Osobitosti hiperlipoproteinemija u inzulin neovisnom dijabetesu

Pavković, Pajica (2003) Osobitosti hiperlipoproteinemija u inzulin neovisnom dijabetesu. PhD thesis, Sveučilište u Zagrebu.

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Abstract

An open prospective study including 200 newly detected patients with NIDDM and hyperlipoproteinemia was carried out. Sixty-four patients with NIDDM were excluded from the study for failing to comply with the instructions by the researchers: loss to follow-up, switch to insulin therapy, cessation of menstrual periods, taking oral contraceptive agents, hypolipemics, diuretics or beta blockers. The control group consisted of 200 subjects with hyperlipoproteinemia and normal glucose tolerance. Patients with NIDDM were divided in two groups. The first group consisted of men (N=86), and the other of women (N=52). These two groups were further divided into subgroups: subjects below and above 50 years of age. The study aimed to determine the type and extent of changes occuring in patients with NIDDM and hyperlipidemia at the moment of optimal glycemic control, lipoprotein, apolipoprotein and leptin levels, as well as the influence of fat tissue distribution on individual lipoprotein, apolipoprotein and leptin fractions. Possible sex-related differences in particular lipoprotein, apolipoprotein and leptin fractions and the fertile age of female patients as compared to postmenopausal one, respectively, were studied. The following changes occurred at the moment of optimal glycemic control (HbA1c≤6.30%) in patients with newly detected NIDDM and hyperlipidemia: statistically significant reduction in total, HDL2 and VLDL cholesterol and triglycerides, although lipoprotein level was not optimal. HDL3 cholesterol and apo B levels were increased. Patients taking glibenclamide for glycemic control had a statistically significant increase in Lp(a) (p<0.045), whereas patients on diet alone did not reveal such an increase. Glycemic control had no effect on serum leptin level. In women with NIDDM, at the moment of optimal diabetes control, HDL cholesterol level negatively correlated with waist circumference, while triglyceride level showed a trend of positive correlation with waist circumference. HDL3 cholesterol showed negative correlation with WHR.l Women with NIDDM younger than 50 yrs. revealed positive correlation between apo B level and waist circumference. Women with NIDDM older than 50 yrs. showed negative correlation of HDL and HDL3 cholesterol levels to waist circumference at the moment of good glycemic control, whereas their correlation with triglyceride and VLDL cholesterol was found to be positive. WHR showed negative correlation with HDL3 cholesterol level. In men with NIDDM younger than 50 yrs. at the moment of good glycemic control positive correlation was found between triglyceride level and WHR and waist circumference. Correlation of VLD cholesterol to WHR was also positive, whereas to HDL cholesterol it was found to be negative. HDL2 cholesterol correlated negatively with BMI, but positively with WHR. No statistically significant correlation of lipoproteins and apolipoproteins with fat tissue distribution as defined by waist circumference, and BMI and WHR was found in male patients older than 50 yrs.. Fasting and postprandial leptin levels in patients with NIDDM and hyperlipidemia showed positive correlation with waist circumference and WHR. No statistically significant sex-related difference in lipoprotein and apolipoprotein fractions was observed, the same holding true for women of fertile age as compared to those in postmenopause. Female subjects with NIDDM had three times higher fasting and postprandial leptin levels in comparison with male subjects with NIDDM. Leptin level in women and men older than 50 yrs. of age was observed to be statistically significantly higher as compared to younger women and men with NIDDM.

Abstract in Croatian

Učinjena je prospektivna studija otvorenog tipa u koju je bilo uključeno 200 novootkrivenih bolesnika s NIDDM i hiperlipoproteinemijom. Tijekom ispitivanja iz studije je isključeno 64 bolesnika s NIDDM zbog nepridržavanja uputa dobivenih od istraživača: nedolaska na kontrole, prelazak na inzulinsku terapiju, prestanak menstruacije, uzimanje oralnih kontraceptiva, hipolipemika, diuretika ili beta blokatora. Kao kontrolna grupa uzeto je 200 ispitanika s hiperlipoproteinemijom, a čija je teleracija glukoze uredna. bolesnici s NIDDM podjeljeni su u dvije skupine. Prva skupina su muškarci (N = 86), a druga žene (N = 52). Te dvije skupine su podjeljene u podskupine: do 50 godina života i iznad 50 godina života. Studijom se ispitivalo kakove i u kom opsegu nastaju promjene u bolesnika s NIDDM i hiperlipidemijom u trenutku optimalne regulacije glikemije razine lipoproteina, apolipoproteina i leptina. Također je ispitivano utjecaj raspodjele masnog tkiva na određene frakcije lipoprotein, apolipoproteina i leptina. Ispitivano je postojanje razlika u određenim frakcijama lipoproteina, apolipoproteina i leptina u odnosu muško – žensko, odnosno fertilna dob bolesnica u odnosu na postmenopauzalno razdoblje. U trenutku optimalne egulacije glikemije (HbA1c ═ ili manji od 6,30%) bolesnika s novootkrivenom NIDDM i hiperlipidemijom nastale su slijedeće promjene: statistički značajno sniženje ukupnog kolesterola, HDL2 kolesterola, VLDL kolesterola i triglicerida, uz napomenu da nije postignuta optimalna tj. preporučena razina lipoproteina. Također je povećana razina HDL3 kolesterola i apo B. Bolesnici koji su uzimali glibenklamid za regulaciju glikemije imaju statistički značajan porast razine Lp(a) (p < 0,045), dok bolesnici liječeni samo dijetom nisu imali porast razine Lp(a). Regulacija glikemije nema utjecaja na razinu leptina u serumu. U bolesnica s NIDDM, u trenutku optimalne reguliranosti šećerne bolesti razina HDL kolesterola negativno korelira s opsegom struka, dok razina triglicerida pozitivn korelira s opsegom struka. HDL3 kolesterol negativno korelira s WHR om. U bolesnica s NIDDM koje su mlađe od 50 godina razina apo B pozitivno korelira s opsegom struka. U bolesnica s NIDDM starijih od 50 godina razina HDL kolesterola i HDL3 kolesterola negativno korelira s opsegom struka u trenutku regulirane glikemije, dok s razinom triglicerida i VLDL kolesterola pozitivno koreliraju. WHR u žena negativno korelira s razinom HDL3 kolesterola. U muških bolesnika s NIDDM mlađih od 50 godina razina triglicerida pozitivno korelira s WHR i opsegom struka u trenutku regulirane glikemije. Postoji također pozitivna korelacija VLDL kolesterola s WHR-om, dok je negativna s razinom HDL kolesterola. Razina HDL2 kolesterola negativno korelira s BMI a pozitivno s WHR-om. U muških bolesnika starijih od 50 godina života ne postoji statistički značajna povezanost lipoproteina i apolipoproteina s količinom i raspodjelom masnog tkiva procijenjenom opsegom struka, s BMI i WHR-om. Razina leptina natašte i poslije obroka u bolesnika s NIDDM i hiperlipidemijom pozitivno korelira s opsegom struka i WHR-om. Tijekom istraživanja nije nađena statistički značajna razlika u lipoproteinima i apolipoproteinima u odnosu na spol kao ni u bolesnica u fertilnoj dobi u odnosu na one u postmenopauzi. Žene s NIDDM imaju trostruko višu razinu leptina natašte i poslije obroka u odnosu na muške bolesnike s NIDDM. Razina leptina žena i muškaraca starijih od 50 godina života je statistički značajno viša u odnosu na mlađe žene i muškarce s NIDDM.

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