Vztah mezi familiární kombinovanou hyperlipidemií a inzulinovou rezistencí

English version

Autoři: D. Jackuliaková; H. Vaverková; D. Karásek
Působiště autorů: III. interní klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Vlastimil Ščudla, CSc.
Vyšlo v časopise: Vnitř Lék 2008; 54(11): 1045-1053
Kategorie: Původní práce

The paper was presented in part at the “Šobras Day” Conference, Prague, Czech Republic, June 2008

Souhrn

Úvod a cíl:
Familiární kombinovaná hyperlipidemie je nejčastější dědičnou dyslipidemií, obvykle spjatou s inzulinovou rezistencí. Nedávno byla redefinována diagnostická kritéria familiární kombinované hyperlipidemie: v rodině by se měli vyskytovat alespoň 2 prvostupňoví hyperlipidemičtí příbuzní současně s triglyceridy ≥ 1,5 mmol/l a apolipoproteinem B ≥ 1,20 g/l. Cílem této studie bylo zhodnotit vztah mezi lipoproteinovým fenotypem a přítomností inzulinové rezistence a posoudit přítomnost metabolického syndromu.

Metodika:
Lipidové parametry a parametry asociované s inzulinovou rezistencí byly určeny u 90 jedinců z rodin s familiární kombinovanou hyperlipidemií a u 38 kontrol. Členové postižených rodin byli dále rozděleni na hyperlipidemickou a normolipidemickou skupinu.

Výsledky:
Ve srovnání s normolipidemickou a kontrolní skupinou vykazovala hyperlipidemická skupina pouze signifikantně vyšší hladiny proinzulinu nalačno [HL 17,4 ± 1,5 vs NL 12,8 ± 1,4 (p = 0,030) a CO 11,1 ± 1,4 (p = 0,003)]. Rozdíly v hladinách C-peptidu [HL 2,56 ± 0,19 vs NL 2,27 ± 0,17 (p = NS) a CO 2,07 ± 0,18 (p = NS)] a inzulinu [HL 9,40 ± 0,78 vs NL 7,78 ± 0,71 (p = NS) a CO 7,30 ± 0,76 (p = NS)] nalačno a HOMA indexu [HL 2,16 ± 0,21 vs NL 1,84 ± 0,20 (p = NS) a CO 1,69 ± 0,21 (p = NS)] nedosahovaly statistické významnosti. Naproti tomu členové rodin s familiární kombinovanou hyperlipidemií s přítomností metabolického syndromu (NCEP-ATP III) měli ve srovnání se svými příbuznými bez metabolického syndromu a s kontrolami signifikantně vyšší lačnou hladinu inzulinu [FCH s MS 12,74 ± 1,42 vs HL bez MS 9,21 ± 0,92 (p = 0.030); a vs NL bez NS 6,75 ± 0,80 (p = 0.001)], proinzulinu [FCH s MS 25,28 vs HL bez MS 15,69 ± 1,75 (p = 0,002); a vs NL bez MS 11,20 ± 1,51 (p = 0,0001)] a HOMA index [FCH s MS 3,03 ± 0,39 vs HL bez MS 2,13 ± 0,25 (p = 0,042) a NL bez MS 1,56 ± 0,22 (p = 0,003)].

Závěr:
Přítomnost metabolického syndromu by mohla detekovat nejvíce inzulin‑rezistentní jedince v rodinách s familiární kombinovanou hyperlipidemií, kteří jsou v nejvyšším riziku kardiovaskulárních chorob.

Klíčová slova:
familiární kombinovaná hyperlipidemie – inzulinová rezistence – metabolický syndrom

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