单核细胞与高密度脂蛋白胆固醇比值在动脉粥样硬化性疾病中的研究进展

动脉粥样硬化是动脉血管壁发生纤维脂肪病变,引起斑块形成的慢性炎症过程,是导致心肌梗死、缺血性脑卒中等心脑血管疾病发生的病理基础。单核细胞是人体内常见的免疫细胞;高密度脂蛋白胆固醇在体内对动脉粥样硬化具有保护作用。单核细胞与高密度脂蛋白胆固醇比值(monocytes-to-HDL cholesterol ratio, MHR)是一种新的炎症性指标,本文就MHR的定义及其与动脉粥样硬化性疾病的关系进行综述,以期为临床诊治动脉粥样硬化性疾病提供一种新的生物学标志物。     

单核细胞/高密度脂蛋白胆固醇比值在心血管疾病中研究进展

心血管疾病是世界范围内危害人类生命和健康的第一杀手,其发病机制多与炎症反应相关。单核细胞/高密度脂蛋白胆固醇的比值(monocyte to high-density lipoprotein cholesterol ratio,MHR)是一种潜在的反映炎症状态的生物标志物,整合了机体炎症状态及抗炎能力,其被证实与多种心血管疾病相关。本文就MHR在冠状动脉疾病、高血压、心房颤动、心力衰竭、代谢综合征、急性主动脉夹层等多种心血管疾病中的研究进展进行综述,旨在为心血管疾病的危险分层及预后提供依据。     

单核细胞/高密度脂蛋白胆固醇值与冠心病关系研究进展

<正>动脉粥样硬化(atherosclerosis,AS)是一种慢性炎症反应性疾病[1],为冠心病发生和发展的主要病理基础。大量基础研究已证实,炎症参与AS的形成,内皮受损或血脂升高时单核细胞被激活并黏附于血管内皮,转化为泡沫细胞后释放大量促炎因子,促进炎症反应,降低斑块稳定性,从而引发血栓及斑块破裂出血等并发症,故慢性弥漫性炎症反应可参与冠心病发生和发展的各个阶段[2]。高密度脂蛋白胆固醇(HDL)可逆     

超敏C-反应蛋白和胆固醇/高密度脂蛋白胆固醇比值联合测定在心血管疾病中的应用

目的 探讨超敏C-反应蛋白(hs-CRP)和固醇／高密度脂蛋白胆固醇的比值(TC／HDL-C)在心血管疾病中的应用。方法 超敏C-反应蛋白的测定采用胶乳免疫比浊法,总胆固醇、高密度脂蛋白胆固醇的测定,分别采用氧化酶法和一步法。结果 hs-CRP、TC／HDL-C在高血压组、冠心病组(CAD)和急性心肌梗死组(AMI)与健康对照组比较,均显著升高(P<0.01)。而且急性心肌梗死组显著高于冠心病组(P<0.01),冠心病组又高于高血压组(P<0.05)。结论 ks-CRP浓度和心血管疾病及其病变程度明显相关,且联合检测hs-CRP和TC／HDL-C可提高心血管疾病的预测及危险程度的评估。     

单核细胞与高密度脂蛋白胆固醇比值在糖尿病相关性研究中的进展

炎症、氧化应激、内皮细胞功能障碍等是糖尿病(diabetes mellitus,DM)及其并发症的重要病理生理基础,目前尚缺乏能综合反映上述机制且廉价、易获得的标记物来评估DM及其并发症。单核细胞与高密度脂蛋白胆固醇比值(ratio of monocytes to high-density lipoprotein cholesterol,MHR)被认为是一种能反映炎症、氧化应激及心血管疾病预后的重要标志物,而DM本身或其并发症也与心血管不良事件密切相关。本文阐述MHR在评价DM微血管病变、大血管病变、神经病变或伴发症中具有明显的预测、诊断、评估病情严重程度的作用,但具体机制尚待明确。     

应重视高密度脂蛋白胆固醇在心血管疾病中的地位

以往人们对胆固醇 (ＴＣ)、低密度脂蛋白胆固醇(ＬＤＬ Ｃ)及甘油三酯 (ＴＧ)升高对心血管疾病的影响研究颇多 ,并已达成共识 ,ＴＣ、ＴＧ及ＬＤＬ Ｃ升高在动脉粥样硬化的发生发展及其引起的心血管事件中起到非常重要的作用 ,尤其是ＬＤＬ Ｃ的升高对心血管疾病影响较大[1,2 ] 。近些年来大量的临床及流行病学研究证实 ,高密度脂蛋白胆固醇 (ＨＤＬ Ｃ)水平的降低与心血管疾病患病率呈负相关 ,4 0 %以上心肌梗死患者的主要危险因素为ＨＤＬ Ｃ低下 ,故公认ＨＤＬ Ｃ具有抗动脉粥样硬化的作用[3] 。1　ＨＤＬ Ｃ特性ＨＤＬ Ｃ主要由蛋白质、…     

单核细胞与高密度脂蛋白胆固醇比值在心肌病发生和发展过程中的机制及研究进展

心肌病是一组多种复杂因素参与的心血管疾病,含有多种类型,发病机制异质性大且尚未完全明确。近年来,有组织活检报告显示部分心肌病患者有炎症和氧化应激反应,同时单核细胞计数与高密度脂蛋白胆固醇比值(MHR)作为一种新兴的炎症和氧化应激标志物被广泛报告。本文将从MHR作为炎症和氧化应激标志物的可行性、在心肌病发生发展机制以及现有的临床研究等方面进行系统阐述,并进一步研究其作为心肌病患者的临床检验标志物的可行性。这将对医学界评估心肌病患者的治疗措施,降低心肌病患者的死亡率,改善疾病的预后有一定的参考价值。     

联合检测hs-CRP和TC/HDL-C在冠心病诊断中的应用

多年研究表明,局部和全身炎症是动脉粥样硬化发生和发展的重要原因之一,是冠心病的重要危险因素。超敏C反应蛋白(hs-CRP)作为一项敏感的标志物,对冠心病的发生发展有着重要的监测作用[1]。同时,高血脂对冠状动脉粥样硬化的影响也倍受人们的关注,但单独从某一项结果观测具有一定的局限性,而从血清总胆固醇/高密度脂蛋白胆固醇     

脓毒症患者血清高密度脂蛋白胆固醇浓度变化的分析

目的 探讨高密度脂蛋白胆固醇浓度与脓毒症的发生、发展及预后的关系。方法 检测同期住ICU非脓毒症患者与脓毒症患者各40例的高密度脂蛋白胆固醇浓度，并进行分析比较。结果 脓毒症患者的高密度脂蛋白胆固醇浓度较非脓毒症患者明显降低（P〈0．05），脓毒症死亡组的高密度脂蛋白胆固醇浓度较存活组明显偏低（P〈0．01），且脓毒症死亡组的高密度脂蛋白胆固醇呈进行性降低。结论 高密度脂蛋白胆固醇浓度与脓毒症的发生、发展及预后有密切关系，临床可采取系列措施提高患者的高密度脂蛋白浓度，减少脓毒症的发生，并改善预后。     

非高密度脂蛋白胆固醇与低密度脂蛋白胆固醇对冠心病的临床诊断价值比较

目的非高密度脂蛋白胆固醇与低密度脂蛋白胆固醇对冠心病的临床诊断价值比较。方法将2018年11月-2019年11月来我院的40例冠心病患者作为研究对象,并将其设定为研究组,同时选取40例无心血管疾病的患者作为对照组,检测患者非高密度脂蛋白胆固醇与低密度脂蛋白胆固醇水平,并对比上述指标对冠心病患者的诊断特异性。结果研究组患者的非高密度脂蛋白胆固醇与低密度脂蛋白胆固醇水平明显高于对照组,差异显著(P<0.05);同时非高密度脂蛋白胆固醇对冠心病患者的诊断特异性高于低密度脂蛋白胆固醇,差异显著(P<0.05)。结论非高密度脂蛋白胆固醇与低密度脂蛋白胆固醇均可作为冠心病患者的临床诊断指标,相较低密度脂蛋白胆固醇,非高密度脂蛋白胆固醇临床诊断价值更为突出,应被进一步推广。     

血中胆红素及低密度脂蛋白(LDL-C)的测定对心血管疾病的意义

目的研究心血管病人血中胆红素与低密度脂蛋白(LDL-C)浓度的变化,探讨变化对心血管疾病诊断与治疗的意义及二者是否相关。方法对47例心血管病组(冠心病组26例,心衰组21例)的总胆红素(TB),直接胆红素(DB),间接胆红素(IB)及低密度脂蛋白进行测试,并分别与对照组(27例)各项值进行比较。结果心血管病各组的总胆红素,直接胆红素,间接胆红素各值均低于对照组(P<0·05),心血管病各组的低密度脂蛋白较对照组增高(P<0·05),且各组间LDL-C与胆红素具有相关性。结论血清胆红素浓度降低使体内抗氧化活性减弱,可能引起低密度脂蛋白氧化修饰形成OX-LDL增多,动脉粥样硬化形成增多,从而促进冠心病等各种心血管疾病的发生。且LDL-C与胆红素呈负相关。     

UA、HDL-C、ApoA1/HDL在不同帕金森亚型患者中的差异及其与认知功能的相关性分析

目的研究尿酸(UA)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1与高密度脂蛋白比值(ApoA1/HDL)在不同帕金森亚型中的表达差异及其与认知功能的相关性。方法选取该院2016年10月至2018年10月门诊治疗的100例老年帕金森患者,针对不同的帕金森疾病患者的一般资料及认知功能障碍之间的差异进行对比,同时对比不同帕金森亚型患者及不同认知障碍情况患者血清UA、HDL-C、ApoA1/HDL之间的差异,分析血清UA、HDL-C、ApoA1/HDL水平与患者认知功能之间的相关性。结果不同帕金森亚型患者的性别、年龄、体质量指数之间的差异无统计学意义(P>0.05),而不同亚型帕金森患者的简易智能精神状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分之间的差异有统计学意义(P<0.05);不同亚型帕金森患者的血清UA、HDL-C、ApoA1/HDL水平及不同认知情况的帕金森患者的血清UA、HDL-C、ApoA1/HDL水平之间的差异有统计学意义(P<0.05)。结论帕金森患者的认知功能与血清UA、HDL-C、ApoA1/HDL水平呈负相关,且随着帕金森患者合并临床症状的不断累积,其UA、HDL-C、ApoA1/HDL水平显著下降。     

High-density lipoprotein subfractions in normolipidemic individuals without clinical atherosclerosis lipoprotein subfractions in an adult population

This study evaluated the serum concentrations of lipids, lipoproteins, apolipoproteins, and high-density lipoprotein (HDL) subfractions in Brazilian adults. We analyzed the distribution of lipids in HDL2 and HDL3 in a normolipidemic population without evidence of established cardiovascular disease (CVD). A total of 93 males and 92 females, healthy and normolipidemic, volunteered to be submitted to a clinical examination, a blood collection, and to answer a questionnaire aimed at determining signs and symptoms of atherosclerotic disease. Their fasting plasma lipid, lipoproteins, apolipoproteins, and the cholesterol and triglyceride concentrations in HDL2 and HDL3, isolated by microultracentrifugation, were determined by enzymatic-colorimetric methods. The interpercentile intervals (2.5-97.5) for the population were established as being 5-18 mg/dL in men and 4-28 mg/dL in women for HDL2 cholesterol (HDL2chol) and 1-57 mg/dL in men and 2-61 mg/dL in women for HDL3 cholesterol (HDL3chol). HDL2 triglyceride levels (HDL2Tg) in men were 1-26 mg/dL and in women 2-28 mg/dL; moreover, the HDL3 triglyceride (HDL3Tg) intervals were established as 4-46 mg/dL for both sexes. The determination of reference ranges for lipids in HDL subfractions in populations without clinical atherosclerosis, is an useful tool for metabolic, diagnostic, and therapeutic approaches. We determined the intervals for HDL2chol, HDL3chol, HDL2Tg, and HDL3Tg. There were variations with sex and/or age for HDL2chol, HDL3chol, and HDL2Tg in the studied population.     

Serum microminerals and the indices of lipid metabolism in an apparently healthy population

Serum copper and zinc concentrations were measured in 560 apparently healthy Kuwaitis (238 males and 322 females) aged 15-80 years to assess micromineral effect on the indices of lipid metabolism. Following the recommended guidelines of the European Atherosclerosis Society (EAS) and the National Cholesterol Education Program Expert Panel (NCEPEP), the incidence of dyslipidemia was assessed from enzymatic assay data of triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) concentrations. Males had significantly lower TC (P=0.029) and HDL-C (P<0.0001) levels than females, while TG were significantly (P=0.023) lower in females. The prevalence of hypercholesterolemia, hypertriglyceridemia, elevated LDL-C, and low HDL-C levels were 35, 30, 22, and 13%, respectively. Copper did not correlate with zinc (r = -0.067, P = 0.135) but was positively associated with TC (r=0.196, P<0.0001), LDL-C (r=0.134, P = 0.003), TG (r = 0.092, P=0.039), and age (r=0.281, P<0.0001). It is concluded that unlike in animal studies, copper excess in humans is associated with hyperlipidemia and therefore will predispose to atherosclerosis.     

Relationship of alcohol consumption to changes in HDL-subfractions

Abstract. Epidemiological studies have consistently shown an apparent protective effect of moderate alcohol consumption on coronary artery disease (CAD). This has been considered to be due to the rise in the high-density cholesterol lipoprotein (HDL-cholesterol). Since the response of the HDL-subfractions to moderate or heavy dose of alcohol is less clear, we now compared the high-density lipoprotein cholesterol status between groups consuming different amounts of alcohol. In this population-based survey serum total high-density lipoprotein cholesterol and its HDL₂ and HDL₃ subfractions were blindly compared between 264 consecutive middle-aged men (37 teetotallers, 137 moderate drinkers, 90 heavy drinkers) participating in a voluntary health screening and 104 male alcoholics.
Alcohol consumption correlated significantly (P<0.001) with total HDL-cholesterol, HDL₂, HDL₃ when all subjects ( n = 368) were included but the correlation disappeared when alcoholics were excluded (n = 264). In comparison with teetotallers, alcoholics had significantly higher total HDL-cholesterol, HDL₂ and HDL₃ values (P < 0.001). Moderate or heavy intake of alcohol had no effect on HDL₂ but increased the HDL₃-_-fraction.
If the protective effect of moderate alcohol consumption is mediated by high-density lipoprotein, it may not be accounted for by changes in the HDL₂-_-fraction. The observed increases in the concentration of the HDL₃-_-fraction, however, suggest that this subfraction may not be inert with respect to coronary disease and could possibly have a role in the protective effect.     

解偶联蛋白1基因多态性与2型糖尿病心脑血管并发症的相关性

目的 探讨解偶联蛋白1(UCP1)基因多态性与2型糖尿病(T2DM)心脑血管并发症的相关性.方法 选取2019年7月—2020年7月住院治疗的T2DM 440例,根据有无心脑血管并发症分为观察组(T2DM合并心脑血管并发症)221例和对照组(单纯T2DM)219例.比较两组一般资料,UCP1在rs45539933、rs...     

Critical appraisal of revised cholesterol guidelines for the very high-risk patient

A working group from the Adult Treatment Panel III of the National Cholesterol Educational Program issued a revised algorithm for low-density lipoprotein (LDL)-cholesterol lowering in very high-risk cardiovascular disease patients. The rationale for these recommendations was primarily established from pooled analysis of multiple clinical trials of LDL-cholesterol-lowering therapies and limited data from an acute coronary syndrome trial. In the near future, the findings of these large-scale randomized trials designed to test the hypothesis that more aggressive LDL-cholesterol therapy is accompanied by fewer cardiovascular events than less aggressive LDL-cholesterol lowering therapy, will provide the evidence needed to support or refute these new recommendations. In this article, the authors suggest that an LDL-cholesterol level of less than 70 mg/dl is unattainable and not necessary for many high-risk patients. Furthermore, the potential risks associated with high-dose statin agents in certain patients, such as the elderly, may outweigh these putative benefits.     

Ezetimibe/simvastatin (INEGY) in the treatment of hyperlipidaemia

Ezetimibe/simvastatin (INEGY), a dual inhibitor of both cholesterol production and absorption, is a new approach to the management of hyperlipidaemia. Recent studies have shown that it produces greater reductions in low-density lipoprotein (LDL) cholesterol than the single inhibition of statin therapy, enabling many more patients to achieve their LDL cholesterol treatment goals. With ezetimibe/simvastatin therapy, reductions of up to 61% from baseline have been seen in LDL cholesterol, with clear improvements in other associated lipid fractions. It has been well tolerated across all studies, with a safety profile similar to that of statin therapy. This article will review clinical experience to date with ezetimibe/simvastatin, commenting upon its place and potential value in the prevention of cardiovascular disease.     

Prevalence of low HDL-cholesterol in patients with cardiovascular risk factors: The ECHOS (Etude du Cholesterol HDL en Observationnel) French Survey

A low concentration of high-density lipoprotein-cholesterol (HDL-C) is an independent risk factor for cardiovascular heart disease (CHD), but little is known about the distribution of HDL-C in France. This study evaluated the prevalence of low HDL-C among a large French population (5232 patients) with other cardiovascular risk factors. Depending on the guidelines used, the prevalence of low HDL-C varied from 8.7% (cutoff value of 35 mg/dl) to 26.9% (National Cholesterol Education Program metabolic syndrome cutoff values). The prevalence of low HDL-C gradually increased with the number of associated risk factors. We identified three independent risk predictors for low HDL-C: hypertriglyceridaemia (HTG), abdominal obesity and gender. Overall, the frequency of HDL-C assessment was very high (>85%) and it was highest in patients with hypercholesterolaemia or a history of CHD. Risk factors more frequently associated with low HDL-C (i.e. HTG, abdominal obesity and type 2 diabetes) were not associated with a more frequent assessment of HDL-C. Our findings indicate that in France, the prevalence of low HDL-C remains relatively high, particularly for patients with obesity and HTG.     

非高密度脂蛋白胆固醇与心脑血管病风险研究进展

大量的流行病学及临床数据显示低密度脂蛋白胆固醇水平与动脉粥样硬化性心血管病的发病风险相关。许多一级预防和二级预防的试验显示降低低密度脂蛋白胆固醇能够显著减少心血管病的发病风险。但是,即使经过强化的降脂治疗,很多患者仍有显著的复发风险,这说明除低密度脂蛋白胆固醇外还存在其他的残留风险。学者们用载脂蛋白B,非高密度脂蛋白胆固醇来估算这种残留风险。本文讨论了非高密度脂蛋白胆固醇和冠心病及卒中的关系。