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目的探讨不同糖耐量人群血浆载脂蛋白A5(apolipoprotein A5,apoA5)与胰岛B细胞第一时相胰岛素分泌的关系。方法选取2009年2月至9月重庆医科大学附院门诊35例新诊断的2型糖尿病(T2DM组),30例糖调节受损者(IGR组),35例正常对照(NGT组)。以葡萄糖刺激后3～5 min急性胰岛素反应(AIR3-5)来表示第一时相胰岛素分泌功能指数;测空腹apoA5、游离脂肪酸(FFA)及糖负荷后2hFFA(2hFFA);稳态模型评价胰岛素抵抗指数(HOMA-IR)及胰岛B细胞功能(HOMA-β)。探讨apoA5与AIR3-5、血脂、血糖、HOMA-B及HOMA-IR等关系。结果(1)T2DM组、IGR组的apoA5、AIR3-5、HDL-C、HOMA-B显著低于NGT组(P<0.05),且T2DM组显著低于IGR组(P<0.05);(2)T2DM组、IGR组TG、FFA、2hFFA、LDL-C、FPG、2hPG、FINS、BMI、WHR和HOMA-IR明显高于NGT组(P<0.05),T2DM组显著高于IGR组(P<0.05);(3)apoA5与AIR3-5、HOMA-B、HDL-C均呈正相关,与TG、FFA、2hFFA、LDL-C、FPG、2hPG、FINS、HOMA-IR、BMI、WHR均呈负相关;(4)多元逐步回归分析显示,AIR3-5、TG、FFA、WHR、HOMA-IR是apoA5的独立影响因素。结论从NGT到IGR到T2DM发病进程中,低apoA5血症可能通过升高FFA而导致高甘油三酯血症,使B细胞第一时相胰岛素分泌受损,故推测升高apoA5水平,可能会降低TG,从而改善和恢复第一时相胰岛素分泌,延缓T2DM的进程。
Objective To investigate the relationship between plasma apolipoprotein A5 (apoA5) and the first phase insulin secretion of islet B cells in patients with different glucose tolerance. Methods 35 newly diagnosed type 2 diabetes mellitus (T2DM group), 30 impaired glucose regulation (IGR group) and 35 normal control (NGT group) were selected from the Affiliated Hospital of Chongqing Medical University from February to September 2009. The first phase insulin secretion function index was expressed as 3 to 5 min acute insulin response (AIR3-5) after glucose stimulation. The fasting apoA5, free fatty acid (FFA) and 2hFFA (2hFFA) Resistance index (HOMA-IR) and islet B cell function (HOMA-β). To investigate the relationship between apoA5 and AIR3-5, blood lipids, blood glucose, HOMA-B and HOMA-IR. Results (1) The levels of apoA5, AIR3-5, HDL-C and HOMA-B in T2DM group and IGR group were significantly lower than those in NGT group and T2DM group (P <0.05) The levels of TG, FFA, 2hFFA, LDL-C, FPG, 2hPG, FINS, BMI, WHR and HOMA-IR in T2DM group and IGR group were significantly higher than those in NGT group and T2DM group (P < 0.05). (3) ApoA5 was positively correlated with AIR3-5, HOMA-B and HDL-C, and negatively correlated with TG, FFA, 2hFFA, LDL-C, FPG, 2hPG, FINS, HOMA-IR, BMI and WHR (4) Multiple stepwise regression analysis showed that AIR3-5, TG, FFA, WHR and HOMA-IR were independent influencing factors of apoA5. Conclusions From NGT to IGR to the pathogenesis of T2DM, low apoA5-induced hyperlipidemia may result in hypertriglyceridemia by increasing FFA, impaired the first-phase insulin secretion of B cells. Therefore, it is speculated that increasing apoA5 may result in Lower TG, thereby improving and restoring the first phase of insulin secretion, delaying the progression of T2DM.