脂蛋白(a)与胰岛素依赖型糖尿病患者青春期的关系。

Association of lipoprotein(a) with puberty in IDDM.

作者信息

Couper J J, Bates D J, Cocciolone R, Magarey A M, Boulton T J, Penfold J L, Ryall R G

机构信息

Department of Endocrinology and Diabetes, Adelaide Children's Hospital, South Australia.

出版信息

Diabetes Care. 1993 Jun;16(6):869-73. doi: 10.2337/diacare.16.6.869.

DOI:10.2337/diacare.16.6.869

PMID:8325200

Abstract

OBJECTIVE

To determine serum lipoprotein(a) in a large sample of IDDM and control children and to examine a possible association with puberty.

RESEARCH DESIGN AND METHODS

Serum lipoprotein(a), apoB-100, and apoA-I were measured under identical conditions in 170 Caucasian children with IDDM aged 12.3 +/- 3.59 yr and 233 Caucasian control children aged 13.6 +/- 1.12 yr. Patients with persistent microalbuminuria were excluded. Lipoprotein(a), apoB-100, and apoA-I were measured by nephelometry using a specific monoclonal antibody. Pubertal assessment was performed using Tanner staging and testicular volume measurement.

RESULTS

Lipoprotein(a) was higher in the IDDM than control group (geometric mean 237 mg/L, 25-75th percentile 134-465 vs. 172 [99-316] mg/L, P = 0.0008). When analyzed according to pubertal stage, only pubertal and postpubertal patients had higher levels than control subjects (265 [148-560] vs. 174 [101-320] mg/L, P = 0.0001), with prepubertal patients showing no difference. Pubertal and postpubertal patients showed both higher lipoprotein(a) (P = 0.01) levels and higher albumin excretion rates (P = 0.02) than prepubertal patients, correcting for the other variable. Lipoprotein(a) was not related to HbA1c, albumin excretion rate, duration, age, sex, mean arterial pressure, or a family history of premature coronary artery disease in the IDDM group. Lipoprotein(a) was not higher in patients with overnight albumin excretion rate above the 95th percentile but below the microalbuminuric range. ApoB-100 did not differ between IDDM and control children. ApoA-I was significantly lower in the IDDM group (1.04 [0.94-1.17] vs. 1.21 [1.10-1.31] g/L; P < 0.0001).

CONCLUSIONS

Pubertal and postpubertal IDDM patients have higher serum lipoprotein(a) than Caucasian control subjects. Our findings suggest a rise in lipoprotein(a) may occur during puberty in IDDM. Longitudinal studies are required to clarify the relationship between lipoprotein(a), albumin excretion rate, and puberty.

摘要

目的

测定大量1型糖尿病患儿及对照儿童的血清脂蛋白(a)，并研究其与青春期的可能关联。

研究设计与方法

在相同条件下，对170名年龄为12.3±3.59岁的白种人1型糖尿病患儿和233名年龄为13.6±1.12岁的白种人对照儿童测定血清脂蛋白(a)、载脂蛋白B-100和载脂蛋白A-I。排除持续性微量白蛋白尿患者。使用特异性单克隆抗体通过散射比浊法测定脂蛋白(a)、载脂蛋白B-100和载脂蛋白A-I。采用 Tanner分期和睾丸体积测量进行青春期评估。

结果

1型糖尿病组的脂蛋白(a)高于对照组（几何均值237mg/L，第25至75百分位数为134 - 465，而对照组为172[99 - 316]mg/L，P = 0.0008）。按青春期阶段分析时，仅青春期和青春期后患者的脂蛋白(a)水平高于对照受试者（265[148 - 560]对174[101 - 320]mg/L，P = 0.0001），青春期前患者无差异。校正其他变量后，青春期和青春期后患者的脂蛋白(a)水平（P = 0.01）和白蛋白排泄率（P = 0.02）均高于青春期前患者。在1型糖尿病组中，脂蛋白(a)与糖化血红蛋白、白蛋白排泄率、病程、年龄、性别、平均动脉压或早发冠心病家族史无关。夜间白蛋白排泄率高于第95百分位数但低于微量白蛋白尿范围的患者，其脂蛋白(a)并不更高。1型糖尿病患儿与对照儿童的载脂蛋白B-100无差异。1型糖尿病组的载脂蛋白A-I显著较低（1.04[0.94 - 1.17]对1.21[1.10 - 1.31]g/L；P < 0.000）。