMR 评估在 T1DM 人群中发现了 LDL 颗粒中的几种脂蛋白紊乱（NMR-LDL 颗粒与常规 LDL 胆固醇之间的差异更大；T1DM 女性的血脂谱更差），这些紊乱在常规分析中被忽视了。需要进一步的研究来阐明它们在该人群 CVD 发展中的作用。
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