Nuclear magnetic resonance lipoprotein abnormalities in prediabetic subjects in the insulin resistance atherosclerosis study
Nuclear magnetic resonance lipoprotein abnormalities in prediabetic subjects in the insulin resistance atherosclerosis study
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DOI：
10.1161/circulationaha.104.512079
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发表时间：
2005-06-28
期刊：
影响因子：
37.8
通讯作者：
Haffner, SM
中科院分区：
文献类型：
--
作者：
Festa, A;Williams, K;Haffner, SM
背景--2型糖尿病患者的低密度脂蛋白和高密度脂蛋白颗粒较小，甘油三酯水平较高，高密度脂蛋白胆固醇较低。升高的胰岛素抵抗、血压和血脂异常(包括小而致密的低密度脂蛋白)可预测糖尿病的发生。在胰岛素抵抗动脉粥样硬化研究(IRAS)中，我们研究了糖尿病前期个体的核磁共振(核磁共振)脂蛋白颗粒测量，考虑了潜在的改变协变量，包括胰岛素抵抗，通过频繁采样的静脉葡萄糖耐量试验直接测量。方法和结果-在830名基线水平的非糖尿病受试者中，130人(15.7%)在平均5.2年的随访期后发展为糖尿病。与随访时保持非糖尿病的受试者相比，糖尿病前期受试者中发现了各种脂蛋白异常。在Logistic回归分析(人口统计学校正)中，VLDL颗粒、大的VLDL、低密度脂蛋白颗粒、小的低密度脂蛋白、大的高密度脂蛋白、小的高密度脂蛋白、极低密度脂蛋白的大小、低密度脂蛋白的大小和高密度脂蛋白的大小与糖尿病的发生有关。VLDL大小和小高密度脂蛋白与糖尿病发病的关系与腰围无关(VLDL大小和小高密度脂蛋白的优势比分别为1.43[1.18~1.73]和1.23[1.01~1.51])，也独立于常规(化学)测定的甘油三酯和高密度脂蛋白(OR[95%CI]，1.45[1.18~1.78]和1.30[1.06~1.60])。胰岛素敏感性降低了极低密度脂蛋白(OR[95%CI]，1.25[1.01~1.53])与糖尿病发病的关系，但与小颗粒高密度脂蛋白(OR[95%CI]，1.25[1.02~1.54])无关。结论：我们发现糖尿病前期个体存在一系列脂蛋白异常，包括高密度脂蛋白和极低密度脂蛋白的成分变化。这些发现扩展了先前的工作，表明健康的非糖尿病受试者在随后发展为糖尿病的患者中存在促动脉粥样硬化状态。
Background - Subjects with type 2 diabetes have smaller LDL and HDL particles in addition to higher levels of triglycerides and lower HDL cholesterol. Elevated insulin resistance, blood pressure, and dyslipidemia ( including small dense LDL) predicted incident diabetes. In the Insulin Resistance Atherosclerosis Study ( IRAS) we studied nuclear magnetic resonance ( NMR) lipoprotein particle measures in prediabetic individuals, considering potentially modifying covariates, including insulin resistance, as directly measured using a frequently sampled intravenous glucose tolerance test.Methods and Results - Of 830 subjects who were nondiabetic at baseline, 130 ( 15.7%) developed diabetes after a mean follow- up of 5.2 years. Various lipoprotein abnormalities were found in prediabetic subjects compared with subjects who stayed nondiabetic at follow- up. In logistic regression analyses ( demographically adjusted), VLDL particles, large VLDL, LDL particles, small LDL, large HDL, small HDL, VLDL size, LDL size, and HDL size were related to incident diabetes. The relation of VLDL size and small HDL to incident diabetes was independent of waist ( odds ratio [ OR] [ 95% CI], 1.43 [ 1.18 to 1.73] and 1.23 [ 1.01 to 1.51] for VLDL size and small HDL, respectively) and independent of conventionally ( chemically) measured triglycerides and HDL cholesterol ( OR [ 95% CI], 1.45 [ 1.18 to 1.78] and 1.30 [ 1.06 to 1.60], respectively). Insulin sensitivity attenuated the relation to incident diabetes of VLDL size ( OR [ 95% CI], 1.25 [ 1.01 to 1.53]) but not of small HDL particles ( OR [ 95% CI], 1.25 [ 1.02 to 1.54]).Conclusions - We have shown a range of lipoprotein abnormalities in prediabetic individuals, including compositional changes in HDL and VLDL. These findings extend previous work indicating a proatherogenic state in healthy, nondiabetic subjects who subsequently develop diabetes.