Bennion L J, Grundy S M
N Engl J Med. 1977 Jun 16;296(24):1365-71. doi: 10.1056/NEJM197706162962401.
In view of the reported excess prevalence of atherosclerosis and cholelithiasis in diabetes, we investigated several aspects of cholesterol metabolism under metabolic ward conditions in six Pima Indians with maturity-onset diabetes mellitus. Cholesterol balance (13.5 versus 11.0 mg per kilogram per day, P less than 0.05), fecal bile acid excretion (415 versus 261 mg per day, P less than 0.05), bile acid pool size (3150 versus 1950 mg, P less than 0.05), fasting plasma cholesterol (193 versus 160 mg per deciliter, P less than 0.05) and plasma triglycerides (251 versus 150 mg per deciliter, P less than 0.05) were higher during uncontrolled hyperglycemia than during relative euglycemia on insulin. The increased plasma lipid levels and total cholesterol synthesis during hyperglycemia may contribute to the acceleration of atherosclerosis in diabetes mellitus. Gallbladder bile was significantly more saturated with cholesterol (181 per cent versus 114 per cent, P less than 0.05) during insulin treatment than during uncontrolled hyperglycemia. Bile lipid composition was thus more favorable to cholesterol precipitation and gallstone formation during insulin treatment than in the untreated diabetic state.
鉴于报道称糖尿病患者动脉粥样硬化和胆石症的患病率过高，我们在代谢病房条件下，对6名成年发病型糖尿病的皮马印第安人胆固醇代谢的几个方面进行了研究。与胰岛素治疗使血糖相对正常时相比，血糖控制不佳时的胆固醇平衡（分别为每天每千克13.5毫克和11.0毫克，P<0.05）、粪便胆汁酸排泄量（分别为每天415毫克和261毫克，P<0.05）、胆汁酸池大小（分别为3150毫克和1950毫克，P<0.05）、空腹血浆胆固醇（分别为每分升193毫克和160毫克，P<0.05）以及血浆甘油三酯（分别为每分升251毫克和150毫克，P<0.05）均更高。高血糖期间血浆脂质水平和总胆固醇合成增加，可能促使糖尿病患者动脉粥样硬化加速。与血糖控制不佳时相比，胰岛素治疗期间胆囊胆汁的胆固醇饱和度显著更高（分别为181%和114%，P<0.05）。因此，与未治疗的糖尿病状态相比，胰岛素治疗期间胆汁脂质成分更有利于胆固醇沉淀和胆结石形成。
