糖尿病性腎症患者における脂質代謝異常に関する検討 : RLP-コレステロールを中心として

Abstract

Remnant like particle (RLP), which is enriched in apo E and cholesterol esters, refers to lipoproteins that do not have an immunoaffinity to gel mixture of anti-apo A-I and anti-apo B-100 monoclonal antibodies. It is one of the most atherogenic lipo- proteins. High levels of RLP indicate the existence of lipid metabolism disorders. To investigate whether disorders of lipid metabolism exist in patients with non-insulin depen- dent diabetes mellitus (NIDDM), we measured RLP-cholesterol (RLP-C) in 64 patients with NIDDM, 21 patients with impaired glucose tolerance (IGT), and 16 healthy controls. Furthemore, we prescribed bezafibrate (500 mg/day for 3 months), which improves hyper- lipidemia through activating lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL), to 6 patients with NIDDM with high levels of serum RLP-C to assess its effect on lipid metabolism and diabetic nephropathy. The levels of serum RLP-C were higher in the NIDDM group than in the healthy controls. These levels had a correlation with the levels of serum triglyceride (TG), but not with the levels of serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C). The levels of serum RLP-C, TC, and TG decreased after treatment with bezafibrate in all patients, but there was no improve- ment of carbohydrate metabolism or urinary albumin excretion. Our findings suggest that the disorders of lipid metabolism exist in patients with NIDDM, and bezafibrate may be useful in improving these disorders in patients with NIDDM.