2型糖尿病患者血清脂蛋白(a)水平变化及其意义

目的　探讨２ 型糖尿病血清Ｌｐ（ａ） 水平与尿白蛋白排泄率的关系。方法　应用单克隆抗体酶联免疫吸附法测定了３１ 例非糖尿病患者和８３ 例２ 型糖尿病患者的血清Ｌｐ（ａ） 水平,并分析它与尿白蛋白排泄率（ＵＡＥＲ） 的相关性。８３ 例２ 型糖尿病患者,根据ＵＡＥＲ 将其分为３ 组：①非糖尿病肾病（ＤＮ）者３２ 例（ＵＡＥＲ＜ ２０ μｇ／ｍｉｎ） ;②微量白蛋白尿者３９ 例（ＵＡＥＲ 介于２０～２００ μｇ／ｍｉｎ之间） ;③大量白蛋白尿者１２ 例（ＵＡＥＲ＞ ２００ μｇ／ｍｉｎ） 。结果　（１） 非糖尿病患者和２ 型糖尿病无ＤＮ 者间血清Ｌｐ（ａ）水平无显著性差异〔（８６ ．４４ ±２ ．１０）ｍｇ／Ｌｖｓ（９３ ．６０ ±１ ．８６）ｍｇ／Ｌ,Ｐ＞ ０ ．０５〕;而在２ 型糖尿病微量白蛋白尿者Ｌｐ（ａ）水平显著升高〔（１４１．１９±２ ．５９）ｍｇ／Ｌ,与非糖尿病患者和２ 型糖尿病无ＤＮ者相比,Ｐ均＜０ ．０５〕;２ 型糖尿病并大量白蛋白尿者Ｌｐ（ａ） 水平有进一步升高〔（２４７ ．５７±１ ．９０）ｍｇ／Ｌ,与非糖尿病患者、２ 型糖尿病无ＤＮ者以及２ 型糖尿病并微量白蛋白尿者相比有显著升高,Ｐ均＜０ ．０５〕。（２）２ 型糖尿病患者中, 血清Ｌｐ（     

2型糖尿病患者脂蛋白(a)水平与尿白蛋白排泄率的关系

许多研究发现糖尿病肾病 (ＤＮ )的尿白蛋白排泄率(ＵＡＥＲ)与血浆脂蛋白 (ａ)〔Ｌｐ(ａ)〕水平存在正相关 ,因此推测Ｌｐ(ａ)为糖尿病肾病的危险因子〔1〕;但是Ｊｅｎｎｋｉｎｓ认为ＤＮ患者白蛋白丢失过多 ,可导致Ｌｐ(ａ)水平上升〔2〕。因此 ,糖尿病肾病患者高Ｌｐ(ａ)浓度是肾病的危险因素 ,还是肾病的伴随现象目前尚不十分清楚。辛伐他汀为羟甲基戊二酰辅酶Ａ抑制剂类降脂药 ,有报道认为能降低糖尿病患者的Ｌｐ(ａ)水平〔3〕;本研究观察辛伐他汀改变血浆Ｌｐ(ａ)水平是否影响ＵＡＥＲ的变化 ,探讨ＤＮ的病因。一、对象和方法1.研究对…     

脂蛋白（a）和载脂蛋白（a）多态性与女性冠心病的相关性研究

冠心病（ＣＨＤ）在病因、发病年龄等诸多方面存在性别差异。载脂蛋白（ａ）［ａｐｏ（ａ）］多态性与脂蛋白（ａ）［Ｌｐ（ａ）］血浆水平对女性ＣＨＤ影响的资料甚少。我们通过检测３５例女性ＣＨＤ患者和４５例女性正常对照者的ａｐｏ（ａ）多态表型及Ｌｐ（ａ）水平，并与相应的男性组对比分析，发现含有等位基因Ｓ１、Ｓ２、Ｂ的ａｐｏ（ａ）低分子量表型的ＣＨＤ患者，女性占３７．１４％，显著高于对照组，而男性仅占２５．７１％，与对照组比较差异无显著性。在女性中低分子量表型发生ＣＨＤ危险度为对照组的４．７倍，在男性中仅为１．４倍。提示：低分子量表型对女性ＣＨＤ的影响大于男性。Ｌｐ（ａ）水平在两性ＣＨＤ组均明显高于对照组，而两性之间则差异无显著性。     

脂蛋白(a)的生化特征与动脉粥样硬化

血清高浓度的脂蛋白（ａ）［Ｌｐ（ａ）］是动脉粥样硬化（ＡＳ）形成的独立危险因素，它与低密度脂蛋白（ＬＤＬ）有许多不同，作为Ｌｐ（ａ）特征性结构的载脂蛋白（ａ）［ａｐｏ（ａ）］与纤维蛋白溶酶原（ｐｌｇ）非常相似，Ｌｐ（ａ）是血脂与纤溶系统之间的桥梁。本文将对Ｌｐ（ａ）的结构、理化特征、基因、代谢、与ＡＳ形成的关系、检测方法及其临床意义等问题作一综述。     

甲亢患者甲状腺次全切除前后血浆Lp(a)水平的变化

已证实高浓度的脂蛋白 (ａ)〔Ｌｐ(ａ)〕是动脉粥样硬化的独立危险因子。Ｌｐ(ａ)含载脂蛋白 (ａ)〔ａｐｏ(ａ)〕和ａｐｏＢ ,二者通过二硫键联接。一般人群中血浆Ｌｐ(ａ)浓度波动范围很大 (0～ 10 0 0ｍｇ/Ｌ) ,但就每一个体而言 ,其血浆Ｌｐ(ａ)水平相当稳定 ,不受年龄、性别、饮食、吸烟和酗酒等因素的影响 ,而主要受遗传因素的控制。最近 ,国外研究发现甲状腺激素对Ｌｐ(ａ)代谢有明显影响〔1,2〕。我们纵向观察了 12例患者甲状腺次全切除前后血浆Ｌｐ(ａ)浓度的变化 ,旨在进一步阐明甲状腺激素与血浆Ｌｐ(ａ)浓度的关系。一、对象与方…     

冠心病家族史少年儿童血清脂蛋白（a）的研究

对５４例有冠心病（ＣＨＤ）家族史和１０７例无ＣＨＤ家族史（作对照组）少年儿童检测血清脂蛋白（ａ）［Ｌｐ（ａ）］、载脂蛋白Ａ－Ｉ（ａｐｏＡ－Ｉ）、载脂蛋白Ｂ（ａｐｏＢ）水平及身高、体重五项指标。结果显示：（１）有ＣＨＤ家族史组Ｌｐ（ａ）平均值为１９８．６ｍｇ／Ｌ，对照组则为１３６．０３ｍｇ／Ｌ，两组有差异显著性（Ｐ＜０．０１）；（２）有ＣＨＤ家族史组Ｌｐ（ａ）增高的频率也明显高于对照组；（３）Ｌｐ（ａ）水平与体重无显著相关，与ａｐｏＡ－Ｉ、ａｐｏＢ、年龄和身高也均无相关性。     

Ⅱ型糖尿病血清脂蛋白（a）水平与心脑血管病变的关系

测定９６例Ⅱ型糖尿病的血清Ｌｐ（ａ）,ＴＧ,ＴＣ,ＡｐｏＡ１,ＡｐｏＢ,ＦＢＧ,ＨｂＡ１ｃ的浓度。结果Ｌｐ（ａ）水平与ＡｐｏＡ１呈负相关,与ＴＣ呈正相关,Ｌｐ（ａ）≥３００ｍｇ组脑血管并发症发病率显增加,提示Ｌｐ（ａ）增高是糖尿病心脑血管并发症的危险因素。     

冠心病患者血浆脂蛋白（a）浓度与组织型纤溶酶原激活剂及…

采用酶免法测定４０例不同伴发病的冠心病患者及２０例健康人的血浆脂蛋白（ａ）［Ｌｐ（ａ）］浓度，并以发色底物法测定其中１６例无伴发病的冠心病患者及１６例健康人的血浆组织型纤溶酶原激活剂（ｔ－ＰＡ）及其抑制物（ＰＡＩ－１）活性。结果显示：冠心病伴发糖尿病组平均Ｌｐ（ａ）浓度显著高于正常对照组及冠心病无伴发病组；冠心病患者及健康人血浆Ｌｐ（ａ）浓度与其ｔ－ＰＡ活性无关，而与其ＰＡＩ－１活性呈显著正相关。     

严重充血性心力衰竭患者血清脂蛋白(a)的变化

目的：探讨严重充血性心力衰竭（心衰）时血清脂蛋白（ａ）［Ｌｐ（ａ）］改变及其与细胞因子间的关系。方法：用酶联免疫吸附法测定１３７例心脏疾病患者（无心衰组６５例,严重充血性心衰组７２例）血清Ｌｐ（ａ）、白细胞介素－６（ＩＬ－６）和肿瘤坏死因子－α浓度。结果：严重充血性心衰组患者血清Ｌｐ（ａ）、ＩＬ－６和肿瘤坏死因子－α浓度明显升高（Ｐ均＜０．０１）,偏相关分析（校正总胆固醇、肾功能等混杂因素）显示Ｌｐ（ａ）与ＩＬ－６呈明显正相关（ｒ＝０．７１,Ｐ＜０．００１）,与肿瘤坏死因子－α呈弱相关（ｒ＝０．２９,Ｐ＜０．０１）。结论：结果提示Ｌｐ（ａ）可能作为一种急性时相蛋白参与充血性心衰的病理生理过程,其血清浓度的增高可能与ＩＬ－６刺激肝脏合成Ｌｐ（ａ）增加有关。     

脂蛋白（a）与冠状动脉狭窄程度的关系

１８６例冠状动脉造影者中，冠脉狭窄≥２支或积分≥７分以上者的病变程度越重，其血清脂蛋白（ａ）［Ｌｐ（ａ）］浓度越高，且后者与狭窄积分成正相关（ｒ’ｓ＝０．５００，Ｐ＜０．００１）。Ｌｐ（ａ）增高对冠心病患者诊断具有一定的预测价值：以其对照值的ｘ＋ｓ为上限，预测敏感性４９．２％、特异性８７．１％、准确性６１．８％。     

Outcomes comparing a pancreaticogastrostomy (PG) and a pancreaticojejunostomy (PJ) after a pancreaticoduodenectomy (PD)

BackgroundThe advantage of a pancreaticogastrostomy (PG) over a pancreaticojejunostomy (PJ) after a pancreaticoduodenectomy (PD) is not clear.AimThe aim of the present study was to compare the pancreatic fistula (PF, defined according to the International Study Group for Pancreatic Fistula classification) rate and other complications between both methods.MethodsRetrospective analysis of prospectively collected data of 424 [median: 65 years (17–83)] patients who underwent PG (239, 56.4%) and PJ (185, 43.6%) reconstruction between January 2005 and December 2009.ResultsPF occurred in 55 (23.5%) in the PG and 30 (16.2%, P= 0.067) patients in the PJ group. Grade A PF occurred in 19 (7.9%), B in 22 (9.2%) and C in 14 (5.8%) in the PG compared with 5 (2.7%), 12 (6.5%) and in 13 (7.0%), respectively, in the PJ group. The median hospital was 10 days in both groups. The morbidity was higher in the PG group (108, 45.2 vs. 62, 33.5%, P= 0.015). However, there was no significant difference in the 90-day mortality between both groups (PG-17, 7.0% vs. PJ-16, 8.6%, P= 0.558).ConclusionThere was no difference in the overall PF rate, hospital stay and overall mortality between PG and PJ reconstruction methods. However, the grade A PF rate was higher in the PG group.     

Lipoprotein (a)

The lipids are transported by lipoproteins in the blood system. Lipoprotein (a) [Lp (a)] is a unique lipoprotein of the human plasma discovered by professor Berg in 1963. Lp (a) consists of apolipoprotein (a) and LDL particles (apolipoprotein B100). The level and size of Lp (a) are highly variable and largely determined heredity. Clinical studies on animal models have shown that elevated Lp (a) levels are linked with a higher risk of atherosclerosis, even though not all of the conclusions based on the studies that have been carried are convincing. Concentration over 35 mg/dl is considered to be a risk level. Surprisingly high Lp (a) levels in old age are associated with longevity. This may be explained by the physiological role of Lp (a) in tissue reparation, wound healing and anti-cancer effect.     

A novel (g)gamma(a)gamma(deltabeta)O-thalassemia with a 27 kb deletion

A new (G)gamma(A)gamma(deltabeta)O-thalassemia (thal) was found in six unrelated Japanese individuals, and characterized by a method employing only polymerase chain reaction (PCR) and direct sequencing. This (G)gamma(A)gamma(deltabeta)O-thal mutation has removed a fragment of about 27 kb of DNA, that starts approximately 2.8 kb downstream of the Agamma-globin gene and ends in the L1 repeat sequence, 7.0 kb downstream of the beta-globin gene. The 5' breakpoint is similar to that of the previously reported Japanese (G)gamma(A)gamma(deltabeta)O-thal (called here Jpn type 1 for convenience). However, the 3' endpoint is quite different. This new Japanese deltabeta-thal, designated as Japanese type 2 (Jpn type 2), shows a deletion rather similar to Turkish type 3 deltabeta-thal but with 5' and 3' breakpoints located inside the deletion of Turkish type 3. A mutation-specific gap PCR was designed to diagnose patients with the Jpn type 2 (G)gamma(A)gamma(deltabeta)O-thal. The identified carriers exhibited a thalassemia minor.     

Lipoprotein (a) levels, apolipoprotein (a) phenotypes and thyroid autoimmunity

It has been reported that euthyroid normolipidemic males and postmenopausal females exhibit significantly higher serum lipoprotein (a) (Lp(a)) levels compared with age- and sex-matched normolipidemic controls. However, it is well known that there is an inverse correlation between Lp(a) concentration and apolipoprotein (a) (apo(a)) isoform size. Thus, it is imperative to exclude differences in apo(a) isoform frequencies between subjects with or without thyroid autoimmunity in order to verify if there is an association between thyroid autoimmunity and increased Lp(a) concentration. To exclude such an effect of different apo(a) isoform frequencies, we determined apo(a) phenotypes in 22 patients (9 males and 13 postmenopausal females) with thyroid autoimmunity and in 64 (29 males and 35 females) age- and sex-matched individuals without thyroid autoimmunity (control group). There were no significant differences in the values of lipid parameters between the two groups, including Lp(a). We did not detect any significant differences in the apo(a) phenotype frequencies between the two groups. Additionally, in neither of the subgroups formed according to the presence of low molecular vs high molecular weight apo(a) isoforms were there any significant differences in median serum Lp(a) levels between patients with and without thyroid autoimmunity. Thus, our results contradict the previously reported association between thyroid autoimmunity and Lp(a) concentrations.