Rosenstock J, Vega G L, Raskin P
Department of Internal Medicine, University of Texas Health Science Center, Dallas 75235.
Diabetes. 1988 Apr;37(4):393-7. doi: 10.2337/diab.37.4.393.
The metabolism of low-density lipoprotein (LDL) was studied in six insulin-dependent (type I) diabetic patients during a 7-wk period of conventional and intensive therapy with insulin. Plasma glucose and HbA1c were normalized, demonstrating the effectiveness of our intensive treatment program. Plasma lipoprotein profiles and LDL apolipoprotein B kinetic parameters were estimated during conventional and then during intensive therapy for each patient. Intensive therapy resulted in a significant reduction of plasma and LDL cholesterol and an increase in high-density lipoprotein (HDL) cholesterol. The lower LDL levels resulted from a decreased production of lipoprotein rather than an increased fractional catabolic rate. These results are consistent with our previous observations of very-low-density lipoprotein (VLDL) metabolism during intensive therapy. VLDL production is significantly reduced; thus, a decreased production of LDL supports the contention that intensive therapy with insulin in normolipemic type I diabetic patients reduces the production of lipoproteins containing apolipoprotein B rather than increasing the clearance, and therapy also increases HDL cholesterol. Both of these effects may be beneficial in reducing the risk for coronary heart disease in type I diabetes.
在6名胰岛素依赖型（I型）糖尿病患者接受为期7周的常规胰岛素治疗和强化胰岛素治疗期间，对低密度脂蛋白（LDL）的代谢情况进行了研究。血浆葡萄糖和糖化血红蛋白（HbA1c）恢复正常，证明了我们强化治疗方案的有效性。在每位患者的常规治疗期间及随后的强化治疗期间，评估了血浆脂蛋白谱和LDL载脂蛋白B动力学参数。强化治疗导致血浆和LDL胆固醇显著降低，高密度脂蛋白（HDL）胆固醇升高。较低的LDL水平是由于脂蛋白生成减少，而非分解代谢率分数增加所致。这些结果与我们之前对强化治疗期间极低密度脂蛋白（VLDL）代谢的观察结果一致。VLDL生成显著减少；因此，LDL生成减少支持了这样的观点，即正常血脂的I型糖尿病患者进行强化胰岛素治疗会减少含载脂蛋白B的脂蛋白生成，而非增加清除率，并且该治疗还会增加HDL胆固醇。这两种效应可能都有助于降低I型糖尿病患者患冠心病的风险。
