糖尿病与动脉粥样硬化PPT课件

TG Apo A-1
Insulin
Kidney
Mechanisms Relating Insulin Resistance and Dyslipidemia
Fat Cells
Liver
FFA
CE
IR X
Insulin
TG Apo B
VLDL (CETP)
HDL
(hepatic lipase)
VLDL
51
87
47
29
24
54
34
30
36
543
85
9
6
* Feingold KR et al. Arterioscler Thromb 1992; 12:1496-1502. ** Selby JV et al. Circulation 1993; 88:381-387.
Reduced HDL-C
Small, dense LDL-C
Dyslipidemias in Adults with Diabetes Framingham Heart Study
Increased cholesterol
MEN
Normal DM
14% 13%
Increased LDL
11% 9%
Liver
FFA
IR X
TG Apo B VLDL
VLDL
Insulin
Mechanisms Relating Insulin Resistance and Dyslipidemia
Fat Cells
Liver
FFA
CE
IR X
TG Apo B VLDL
VLDL (CETP)
HDL
(hepatic lipase)
Decreased
HDL Apo A-I
LDL Subclass Phenotypes in Diabetes Mellitus
Men* Diabetic Nondiabetic
Women** Diabetic Nondiabetic
百度文库
LDL Subclass
n
A
Int
B
Percent
29
28
21
Hyperinsulinemia Diabetes
Hypertriglyceridemia Small, dense LDL Low HDL Hypercoagulability
Atherosclerosis
Insulin Resistance and Hyperinsulinemia: Clinical Clues
Number of Pts TC (mg/dl) LDL-C (mg/dl) HDL-C (mg/dl) TG (mg/dl)
MEN
Type 2 Control
2139
52
213
205
139
132
39** 43
159*
103
WOMEN
Type 2 Control
1574
143
224
217
151* 135
Abdominal obesity TG + HDL-C Glucose intolerance Hypertension Atherosclerosis Ethnicity
Dyslipidemia in the Insulin Resistance Syndrome Elevated total TG
Association Between Hyperinsulinemia and Low HDL-C
60
P<0.005 50
Hyperinsulinemic Normoinsulinemic P<0.005
40
HDL-C (mg/dL)
30
20 Nonobese
Reaven GM. In: LeRoith D et al., eds. Diabetes Mellitus. Philadelphia: Lippincott-Raven,1996:509-519.
TG
CE (CETP) TG
Apo A-1
Kidney
LDL
SD LDL
(lipoprotein or hepatic lipase)
Dyslipidemia in Diabetes
Increased
Triglycerides
VLDL
LDL and small dense LDL
Apo B
Decreased HDL
12% 21%
Increased triglycerides 9% 19%
WOMEN
Normal DM 21% 24%
16% 15%
10% 25%
8% 17%
Garg A et al. Diabetes Care 1990;13:153-169.
Mean Plasma Lipids at Diagnosis of Type 2 Diabetes - UKPDS
43*
55
159*
95
* P<0.001, ** P<0.02 comparing type 2 vs. controll UKPDS Group. Diabetes Care 1997;20:1683-1687.
Plasma TG (mg/dL)
Relation Between Insulin Resistance and Hypertriglyceridemia
Diabetic Dyslipidemia and Atherosclerosis
Henry Ginsberg, MD
Interrelation Between Atherosclerosis and Insulin Resistance
Insulin Resistance
Hypertension Obesity
Obese
Mechanisms Relating Insulin Resistance and Dyslipidemia
Fat Cells
Liver
FFA
IR X
Insulin
Mechanisms Relating Insulin Resistance and Dyslipidemia
Fat Cells
625 r = 0.73 P < 0.0001
500
400
300
200
100 100 200 300 400 500 600
Insulin Response to Oral Glucose*
* Total area under 3-hour response curve (mean of 2 tests). Olefsky JM et al. Am J Med. 1974;57:551-560.