Tsalamandris C, Panagiotopoulos S, Allen T J, Waldrip L, Van Gaal B, Goodall I, Jerums G
Department of Endocrinology, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
J Diabetes Complications. 1998 Jul-Aug;12(4):208-14. doi: 10.1016/s1056-8727(97)00122-0.
The objective of this study was to estimate the long-term intraindividual variability of lipid levels in adult type I and type II diabetic patients. Total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and hemoglobin A1c were measured every 3-6 months in 135 patients attending the Austin Hospital diabetes clinic. Analysis was performed on 60 diabetic patients (33 type I and 27 type II) who had not been treated with lipid lowering drugs and who met the inclusion criteria of at least five measurements [mean +/- standard error of the mean (SEM), 9.5 +/- 0.4; range, 5-17] collected over a minimum of 4 years (5.1 +/- 0.1; 4-6.5 years). Total variability, expressed as coefficient of variation, was 8.8 +/- 0.4% for total cholesterol, 23.9 +/- 1.5% for triglycerides, 10.2 +/- 0.5% for HDL cholesterol, and 12.0 +/- 0.5% for LDL cholesterol. Biological variability, derived from total and analytical variability, was higher than previous estimates in nondiabetic subjects for total cholesterol and HDL cholesterol but similar for triglycerides and LDL cholesterol. No relationship was observed between total lipid variability and diabetes type, age, baseline or mean lipid levels, duration of follow-up, or the number of samples per patient. Men demonstrated greater variability than women for total cholesterol (men 9.5 +/- 0.5%, n = 34, women 7.9 +/- 0.5%, n = 26, p < 0.01) and triglycerides (men 26.5 +/- 2.2%, women 20.4 +/- 1.4%, p = 0.03). Total lipid variability was also unrelated to baseline or mean hemoglobin A1c or to the change in hemoglobin A1c during the study as a whole. However, the change in hemoglobin A1c was associated with the change in total cholesterol (r = 0.30, p < 0.03) and the change in LDL cholesterol (r = 0.27, p < 0.05). In conclusion, long-term intraindividual lipid variability in adult diabetic subjects is higher for total and HDL cholesterol than previously published values in nondiabetic subjects. Variability of triglycerides is at least double that of total cholesterol, HDL cholesterol and LDL cholesterol. Biological variability, not measurement error, accounts for the greatest proportion of total variability for all lipid parameters. Confidence levels calculated from these data have implications for the initiation of lipid lowering therapy and in monitoring the effects of intervention.
本研究的目的是评估成年I型和II型糖尿病患者血脂水平的长期个体内变异性。对奥斯汀医院糖尿病诊所的135名患者每3至6个月测量一次总胆固醇、甘油三酯、高密度脂蛋白（HDL）胆固醇、低密度脂蛋白（LDL）胆固醇和糖化血红蛋白A1c。对60名未接受过降脂药物治疗且符合纳入标准（至少进行了5次测量[平均值±平均标准误差（SEM），9.5±0.4；范围，5 - 17]）的糖尿病患者（33名I型和27名II型）进行分析，这些测量在至少4年（5.1±0.1；4 - 6.5年）内收集。以变异系数表示的总变异性，总胆固醇为8.8±0.4%，甘油三酯为23.9±1.5%，HDL胆固醇为10.2±0.5%，LDL胆固醇为12.0±0.5%。由总变异性和分析变异性得出的生物学变异性，对于总胆固醇和HDL胆固醇高于先前对非糖尿病受试者的估计，但对于甘油三酯和LDL胆固醇则相似。未观察到总血脂变异性与糖尿病类型、年龄、基线或平均血脂水平、随访时间或每位患者的样本数量之间存在关联。男性在总胆固醇（男性9.5±0.5%，n = 34，女性7.9±0.5%，n = 26，p < 0.01）和甘油三酯（男性26.5±2.2%，女性20.4±1.4%，p = 0.03）方面的变异性高于女性。总血脂变异性也与基线或平均糖化血红蛋白A1c无关，也与整个研究期间糖化血红蛋白A1c的变化无关。然而，糖化血红蛋白A1c的变化与总胆固醇的变化相关（r = 0.30，p < 0.03）以及与LDL胆固醇的变化相关（r = 0.27，p < 0.05）。总之，成年糖尿病患者总胆固醇和HDL胆固醇的长期个体内血脂变异性高于先前发表的非糖尿病受试者的值。甘油三酯的变异性至少是总胆固醇、HDL胆固醇和LDL胆固醇变异性的两倍。生物学变异性而非测量误差占所有血脂参数总变异性的最大比例。根据这些数据计算出的置信水平对降脂治疗的启动和干预效果的监测具有重要意义。
