第49届欧洲糖尿病研究协会年会(EASD2013)于9月23-27日在西班牙巴塞罗那召开。当地时间9月27日上午，在“Lipids: prediction and functional studies”专场上，意大利比萨大学内分泌代谢系Giuseppe Penno博士报告的一项多中心研究指出，无论有否采用他汀类药治疗，高甘油三酯(HTG)与所有的慢性肾病（CKD）表型相关，而无论甘油三酯（TG）水平如何，CKD表型均与心血管疾病（CVD）相关。这些数据指出HTG在CKD发生中可能发挥作用，治疗致动脉粥样硬化的血脂异常非常重要。
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| Giuseppe Penno博士 |
致动脉粥样硬化的血脂异常包括高甘油三酯(HTG)和低高密度胆固醇(HDL-C），可使2型糖尿病患者的心血管疾病（CVD）患病率和死亡率增加。研究者在一项意大利多中心的“肾功能不全和心血管事件（RIACE）"研究招募的2型糖尿病患者中评估了甘油三酯增高与肾、视网膜和CVD并发症增加是否相关。
共纳入RIACE研究中15773例患者，依据其血浆TG 水平是否低于（NTG）或高于(HTG)150mg/dl、及其是否使用他汀类药治疗（后者可降低TG多达40%）而分为4组。TG通过标准的比色测定法测定；估计GFR（eGFR）用简化的MDRD方程式计算；白
与NTG患者比较，所有HTG患者（用或未用他汀类药）的HbA1c、BMI、腰围、非HDL-C水平和白蛋白尿较高，而HDL-C水平较高，仅使用他汀类药的患者eGFR较低 (p＜0.001) 。 与NTG患者相比，HTG患者、特别是用他汀类药者的慢性肾病（CKD）发病率更高。不管TG水平如何，与未用他汀类药者比较，使用他汀类药的患者有较高的CVD及（晚期）视网膜病变。反向变量选择的logistic回归分析证实，无论有否采用他汀类药治疗，HTG均与CKD高风险独立相关，1-2期（1.227 [1.081-1.393]）及1.246 [1.090-1.426]）, 3-5期, 有白蛋白尿者(2.003 [1.654-2.327]及2.667 [2.213-3.214])，无白蛋白尿者(1.535 [1.294-1.820]及1.838 [1.553-2.175])。使用他汀类药的HTG 患者只与后者相关。相反，NTG 和HTG患者，均与独立CVD风险较高独立相关，总的（2.893 [2.621-3.195]及2.705 [2.399-3.049]），与血管(冠状动脉、脑血管、周围血管) 病变相关，但与任何或晚期视网膜病变无关。
| Association of hypertriglyceridaemia with complications in subjects with type 2 diabetes（高甘油三酯血症与2型糖尿病患者并发症的关系） |
| Background and aims: Atherogenic dyslipidemia, i.e. high triglyceride (TG) and low HDL cholesterol levels, contributes to the increased morbidity and mortality for cardiovascular disease (CVD) in subjects with type 2 diabetes. We assessed whether raised TG levels are associated with an increased burden from renal, retinal and CVD complications in patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study. Materials and methods: Subjects from the RIACE (n=15,773) were divided in 4 groups depending on whether they had plasma TG levels below (NTG) or above (HTG) 150 mg/dl and were or not on statin therapy, which reduces TGs by up to 40%. TGs were assessed by standard colorimetric methods, estimated GFR (eGFR) was calculated using the simplified MDRD equation, albuminuria was measured by immunonephelometry or immunoturbidimetry, retinopathy was evaluated by fundus examination, and CVD was adjudicated based on hospital discharge records or specialist visits. Results: HGT subjects, either with or without statin, had higher HbA1c, BMI, waist, non-HDL cholesterol and albuminuria, and lower HDL cholesterol and, only for subjects on statin, eGFR, as compared with NTG individuals (P<0.001). HTG patients, particularly if on statin, had higher prevalence of chronic kidney disease (CKD), especially albuminuric, than NTG subjects. In contrast, CVD and (advanced) retinopathy were more prevalent in subjects on statin than in those not, independently of TG levels. Logistic regression analysis with backward variable selection confirmed that HTG without or with statin was independently associated with a higher risk of CKD, Stages 1-2 (1.227 [1.081-1.393] and 1.246 [1.090-1.426]), and Stages 3-5 albuminuric (2.003 [1.654-2.427] and 2.667 [2.213-3.214]) and nonalbuminuric (1.535 [1.294-1.820] and 1.838 [1.553-2.175]). NTG with statin therapy was associated only with the latter. Conversely, in NTG and HTG subjects, statin treatment was independently associated with a higher risk of CVD, total (2.893 [2.621-3.195] and 2.705 [2.399-3.049]) and by vascular bed (coronary, cerebrovascular and peripheral), but not of any or advanced retinopathy. Conclusion: HTG is associated with all CKD phenotypes independently of statin treatment, whereas the latter correlates with CVD independently of TG levels. These data point to a possible role of HTG in the development of CKD and to the importance of treating atherogenic dyslipidemia. |
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