Plazmas acilkarnitīnu līmeņa izmantošana insulīna rezistences diagnostikā
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Acilkarnitīni ir taukskābju metabolisma starpprodukti, kas nepieciešami taukskābju beta-oksidācijas nodrošināšanai. To uzkrāšanās, īpaši postprandiālā stāvoklī, varētu liecināt par mitohondriju disfunkciju un metabolo neelastību šūnu enerģētiskajā metabolismā, kas raksturīga insulīna rezistences apstākļiem. Iespējams, augstāki acilkarnitīnu līmeņi pēc maltītes testa varētu kalpot par agrīnāku insulīna rezistences marķieri nekā glikozes līmeņa paaugstināšanās.
Šī pētījuma mērķis bija noskaidrot, vai plazmas acilkarnitīnu līmeņi pacientiem ar insulīna rezistenci pēc jauktas maltītes testa ir saistīti ar tradicionālajiem insulīna rezistences marķieru līmeņiem.
Materiāli un metodes. 16 pacientiem ar 2.tipa cukura diabētu vai prediabētu tika veikts jauktas maltītes tests (Rimi “Flapjack” batoniņš un “Ehrmann” jogurta dzēriens, kopējā kalorāža 433,3kcal, tauku saturs ēdienreizē 9,5g, ogļhidrāti 75g, olbaltumvielas 11,4g). Plazmas acilkarnitīnu un karnitīna līmeņi, kopā 14 metabolīti, tika mērīti tukšā dūšā un 30, 60 un 120 minūtes pēc jauktas maltītes testa. Par „tradicionālajiem” insulīna rezistences marķieriem kalpoja HOMA2-IR indekss, abdomināla aptaukošanās (pacienta ĶMI >30 kg/m2), paaugstināts triglicerīdu (TG) līmenis, paaugstināts brīvo taukskābju (NEFA) līmenis tukšā dūšā un postprandiāli un disglikēmija.
Rezultāti. Ar dažādiem insulīna rezistences marķieriem korelēja vairāki acilkarnitīni, no kuriem visvairāk pozitīvu korelāciju bija rādītājos 30 minūtes pēc jauktas maltītes testa. Visvairāk statistiski nozīmīgu korelāciju ar insulīna rezistences marķieriem uzrādīja acilkarnitīns C2 30 minūtes pēc jauktas maltītes testa, kas pozitīvi korelēja ar HOMA2-IR indeksu, pacienta svaru un ĶMI, TG līmeni, NEFA līmeni 30, 60 un 120 minūtes pēc jauktas maltītes, glikozes līmeni 30 minūtes pēc jauktas maltītes, HbA1c, un ALAT līmeni (p<0,05).
Secinājumi. Paaugstināti plazmas acilkarnitīnu līmeņi, īpaši pēc jauktas maltītes testa, ir saistīti ar insulīna rezistences marķieru līmeņiem. Pēc pilotprojekta rezultātiem visnoderīgākais insulīna rezistences marķieris praksē varētu būt īsķēžu acilkarnitīns C2. Optimālais laiks plazmas acilkarnitīnu noteikšanai pēc jauktas maltītes testa varētu būt 30 minūtes.
Acylcarnitines are intermediates of fatty acid metabolism that are needed for beta-oxydation of fatty acids. Accumulation of acylcarnitines, especially in the postprandial state, might indicate mitochondrial dysfunction and metabolic inflexibility in the energetic metabolism of cells, which is a characteristic of insulin resistant states. Higher levels of acylcarnitines after a mixed-meal test might be used as an earlier marker of insulin resistance than elevated glucose levels. The aim of this study was to determine whether plasma acylcarnitine levels of patients with insulin resistance after a mixed-meal test are associated with the levels of “traditional” insulin resistance markers. Materials and methods. A mixed-meal test was conducted on 16 patients with either type 2 diabetes or prediabetes. The mixed-meal consisted of one Rimi “Flapjack” bar and one “Ehrmann” yoghurt drink (total nutrition 433.3 kcal, fat 9.5g, carbohydrates75g, protein 11.4g). Plasma acylcarnitine and carnitite levels, 14 metabolites in total, were measured in the fasting state and 30, 60 and 120 minutes after the mixed-meal test. “Traditional” markers of insulin resistance were HOMA2-IR index, abdominal obesity (BMI >30 kg/m2 ), elevated triglyceride (TG) level, elevated non-esterified fatty acid levels (NEFA) in the fasting and postprandial states, and dysglycemia. Results. Several acylcarnitines correlated with different markers of insulin resistance. The most number of positive correlations were found with the levels of measured metabolites 30 minutes after the mixed meal. The most number of statistically significant correlations with markers of insulin resistance was found with the levels of acylcarnitine C2 30 minutes after the mixed meal, which correlated positively with HOMA2-IR index, patient’s weight and BMI, level of TG, level of NEFA 30, 60 and 120 minutes after the mixed meal, glucose level 30 minutes after the mixed meal, as well as with HbA1c and alanine aminotranferase (ALT) level (p<0,05). Conclusions. Elevated levels of plasma acylcarnitines, especially after a mixed-meal test, are associated with markers of insulin resistance. The results of this pilot study indicate that the most useful marker for insulin resistance might be the short-chained acylcarnitine C2. The optimal time for measuring acylcarnitines in plasma after a mixed-meal test might be 30 minutes.
Acylcarnitines are intermediates of fatty acid metabolism that are needed for beta-oxydation of fatty acids. Accumulation of acylcarnitines, especially in the postprandial state, might indicate mitochondrial dysfunction and metabolic inflexibility in the energetic metabolism of cells, which is a characteristic of insulin resistant states. Higher levels of acylcarnitines after a mixed-meal test might be used as an earlier marker of insulin resistance than elevated glucose levels. The aim of this study was to determine whether plasma acylcarnitine levels of patients with insulin resistance after a mixed-meal test are associated with the levels of “traditional” insulin resistance markers. Materials and methods. A mixed-meal test was conducted on 16 patients with either type 2 diabetes or prediabetes. The mixed-meal consisted of one Rimi “Flapjack” bar and one “Ehrmann” yoghurt drink (total nutrition 433.3 kcal, fat 9.5g, carbohydrates75g, protein 11.4g). Plasma acylcarnitine and carnitite levels, 14 metabolites in total, were measured in the fasting state and 30, 60 and 120 minutes after the mixed-meal test. “Traditional” markers of insulin resistance were HOMA2-IR index, abdominal obesity (BMI >30 kg/m2 ), elevated triglyceride (TG) level, elevated non-esterified fatty acid levels (NEFA) in the fasting and postprandial states, and dysglycemia. Results. Several acylcarnitines correlated with different markers of insulin resistance. The most number of positive correlations were found with the levels of measured metabolites 30 minutes after the mixed meal. The most number of statistically significant correlations with markers of insulin resistance was found with the levels of acylcarnitine C2 30 minutes after the mixed meal, which correlated positively with HOMA2-IR index, patient’s weight and BMI, level of TG, level of NEFA 30, 60 and 120 minutes after the mixed meal, glucose level 30 minutes after the mixed meal, as well as with HbA1c and alanine aminotranferase (ALT) level (p<0,05). Conclusions. Elevated levels of plasma acylcarnitines, especially after a mixed-meal test, are associated with markers of insulin resistance. The results of this pilot study indicate that the most useful marker for insulin resistance might be the short-chained acylcarnitine C2. The optimal time for measuring acylcarnitines in plasma after a mixed-meal test might be 30 minutes.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Acilkarnitīni, insulīna rezistence, jauktas maltītes tests, metabolā elastība, mitohondriju disfunkcija., Acylcarnitines, insulin resistance, mixed-meal test, metabolic flexibility, mytochondrial dysfuncion.