李 哲，王瑞英，张志成

血清游离脂肪酸代谢及成分变化与2型糖尿病患者大血管并发症的关系

李 哲，王瑞英，张志成

目的 探讨2型糖尿病（type 2 diabetes mellitus，T2DM）患者血清游离脂肪酸（free fatty acid，FFA）与大血管病变的关系。方法 选取河北医科大学第二附属医院2010年12月—2012年1月住院的T2DM患者173例；其中，无大血管病变T2DM 36例［A组，年龄（55.7±5.9）岁］，并发1种大血管病变59例［B组，年龄（56.7±9.7）岁］，并发2种大血管病变58例［C组，年龄（58.3±7.4）岁］，并发3种及3种以上大血管病变20例［D组，年龄（59.8±8.9）岁］及正常对照组41例健康人［N组，年龄（54.2±7.4）岁］，采用气相色谱外标定法，进行血清FFA含量和成分的测定。结果 T2DM患者总脂肪酸（total fatty acid，TFA）、饱和脂肪酸（saturated fatty acid，SFA）、多不饱和脂肪酸（polyunsaturated fatty acids，PUFA）均显著升高（P＜0.05）。SFA中软脂酸（C16∶0）、硬脂酸（C18∶0）、二十四烷酸（C24∶0）在T2DM患者中明显升高（C16∶0、C18∶0 P＜0.01，C24∶0 P＜0.05）。单不饱和脂肪酸（monounsaturated fatty acid，MUFA）中油酸（C18∶1）显著升高（P＜0.05）。PUFA中亚油酸（C18∶2）显著升高（P＜0.01），二十二碳六烯酸下降明显（P＜0.01）。大血管病变组组间脂肪酸成分比较，TFA、MUFA、SFA及C16∶0、C18∶0、C18∶1在A组、B组、C组、D组中随血管病变严重程度显著升高。两两比较:C组和D组的C16∶0、C18∶0、C18∶1及SFA、MUFA、TFA均较A组显著升高（P＜0.05）；C组的C18∶0、D组C18∶1和MUFA较B组高（P＜0.05）。结论 T2DM患者体内脂肪酸成分的改变是脂代谢紊乱早期指标之一，并参与大血管病变的发生。

2型糖尿病；脂代谢紊乱；游离脂肪酸；大血管病变

［Abstract］Objective To discuss the relationship between the serum free fatty acid（FFA）composition and macrovascular complications in type 2 diabetes mellitus（T2DM）.Methods One hundred and seventy-three cases of T2DM patients in the second hospital of hebei medical university between December 2010 and January 2012 were selected，and divided into four groups.Group A，36 cases，without macrovascular complications in T2DM patients，the age was（55.7±5.9）years old. Group B，59 cases，with 1 kind of macrovascular complications in T2DM patients，the age was（56.7± 9.7）years old.Group C，58 cases，with 2 kinds of macrovascular complications in T2DM patients，the age was（58.3±7.4）years old.Group D，20 cases，with 3 kinds of macrovascular complications in T2DM patients，the age was（59.8±8.9）years old.Fourty one healthy people were compared as normal group，group N，the age of（54.2±7.4）years old.Tested the serum FFA content and composition by gas chromatography of external standard method.Results Levels of total fatty acids（TFA），saturated fatty acids（SFA），polyunsaturated fatty acids（PUFA）in diabetes patients were significantly higher than those in the healthy control（P＜0.05）.The palmitic acid（C16∶0），stearic acid（C18∶0），lignoceric acid（C24∶0）levels were significantly increased in the diabetes（C16∶0，C18∶0，P＜0.01，C24∶0（P＜0.05）.Oleic acid（C18∶1）level and linoleic acid （C18∶2）level were significantly higher than the normals（P＜0.05）.Docosahexaenoic acid level was decreased significantly（P＜0.01）.The total fatty acids，C16∶0，C18∶0，C18∶1 levels in groupA，group B，group C，group D were remarkable correlated with the severity of vascular lesions. Conclusion For type 2 diabetic patients，the change of free fatty acids component，as an early index of lipid metabolic disorder，was closely related to large vascular lesions.

1 资料与方法

1.1研究对象 选取河北医科大学第二附属医院2010年12月—2012年1月住院的T2DM患者173例，均符合1999年世界卫生组织糖尿病诊断标准；其中，男性100例、女性73例，年龄34～93（56.7± 10.9）岁。根据有无大血管并发症进行分组:A组为单纯T2DM患者无大血管病变36例，男性24例、女性12例，年龄（55.7±5.9）岁；B组为合并1种大血管病变患者59例，男性36例、女性23例，年龄（56.7±9.7）岁；……