Could non-HDL-cholesterol be a better marker of atherogenic dyslipidemia in obstructive sleep apnea?

Background/objectiveObstructive sleep apnea (OSA) is independently associated with dyslipidemia, a surrogate marker of atherosclerosis. Low-density lipoprotein (LDL)-cholesterol is accepted as a major independent risk factor for cardiovascular disease. However, non-high-density lipoprotein (HDL)-cholesterol is a better marker of atherogenic dyslipidemia and recommended as a target of lipid lowering therapy. We aimed to assess the prevalence of atherogenic dyslipidemia, and relationship between OSA severity and serum LDL-cholesterol and non-HDL cholesterol levels in OSA patients.MethodsWe retrospectively evaluated treatment naïve 2361 subjects admitted to the sleep laboratory of a university hospital for polysomnography. All subjects’ lipid profile including total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, and non-HDL-cholesterol were measured.ResultsOut of 2361 patients (mean age 49.6 ± 11.9 years; 68.9% male, apnea-hypopnea index 36.6 ± 28.4/h), 185 (7.8%) had no OSA and 2176 (92.2%) had OSA. Atherogenic dyslipidemia prevalence was high (57–66%) in OSA patients, and especially increased in severe OSA compared to other groups (p < 0.05). Though total and LDL-cholesterol did not differ between those with and without OSA, non-HDL-cholesterol (p = 0.020), and triglycerides (p = 0.001) were higher and HDL-cholesterol levels (p = 0.018) were lower in OSA patients than non-OSA. Non-HDL-cholesterol was significantly correlated with OSA severity (p < 0.001) and hypoxia parameters (p < 0.01), whereas LDL-cholesterol showed no correlation.ConclusionsAtherogenic dyslipidemia is highly prevalent and non-HDL-cholesterol levels are significantly increased, predominantly in severe OSA patients. Non-HDL-cholesterol but not LDL-cholesterol, is significantly correlated with OSA severity and hypoxia parameters. Therefore, it could be better to use non-HDL-cholesterol, which is a guideline recommended target of lipid therapy, as a marker of atherosclerotic cardiovascular risk in OSA patients.     

职业人群不健康行为生活方式与高尿酸血症的关系及高血压、血脂异常的效应修饰作用

目的 探索不健康行为生活方式与高尿酸血症的关系,以及高血压、血脂异常的效应修饰作用,为预防高尿酸血症提供理论依据。方法 采用横断面调查研究设计,基于2021年10-12月来自四川省、贵州省28个地级市和重庆市33个区（县）中国铁路成都局集团有限公司的西南职业人群队列基线数据,通过问卷调查、体格测量及实验室生化检测收集研究对象的人口学特征、行为生活方式、慢性非传染性疾病患病情况。不健康行为生活方式得分根据吸烟、饮酒、膳食模式、体力活动和低体重/超重状况进行评分,分值越高不健康行为生活方式越多。采用多因素logistic回归模型分析不健康行为生活方式评分、吸烟状况、饮酒状况等与高尿酸血症的关系,采用分层分析探索高血压等疾病对不健康行为生活方式与高尿酸血症之间关系的修饰效应。结果 共纳入11 748名研究对象,高尿酸血症患病率为34.4%。多因素logistic回归分析显示,现在吸/既往吸烟、现在饮/既往饮酒及BMI异常是高尿酸血症患病的危险因素,不健康行为生活方式对高尿酸血症患病风险呈现累积效应,随着得分的升高,高尿酸血症患病风险升高,OR值由1.64（95%CI：1.34~2.00）上升至2.89（95%CI：2.39~3.50）。分层分析结果显示,在高血压及血脂异常人群中,不健康行为生活方式对高尿酸血症患病风险影响更大。结论 多种不健康行为生活方式的共存会升高高尿酸血症患病风险,这一效应在高血压、血脂异常人群中更明显。及时纠正不健康行为生活方式,并控制高血压和血脂异常,降低患高尿酸血症的风险。     

小檗碱对糖皮质激素大鼠血脂异常的调节作用

目的 探讨小檗碱对糖皮质激素大鼠血脂异常的调节作用.方法 50只3月龄雄性SD大鼠,随机分成5组,每组10只,分别给予泼尼松与不同剂量小檗碱12周,观察大鼠体质量、血液中血糖、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、钙、磷、丙二醛及超氧化物歧化酶的变化.结果 给予泼尼松后大鼠体质量增加减慢,小檗碱可减轻泼尼松所致大鼠体质量增长幅度下降.给予泼尼松12周后,大鼠血液中血糖、甘油三酯、总胆固醇和丙二醛显著升高,高密度脂蛋白胆固醇降低;小檗碱可降低糖皮质激素大鼠血液中血糖、甘油三酯、总胆固醇和丙二醛含量,升高高密度脂蛋白胆固醇,对钙、磷及超氧化物歧化酶无显著影响.结论 小檗碱可改善糖皮质激素所致大鼠血脂代谢异常.     

多囊卵巢综合征患者的血脂代谢异常及与胰岛素抵抗的关系分析

目的:探讨多囊卵巢综合征(PCOS)患者血脂代谢异常及与胰岛素抵抗(IR)的关系,以期为血脂代谢异常PCOS患者的临床管理提供参考。方法:回顾性分析507例PCOS患者的临床资料,分析血脂代谢异常及其与腰臀比、体重指数(BMI)、IR指数、性激素水平等指标的相关关系。结果:PCOS患者IR的发生率为38.1%;与非IR的患者相比,伴有IR的患者具有较高的甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)和较低的高密度脂蛋白(HDL)(1.83±1.19vs1.12±0.70mmol/L、5.23±1.06vs4.91±0.90mmol/L、3.25±0.98vs2.88±0.79mmol/L、1.41±0.40vs1.64±0.36mmol/L,P<0.001)。总体血脂异常的发生率为24.7%,IR组显著高于非IR组(39.9%vs15.3%,P<0.001);TG、TC、LDL水平与胰岛素稳态模型-IR指数(HOMA-IR)值呈正相关,HDL水平与HOMA-IR值呈负相关。在控制BMI的影响后,TG与HDL水平仍与HOMA-IR值呈显著相关性。总体上,随着HOMA-IR值的增大,血脂异常的发生率逐渐增加。结论:PCOS患者胰岛素抵抗和血脂异常的发生率均较高,血脂异常与胰岛素抵抗呈相关性,推测临床上使用胰岛素增敏剂可能通过改善IR进而改善PCOS患者的血脂代谢异常。     

不同肥胖测量指标对心脏代谢性疾病预测价值的比较

目的 探索不同肥胖测量指标对高血压、糖尿病及血脂异常的预测价值.方法 2013 ～2014年期间,采用整群随机抽样的方法,对全国4个县开展了心血管病危险因素调查,实际入选5402人,有效数据4704人.利用该资料分析体重指数、腰围、臀围、腰臀比、腰围身高比、身体脂肪率及内脏脂肪指数对高血压、糖尿病和血脂异常的预测价值.结果 经单因素分析发现,内脏脂肪指数对高血压的预测价值较高,ROC曲线下面积达到0.67（95％ CI：0.65～0.69）,而腰围对糖尿病及血脂异常的预测价值较高,ROC曲线下面积分别达到0.66（95％ CI：0.63～0.69）和0.67（95％ CI：0.65～0.68）.Logistic回归调整年龄、性别、体力活动、吸烟、饮酒及教育程度因素后发现身体脂肪率对高血压（标准化OR =1.71,95％ CI：1.57～1.87）和血脂异常（标准化OR=1.88,95％ CI：1.72～2.06）的预测效果较好;而对于糖尿病来说,腰围的预测效果较好（标准化OR=1.62,95％ CI：1.45 ～1.80）.结论 本次调查发现身体脂肪率对我国35～64岁中年人群高血压和血脂异常的预测效果较好,而腰围对于糖尿病的预测效果较好.     

西藏农牧地区藏族人群血脂异常流行特点分析

目的了解西藏地区藏族人群中血脂异常的患病情况及流行病学特点。方法调查时间为2007年5月～7月,抽取1456名≥18岁藏族农牧民调查对象空腹血浆进行总胆固醇、甘油三酯、高密度脂蛋白胆固醇测定。结果18岁及以上人群血脂异常患病率为30.3%,其中男性36.9%,女性26.0%,男女之间存在差异(P<0.01)。血脂异常类型以高胆固醇血症为主,高甘油三脂血症次之,有其自身的类型特点。结论西藏地区18岁及以上成人血脂异常患病率明显高于全国水平,应针对其流行病学特点及改善饮食结构进行积极的防治工作。     

原发性高血压患者血胰岛素敏感指数及血脂代谢关系

目的：探讨原发性高血压(EH)患血胰岛素敏感指数(ISI)及血脂代谢的特点。方法：对60例原发性高血压患与60例健康根据体重指数(BMI)分为体重正常组、单纯肥胖组、EH组、EH 肥胖组,分别进行空腹血糖(FPG)、空腹胰岛素(FINS)、血甘油三脂(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)的测定。并对所得的结果进行分析,比较各组患上述指标的异同。结果：EH 肥胖组ISI与EH组比较明显减低;EH 肥胖组ISI与单纯肥胖组比较明显减低;EH 肥胖组与单纯肥胖组比较TC、TG、LDL-C明显增高,而HDL-C明显降低。结论：高血压合并肥胖组存在明显的胰岛素抵抗(IR)及血脂代谢异常。     

血脂异常者血清MCP-1、HO-1、APN和TNF-α水平的检测及临床价值

目的探讨血脂异常者血清单核细胞趋化蛋白-l(MCP-1)、血红素加氧酶-1(HO-1)、脂联素(APN)及肿瘤坏死因子α(TNF-α)水平的检测及临床价值。方法采用酶联免疫吸附法(ELISA)检测85例血脂异常者和35例健康对照者血清MCP-1、HO-1、APN及TNF-α的水平,同时检测血脂异常者血清其他脂类代谢指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)]的水平,并分析MCP-1、HO-1、APN及TNF-α与脂类代谢指标的相关性。结果血脂异常者血清MCP-1、HO-1和APN水平较健康对照组均显著升高,差异具有统计学意义(P0.01),而TNF-α水平较健康对照组则明显降低,差异具有统计学意义(P0.01);同时血脂异常者血清HO-1水平与MCP-1及LDL-C水平均呈正相关关系;APN水平则与TNF-α呈负相关关系,与LDL-C水平呈正相关关系;而健康对照组的HO-1水平与MCP-1水平无明显关系。结论血脂异常者血清MCP-1、HO-1和APN水平显著升高,而TNF-α水平则明显降低,说明MCP-1、HO-1、APN及TNF-α可能参与了动脉粥样硬化的发生及发展,并可能成为动脉粥样硬化潜在的预防或治疗靶点。     

Protein Oxidative Stress and Dyslipidemia in Dialysis Patients

Our aim was to investigate and determine the associations between oxidative stress (OS), dyslipidemia and inflammation in patients treated with continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) using observational cross‐sectional study. Twenty patients in CAPD and 48 in HD for at least 8 weeks and aged ≥18 years were included in the study. Individuals with malignant or acute inflammatory disease were excluded. A control group of 17 healthy individuals was also recruited. The biochemical parameter evaluations were analyzed using colorimetric kits for albumin, serum glucose, total cholesterol (TC) and lipid fractions. To determine the inflammatory status, CRP, IL‐6 and TNF‐α were analyzed by automated chemiluminescence kits. Plasma advanced oxidation protein products (AOPP) were determined by spectrophotometry. Mean AOPP levels were significantly higher for the HD group compared to the control, and there was no difference in AOPP concentrations between the control and CAPD groups. Dialysis patients had levels of inflammatory parameters higher than controls, and showed a high prevalence of patients with dyslipidemia, especially in CAPD. In the HD group, AOPP was positively correlated with triglycerides (TG) and inversely associated with HDL. Also the HD group was observed to have negative associations between TNF‐α and HDL, LDL and TC. In the CAPD group, CRP was inversely correlated with HDL. Hemodialysis patients had increased protein OS and associations of inflammation and dyslipidemia were also observed in these dialysis groups. A more detailed characterization of the relations between oxidative stress and other more traditional risk factors has therapeutic importance, since cardiovascular diseases are the leading cause of death among dialysis patients.