左卡尼汀在糖尿病的作用

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,左卡尼汀 对葡萄糖代谢的影响,促进健康人对葡萄糖利用,促进2型DM患者对葡萄糖的利用,机理：,降低线粒体内酰基COA/COA比例,激活丙酮酸脱氢酶复合体PDH,Journal of the American College of Nutrition,1999 18(4),289295,Journal of the American College of Nutrition,1999 18(1),7782,糖尿病患者尿左卡尼汀排出增加,Journal of pediatric endocrinilogy and metabolism 2002,15:841-849,Urinary carnitine excretion(nmol/mg),1,型,DM,患者血清左卡尼汀变化,卡尼汀,1,型糖尿病（,47,例）,对照,（,30,例）,P,值,总卡尼汀,30.1,7.2,46.1,6.4,0.001,游离卡尼汀,20.0,4.5,37.9,5.0,0.001,酰基卡尼汀,10.2,6.4,8.2,2.3,0.109,A/F,比率,0.54,0.36,0.22,0.05,0.001,Journal of Diabetes and Its Complications 18(2004)271 274,血清总左卡尼汀与患病年限的关系,r,=-0.304,P,=0.036,Journal of Diabetes and Its Complications 18(2004)271 274,糖尿病并发症中左卡尼汀缺乏,检测血清游离、总卡尼汀,24,例有并发症的,II,型,DM,患者和,15,例无并发症的,II,型,DM,分组：,group 1,：无并发症患者,group 2,：合并视网膜病,group 3,：合并高脂血症,group 4,：合并神经病变,J Diabetes Complications.1999;13(5-6):251-3,各组患者血清左卡尼汀水平比较,分组,n,总卡尼汀,游离卡尼汀,无并发症,15,89.9,15.4,58.1,14.3,视网膜病变,20,75.4,30.4,34.2,19.5,高脂血症,13,72.5,29.6,34.8,16.6,多神经病变,20,76.2,30.8,35.7,18.8,P,值,0.05,0.05,糖尿病并发症患者血清左卡尼汀明显降低,左卡尼汀缺乏对机体的影响,心肌能量供给缺乏,骨骼肌能量供给缺乏,脂肪酸堆积：加剧胰岛素抵抗,抑制机体对葡萄糖的利用,胰腺细胞凋亡,破坏血管上皮细胞,News Physiol Sci.2004 Jun;19:92-6.,Am J Med.2003 Dec 8;115 Suppl 8A:29S-36S.,左卡尼汀对糖尿病患者的治疗作用,降低空腹血糖水平,研究方法：随机双盲对照,患者特征：,35,例,2,型,DM,，平均年龄,51.33.7 y,用药方法：左卡尼汀,1 g po tid;12 weeks,结果：,空腹血糖水平由,14335,降至,13033 mg/dl,(,P,=0.03),Eur J Clin Nutr.2005;59(4):592-6.,促进脂肪代谢,降低血清甘油三酯水平,参数,治疗前,治疗后,P,值,总体脂肪百分数,35.4%7.1%,32.9%6.9%,0.01,躯干脂肪百分数,33.2%6.7%,31.8%6.3%,0.01,腹围,/,臀围比,0.990.18,0.950.16,0.01,甘油三酯,mmol/L,4.01.6,2.6 1.2,0.05,中山医科大学学报,2000,21(3):215,218,50,例,2,型糖尿病患者；随机双盲对照研究,左卡尼汀用量：,3 g/d,，,3,mon,显著降低血浆脂蛋白水平降低酮体浓度,Clin Ther.2003 May;25(5):1429-39.,Can J Physiol Pharmacol.1990 68:1601-1608,其他作用,