协和医学杂志
協和醫學雜誌
협화의학잡지
MEDICAL JOURNAL OF PEKING UNION MEDICAL COLLEGE HOSPITAL
2014年
3期
264-269
,共6页
禹松林%周伟燕%杨睿悦%李红霞%张顺利%张天娇%赵海建%张传宝%王抒%陈文祥%董军
禹鬆林%週偉燕%楊睿悅%李紅霞%張順利%張天嬌%趙海建%張傳寶%王抒%陳文祥%董軍
우송림%주위연%양예열%리홍하%장순리%장천교%조해건%장전보%왕서%진문상%동군
脂肪酸%2型糖尿病%脂肪酸脱氢酶
脂肪痠%2型糖尿病%脂肪痠脫氫酶
지방산%2형당뇨병%지방산탈경매
fatty acids%type 2 diabetes mellitus%desaturase
目的:探讨老年2型糖尿病( diabetes mellitus, DM)患者血清胆固醇酯脂肪酸及相关生化指标变化情况。方法研究纳入2012年8月至12月北京医院老年体检志愿者145例(年龄≥60岁),包括确诊为2型DM患者( DM组)73例和健康对照者(对照组)72名,抽取空腹静脉血。用液相色谱串联质谱法测定血清11种主要胆固醇酯脂肪酸,计算各脂肪酸脱氢酶及脂肪酸碳链延长酶活性;同时用自动生化分析仪测定空腹血糖( fasting plasma glucose, FPG)、总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇( low-density lipoprotein cholesterol, LDL-C)、载脂蛋白AI ( apolipoprotein AI, ApoAI)、载脂蛋白 B (apolipoprotein B, ApoB)、超敏C反应蛋白(high sensitivity C-reactive protein, hsCRP)等生化指标,用独立样本t检验、非参数检验、 Logistic 回归等方法对数据进行分析。结果 DM组血清脂肪酸CE14∶0、 CE16∶1和CE22∶6显著低于对照组(P<0.05),其他脂肪酸成分差异不具有统计学意义;与对照组相比, DM组Δ9-脂肪酸脱氢酶(Δ9-desaturase)活性显著降低(P=0.001); Logistic回归分析显示CE22∶6和Δ9-desaturase活性对预测DM患病风险具有统计学意义(P<0.05);校正年龄、性别、体重指数(body mass index, BMI)、 TC、 TG、 FPG 因素影响后,与 CE22∶6最低四分位数(CE22∶6≤0.47%)相比,最高四分位数(CE22∶6>0.68%)患DM的比值比为0.27(95%CI:0.08~0.86, Wald值4.93, P<0.05);与Δ9-desaturase活性最低四分位数(Δ9-desaturase活性≤0.12)相比,最高四分位数(Δ9-desaturase活性>0.17)患DM的比值比为0.06(95%CI:0.01~0.22, Wald值17.39, P <0.01)。 CE14∶0和 CE20∶3与 FPG呈显著负相关(r =-0.18、-0.17, P<0.05); CE18∶0与BMI、 TG呈显著正相关( r=0.25、0.24, P<0.01),而与HDL-C和ApoAI呈显著负相关( r=-0.39、-0.35, P<0.01); CE20∶3与BMI的相关性最强( r=0.42, P<0.01)。结论老年2型DM患者血清部分胆固醇酯脂肪酸降低, CE22∶6和Δ9-desaturase可能对2型DM具有保护作用,平衡脂肪酸摄入对防治2型DM具有重要意义。
目的:探討老年2型糖尿病( diabetes mellitus, DM)患者血清膽固醇酯脂肪痠及相關生化指標變化情況。方法研究納入2012年8月至12月北京醫院老年體檢誌願者145例(年齡≥60歲),包括確診為2型DM患者( DM組)73例和健康對照者(對照組)72名,抽取空腹靜脈血。用液相色譜串聯質譜法測定血清11種主要膽固醇酯脂肪痠,計算各脂肪痠脫氫酶及脂肪痠碳鏈延長酶活性;同時用自動生化分析儀測定空腹血糖( fasting plasma glucose, FPG)、總膽固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、高密度脂蛋白膽固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白膽固醇( low-density lipoprotein cholesterol, LDL-C)、載脂蛋白AI ( apolipoprotein AI, ApoAI)、載脂蛋白 B (apolipoprotein B, ApoB)、超敏C反應蛋白(high sensitivity C-reactive protein, hsCRP)等生化指標,用獨立樣本t檢驗、非參數檢驗、 Logistic 迴歸等方法對數據進行分析。結果 DM組血清脂肪痠CE14∶0、 CE16∶1和CE22∶6顯著低于對照組(P<0.05),其他脂肪痠成分差異不具有統計學意義;與對照組相比, DM組Δ9-脂肪痠脫氫酶(Δ9-desaturase)活性顯著降低(P=0.001); Logistic迴歸分析顯示CE22∶6和Δ9-desaturase活性對預測DM患病風險具有統計學意義(P<0.05);校正年齡、性彆、體重指數(body mass index, BMI)、 TC、 TG、 FPG 因素影響後,與 CE22∶6最低四分位數(CE22∶6≤0.47%)相比,最高四分位數(CE22∶6>0.68%)患DM的比值比為0.27(95%CI:0.08~0.86, Wald值4.93, P<0.05);與Δ9-desaturase活性最低四分位數(Δ9-desaturase活性≤0.12)相比,最高四分位數(Δ9-desaturase活性>0.17)患DM的比值比為0.06(95%CI:0.01~0.22, Wald值17.39, P <0.01)。 CE14∶0和 CE20∶3與 FPG呈顯著負相關(r =-0.18、-0.17, P<0.05); CE18∶0與BMI、 TG呈顯著正相關( r=0.25、0.24, P<0.01),而與HDL-C和ApoAI呈顯著負相關( r=-0.39、-0.35, P<0.01); CE20∶3與BMI的相關性最彊( r=0.42, P<0.01)。結論老年2型DM患者血清部分膽固醇酯脂肪痠降低, CE22∶6和Δ9-desaturase可能對2型DM具有保護作用,平衡脂肪痠攝入對防治2型DM具有重要意義。
목적:탐토노년2형당뇨병( diabetes mellitus, DM)환자혈청담고순지지방산급상관생화지표변화정황。방법연구납입2012년8월지12월북경의원노년체검지원자145례(년령≥60세),포괄학진위2형DM환자( DM조)73례화건강대조자(대조조)72명,추취공복정맥혈。용액상색보천련질보법측정혈청11충주요담고순지지방산,계산각지방산탈경매급지방산탄련연장매활성;동시용자동생화분석의측정공복혈당( fasting plasma glucose, FPG)、총담고순(total cholesterol, TC)、감유삼지(triglyceride, TG)、고밀도지단백담고순(high-density lipoprotein cholesterol, HDL-C)、저밀도지단백담고순( low-density lipoprotein cholesterol, LDL-C)、재지단백AI ( apolipoprotein AI, ApoAI)、재지단백 B (apolipoprotein B, ApoB)、초민C반응단백(high sensitivity C-reactive protein, hsCRP)등생화지표,용독립양본t검험、비삼수검험、 Logistic 회귀등방법대수거진행분석。결과 DM조혈청지방산CE14∶0、 CE16∶1화CE22∶6현저저우대조조(P<0.05),기타지방산성분차이불구유통계학의의;여대조조상비, DM조Δ9-지방산탈경매(Δ9-desaturase)활성현저강저(P=0.001); Logistic회귀분석현시CE22∶6화Δ9-desaturase활성대예측DM환병풍험구유통계학의의(P<0.05);교정년령、성별、체중지수(body mass index, BMI)、 TC、 TG、 FPG 인소영향후,여 CE22∶6최저사분위수(CE22∶6≤0.47%)상비,최고사분위수(CE22∶6>0.68%)환DM적비치비위0.27(95%CI:0.08~0.86, Wald치4.93, P<0.05);여Δ9-desaturase활성최저사분위수(Δ9-desaturase활성≤0.12)상비,최고사분위수(Δ9-desaturase활성>0.17)환DM적비치비위0.06(95%CI:0.01~0.22, Wald치17.39, P <0.01)。 CE14∶0화 CE20∶3여 FPG정현저부상관(r =-0.18、-0.17, P<0.05); CE18∶0여BMI、 TG정현저정상관( r=0.25、0.24, P<0.01),이여HDL-C화ApoAI정현저부상관( r=-0.39、-0.35, P<0.01); CE20∶3여BMI적상관성최강( r=0.42, P<0.01)。결론노년2형DM환자혈청부분담고순지지방산강저, CE22∶6화Δ9-desaturase가능대2형DM구유보호작용,평형지방산섭입대방치2형DM구유중요의의。
Objective To evaluate the alteration of cholesterol ester fatty acids and related serum biochemical parameters in elderly patients with type 2 diabetes mellitus ( T2DM).Methods Totally 73 T2DM patients (T2DM group) and 72 healthy subjects (control group) (aged ≥60 years) who received health check-ups in Beijing Hospital from August to December in 2012 were recruited and blood samples were collected .Eleven main cholesterol ester fatty acids in serum were determined with liquid chromatography tandem mass spectrometry , and endogenous conversions by desaturases and elongases were estimated from product -to-precursor ratios .Fasting plas-ma glucose (FPG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) AI (ApoAI), ApoB, and high sensitivity C-reactive protein (hsCRP) were analyzed with an automatic biochemistry analyzer and the results were statisti -cally analyzed .Results CE14∶0, CE16∶1 and CE22∶6 in T2DM group were significantly lower than those in the control group ( P <0.05 ) , while no significant difference existed between other fatty acid compositions .Δ9-desaturase activity was lower in T2DM group compared with that in control group (P=0.001).After adjus-ting for age, gender, body mass index (BMI), TC, TG, and FPG, Logistic analysis showed the quartiles of CE22∶6 andΔ9-desaturase activity were associated with risk of type 2 DM, and the odds ratios were 0.27 (95%CI:0.08-0.86, Wald:4.93, P<0.05) and 0.06 (95%CI:0.01-0.22, Wald: 17.39, P<0.01), respec-tively, for comparison of the top to bottom quartile .Both CE14∶0 and CE20∶3 negatively correlated with FPG (r=-0.18, -0.17, P<0.05);CE18∶0 positively correlated with BMI and TG (r=0.25, 0.24, P<0.01) and negatively correlated with HDL-C and ApoAI (r=-0.39, -0.35, P<0.01);CE20∶3 positively correlated with BMI, with a correlation coefficient of 0.42 (P<0.01).Conclusions Several cholesterol ester fatty acids de-crease in elderly T2DM patients.CE22∶6 andΔ9-desaturase may protect against T 2DM.An appropriately balanced intake of fatty acids is helpful for the prevention of T 2DM in the elderly population .