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首页> 外文期刊>Peritoneal dialysis international: Journal of the International Society for Peritoneal Dialysis >The effect of insulin delivery route on lipoproteins in type I diabetic patients on CAPD.
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The effect of insulin delivery route on lipoproteins in type I diabetic patients on CAPD.

机译：胰岛素递送途径对CAPD I型糖尿病患者脂蛋白的影响。

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OBJECTIVE: To evaluate the influence of subcutaneous and intraperitoneal (i.p.) insulin on plasma lipoproteins in type I diabetic (IDDM) patients with end-stage renal failure (ESRD) treated with continuous ambulatory peritoneal dialysis (CAPD). DESIGN: A before-after trial. SETTING: University hospital outpatient care. PARTICIPANTS: Eleven IDDM patients with stabilized peritoneal dialysis, age 42.9 +/- 2.9 (SEM) years and duration of diabetes 31.4 +/- 3.4 years. INTERVENTION: Two treatment periods during stabilized CAPD. All patients were first treated with subcutaneous and then with i.p. insulin.The studies were performed after a median time of 3 months on each treatment. MAIN OUTCOME MEASURES: Plasma lipids; apoproteins (Apo) A-I, A-II, and B; high-density lipoprotein (HDL) subfractions; glycemic status; and uremic status. RESULTS: After changing from subcutaneous insulin to i.p. insulin, plasma HDL cholesterol decreased (from 1.29 +/- 0.13 mmol/L to 0.96 +/- 0.06 mmol/L, p < 0.05), and the low density to high density lipoprotein (LDL/HDL) cholesterol ratio increased (p < 0.05). The HDL cholesterol decreased in both HDL2 and HDL3 fractions, but significantly so only in HDL3 (p < 0.01). ApoA-I (p < 0.05) decreased while the ApoB/ApoA-I ratio (p < 0.01) and the ApoA-I/HDL-cholesterol ratio (p < 0.01) increased during i.p. insulin therapy. Intraperitoneal insulin resulted in significantly better glycemic control than subcutaneous insulin (p < 0.01). CONCLUSIONS: In diabetic patients on CAPD therapy, i.p. insulin, although inducing better glycemic control than subcutaneous insulin, was associated with lowered plasma HDL cholesterol and ApoA-I levels. The atherogenic potential is probably less than expected as the relative particle size of HDL remained unchanged.
机译：目的：评估皮下和腹膜内（i.p.）胰岛素对连续非卧床腹膜透析（CAPD）治疗的I型糖尿病（IDDM）终末期肾衰竭（ESRD）患者的血浆脂蛋白的影响。设计：先审后试。地点：大学医院的门诊服务。参与者：11例IDDM腹膜透析稳定的患者，年龄42.9 +/- 2.9（SEM）岁，糖尿病持续时间31.4 +/- 3.4岁。干预：CAPD稳定期间需要两个治疗期。所有患者首先接受皮下治疗，然后接受腹膜内注射。在每次治疗的中位时间为3个月后进行研究。主要观察指标：血脂;血脂;血脂。载脂蛋白（Apo）A-I，A-II和B;高密度脂蛋白（HDL）亚组分;血糖状态和尿毒症状态。结果：从皮下注射胰岛素改为腹膜内注射后。胰岛素，血浆HDL胆固醇降低（从1.29 +/- 0.13 mmol / L降至0.96 +/- 0.06 mmol / L，p <0.05），低密度脂蛋白（LDL / HDL）胆固醇比率增加（p <0.05 0.05）。 HDL2和HDL3组分中的HDL胆固醇均下降，但只有HDL3下降显着（p <0.01）。 i.p.期间ApoA-I（p <0.05）降低，而ApoB / ApoA-I比（p <0.01）和ApoA-I / HDL-胆固醇比（p <0.01）升高。胰岛素治疗。腹膜内胰岛素比皮下胰岛素具有更好的血糖控制效果（p <0.01）。结论：在接受CAPD治疗的糖尿病患者中，i.p。胰岛素虽然比皮下胰岛素诱导更好的血糖控制，但与血浆HDL胆固醇和ApoA-I水平降低有关。由于HDL的相对粒径保持不变，致动脉粥样化的潜力可能小于预期。

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