Georgopoulos A, Saudek C D
Department of Medicine, University of Minnesota, Minneapolis.
Diabetes Care. 1994 Nov;17(11):1295-9. doi: 10.2337/diacare.17.11.1295.
To investigate whether intraperitoneal insulin (IPII) decreases the levels of circulating chylomicron remnants in patients with insulin-dependent diabetes mellitus (IDDM).
Eight nonobese, normolipidemic IDDM patients were studied twice: before (while on subcutaneous insulin) and 6 months after initiation of IPII by a programmable implanted medication system. Fasting and mean blood glucose, HbA1, and lipid values were determined. Blood samples were also drawn before and every 2 h for 10 h after ingestion of a fat meal (corn oil + Vitamin A). Triglycerides (TGs), apolipoprotein B (apoB), and retinyl esters were determined over time in two TG-rich lipoprotein subfractions (Sf > 100 and Sf20-100) isolated from plasma by density-gradient ultracentrifugation.
IPII slightly decreased the mean blood glucose from 7.8 +/- 1.1 to 7.4 +/- 1.1 mmol/l (mean +/- SD, P = 0.027, paired Student's t test) and the HbA1 from 9.4 +/- 1.5 to 8.7 +/- 1.2 (NS). TG and apoB levels in postprandial Sf > 100 and Sf20-100 were not changed by IPII. On IPII, however, retinyl ester levels in Sf > 100 decreased (P = 0.05, analysis of variance [ANOVA]) and tended to be lower in Sf20-100 (P = 0.075). In addition, following IPII, the retinyl ester:apoB ratio was lower in Sf > 100 (P = 0.0002) and marginally lower (P = 0.06) in Sf 20-100.
IPII decreased chylomicron remnant levels, which might decrease the atherosclerotic risk in IDDM. Since glycemic control was only slightly improved, the effect was most likely due to the intraperitoneal route of delivery.
研究腹腔内注射胰岛素（IPII）是否能降低胰岛素依赖型糖尿病（IDDM）患者循环中乳糜微粒残粒的水平。
对8名非肥胖、血脂正常的IDDM患者进行了两次研究：一次是在皮下注射胰岛素时，另一次是在通过可编程植入式给药系统开始IPII治疗6个月后。测定空腹及平均血糖、糖化血红蛋白（HbA1）和血脂值。在摄入高脂餐（玉米油+维生素A）前及之后的10小时内，每2小时采集一次血样。通过密度梯度超速离心从血浆中分离出两个富含甘油三酯的脂蛋白亚组分（Sf>100和Sf20 - 100），随时间测定甘油三酯（TGs）、载脂蛋白B（apoB）和视黄醇酯。
IPII使平均血糖水平从7.8±1.1毫摩尔/升轻微降至7.4±1.1毫摩尔/升（均值±标准差，P = 0.027，配对学生t检验），HbA1从9.4±1.5降至8.7±1.2（无统计学意义）。IPII未改变餐后Sf>100和Sf20 - 100中的TG和apoB水平。然而，在IPII治疗期间，Sf>100中的视黄醇酯水平降低（P = 0.05，方差分析[ANOVA]），Sf20 - 100中的视黄醇酯水平有降低趋势（P = 0.075）。此外，IPII治疗后，Sf>100中的视黄醇酯:apoB比值降低（P = 0.0002），Sf20 - 100中的该比值略有降低（P = 0.06）。
IPII降低了乳糜微粒残粒水平，这可能降低IDDM患者的动脉粥样硬化风险。由于血糖控制仅略有改善，这种作用很可能归因于腹腔给药途径。
