糖尿病与动脉粥样硬化PPT课件.ppt

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1、DiabeticDyslipidemiaandAtherosclerosisHenryGinsberg,MDInterrelationBetweenAtherosclerosisandInsulinResistanceHypertensionObesityHyperinsulinemiaDiabetesHypertriglyceridemiaSmall,denseLDLLowHDLHypercoagulabilityInsulinResistanceAtherosclerosisAbdomina

2、lobesityTG+HDL-CGlucoseintoleranceHypertensionAtherosclerosisEthnicityInsulinResistanceandHyperinsulinemia:ClinicalCluesElevatedtotalTGReducedHDL-CSmall,denseLDL-CDyslipidemiaintheInsulinResistanceSyndromeDyslipidemiasinAdultswithDiabetesFraminghamH

3、eartStudyIncreasedcholesterolIncreasedLDLDecreasedHDLIncreasedtriglyceridesNormalDMNormalDM14%11%12%9%13%9%21%19%MENWOMEN21%16%10%8%24%15%25%17%GargAetal.DiabetesCare1990;13:153-169.MeanPlasmaLipidsatDiagnosisofType2Diabetes-UKPDSNumberofPtsTC(mg/dl)

4、LDL-C(mg/dl)HDL-C(mg/dl)TG(mg/dl)Type2ControlMENUKPDSGroup.DiabetesCare1997;20:1683-1687.*P<0.001,**P<0.02comparingtype2vs.controll213921313939**159*5220513243103Type2ControlWOMEN1574224151*43*159*1432171355595RelationBetweenInsulinResistanceandHypert

5、riglyceridemiaOlefskyJMetal.AmJMed.1974;57:551-560.*Totalareaunder3-hourresponsecurve(meanof2tests).625500400300200100100200300400500600InsulinResponsetoOralGlucose*PlasmaTG(mg/dL)r=0.73P<0.0001AssociationBetweenHyperinsulinemiaandLowHDL-CHDL-C(mg/dL)

6、ReavenGM.In:LeRoithDetal.,eds.DiabetesMellitus.Philadelphia:Lippincott-Raven,1996:509-519.NonobeseHyperinsulinemicNormoinsulinemicObeseP<0.005P<0.005MechanismsRelatingInsulinResistanceandDyslipidemiaFatCellsLiverInsulinIRXFFAMechanismsRelatingInsulin

7、ResistanceandDyslipidemiaFatCellsLiverInsulinIRXTGApoBVLDLVLDLFFA(hepaticlipase)MechanismsRelatingInsulinResistanceandDyslipidemiaFatCellsLiverKidneyInsulinIRX(CETP)CETGApoBVLDLVLDLHDLTGApoA-1FFA(hepaticlipase)MechanismsRelatingInsulinResis

8、tanceandDyslipidemiaFatCellsLiverKidneyInsulinIRX(CETP)CETGApoBVLDL(CETP)VLDLHDL(lipoproteinorhepaticlipase)SDLDLLDLTGApoA-1TGCEFFAIncreasedDyslipidemiainDiabetesDecreasedTriglyceridesVLDLLDLandsmalldenseLDLApoBHDLApoA-ILDLSubclassPhenot