LP(a)、oxLDL与脑血管疾病关系的对照研究

测定４９例脑卒中患者血脂蛋白ａ（Ｌｐａ），氧化修饰低脂蛋白（ｏｘＬＤＬ）的含量变化，并以２０例健康个体为对照。结果显示：短暂性脑缺血（ＴＩＡ）脑血栓形成及脑出血患者血中ＬＰ（ａ）、ｏｘＬＤＬ的测定值与对照组比较明显升高，差异有显著性（Ｐ〈０．０１）。提示ＬＰ（ａ）、ｏｘＬＤＬ的异常与脑卒中发生有关。     

脑卒中与8项血脂项目的关系探讨

测定了２５０例脑卒中（脑梗塞１２５例，脑出血１２５例）病人和４０例健康对照者血总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白（ＨＤＬ）、低密度脂蛋白（ＬＤＬ）、载脂蛋白Ａ—Ｉ，Ｂ（ＡｐｏＡ—Ｉ、ＡｐｏＢ）、脂蛋白（ａ）［ＬＰ（ａ）和氧化修饰低密度脂蛋白（ｏｘＬＤＬ）浓度。结果显示：与对照组比较，脑卒中病人ｏｘＬＤＬ升高（ｐ＜０．０１），ＨＤＬ降低（ｐ＜０．０１），脑梗塞和脑出血ＴＧ、ＬＤＬ、ＡｐｏＡ－Ｉ、ＡｐｏＢ、ＬＰａ的异常存在着差异。提示：脑卒中病人存在着脂代谢异常，但脑梗塞与脑出血脂代谢异常不完全相同，ＬＰａ是反映脑梗塞脂代谢异常的突出指标，而ＨＤＬ和ｏｘＬＤＬ为两者共有的异常指标。     

氧化修饰低密度脂蛋白与脑卒中

采用酶联免疫吸附试验（ＥＬＩＳＡ）测定脑卒中８４例和对照组４０例血浆氧化修饰低密度脂蛋白（ｏｘＬＤＬ）浓度。结果表明：脑梗塞和脑出血分组也都高于正常对照组，脑硬塞与脑出血分组也都高于正常对照组，脑梗塞和脑出血分组间、脑卒中急性期与恢复期及性别之间均无明显差异，提示血浆ｏｘＬＤＬ浓度升高与脑卒中发病密切相关，并可作为估价脑卒中危险因素的重要指标之一。     

HbAlc及oxLDL与糖尿病微血管病变的关系

目的：研究分析氧化修饰低密度脂蛋白（ｏｘＬＤＬ）对糖尿病微血管并发生的影响。方法：测定５６例２型糖尿病患者（其中有微血管病变者３６例,无微血管病变者２０例）及４０例正常健康人的ｏｘＬＤＬ及ＨｂＡｌｃ水平,并对两组间各指标进行ｔ检验。结果：糖尿病组ｏｘＬＤＬ及ＨｂＡｌｃ高于正常对照组（分别ｐ〈０．０５）;无微血管病变组ｏｘＬＤＬ及ＨｂＡｌｃ显著高于对照组（分别ｐ〈０．０５）。有微血管病变组ｏｘＬＤＬ     

非胰岛素依赖型糖尿病血清脂蛋白（a）检测的临床意义

为探讨在非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人检测血清脂蛋白（ａ）（Ｌｐ（ａ）的临床意义，研究５２例ＮＩＤＤＭ病人和３０例正常人的Ｌｐ（ａ），空腹血糖，分别Ｌｐ（ａ）水平与有或无合并症ＮＩＤＤＭ的关系，检测了８０例对照为正常人，可疑糖尿病，确诊ＮＩＤＤＭ的空腹血糖（ＦＰＧ），观察不同水平的空腹血糖与相对应的Ｌｐ（ａ）关系，结果显示：（１）有合并症的ＭＩＤＤＭ组，无合并症的ＮＩＤＤＭ组和正常对照组Ｌ     

血清脂蛋白（a）水平及其对低密度脂蛋白测定值的影响

为了解国人血清脂蛋白（ａ）分布情况，调查了１０３２名５０岁以上干部的血清脂蛋白（ａ）［Ｌｐ（ａ）］水平，着重观察Ｌｐ（ａ）对低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）测定值的影响。由于目前所用ＬＤＬ－Ｃ测定法的结果都包含Ｌｐ（ａ）胆固醇［Ｌｐ（ａ）－Ｃ］在内，故以测定值减去０．３Ｌｐ（ａ）作为ＬＤＬ－Ｃ校正值。本组Ｌｐ（ａ）的平均值为１７４ｍｇ／Ｌ，中位数１０５ｍｇ／Ｌ，，实测范围１０～１２００ｍｇ／Ｌ，呈明显正偏态分布。Ｌｐ（ａ）－Ｃ平均占ＬＤＬ－Ｃ实测值的４．３３％，校正后ＬＤＬ－Ｃ平均下降０．１３ｍｍｏｌ／Ｌ，Ｌｐ（ａ）＞３００ｍｇ／Ｌ时半数标本Ｌｐ（ａ）－Ｃ占ＬＤＬ－Ｃ的１０％以上，在ＬＤＬ－Ｃ较低而Ｌｐ（ａ）较高时对ＬＤＬ－Ｃ的影响更大，此时Ｌｐ（ａ）－Ｃ可占ＬＤＬ－Ｃ的２０％～３０％。单因素相关分析示Ｌｐ（ａ）与校正后ＬＤＬ－Ｃ之间无明显相关，因为两者都是冠心病的重要危险因素，比较这两项指标对评价冠心病危险的贡献大小时，最好对ＬＤＬ－Ｃ值进行校正。     

血清脂蛋白（a）水平及其对低密度脂蛋白测定值的影响

为了解国人血清脂蛋白（ａ）分布情况，调查了１０３２名５０岁以上干部的血清脂蛋白（ａ）（Ｌｐ（ａ））水平，着重观察Ｌｐ（ａ）对低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）测定值的影响，由于目前所用ＬＤＬ－Ｃ测定法的结果都包含Ｌｐ（ａ）胆固醇（Ｌｐ（ａ）－Ｃ）在内，以测定值减去０．３Ｌｐ（ａ）作为ＬＤＬ－Ｃ校正值。本组Ｌｐ（ａ）的平均值为１７４ｍｇ／Ｌ中位数１０５ｍｇ／Ｌ，实测范围１０～１２００ｍｇ／Ｌ，呈明显正     

脂蛋白（a）的代谢

脂蛋白（ａ）「Ｌｐ（ａ）」是一种特殊的血浆脂蛋白，有高度致动脉粥样硬化（ＡＳ）作用。了解Ｌｐ（ａ）的代谢对阐明高度致ＡＳ的机理有重要意义。肝脏是Ｌｐ（ａ）的主要合成场所，Ａｐｏ（ａ）以游离的形式被分泌出肝脏，在肝细胞外与ＬＤＬ结合，完成Ｌｐ（ａ）的装配。Ｌｐ（ａ）的分解代谢途径目前主要有三种观点：（１）Ｌｐ（ａ）主要通过ａｐｏＢ１００介导的ＬＤＬ受体代谢；（２）ＬＤＬ受体不足Ｌｐ（ａ）体内代谢的唯     

Lp（a）临床研究中的问题

Ｌｐ（ａ）是 １种致动脉粥样硬化的合大量胆固醇酯脂蛋白，生理功能未明。它有特别的种系分布，它的ａｐｏ（ａ）成分及其多态性，成为生化学、遗传学、代谢和致动脉粥样硬化研究中的难题。１脂蛋白（ａ）的转归 Ｌｐ（ａ）通过什么机制被清除出血液？所知甚少。人体的ＬＤＬ受体在清除完整Ｌｐ（ａ）中似起较小作用（若有作用的话）。约１０％－２５％血浆Ｌｐ（ａ）变为ＬＤＬ，后者经ＬＤＬ受体清除（Ｒａｄｅｒ ＤＪ ｅｔ ａｌ： Ｔｈｅ ＬＤＬ ｒｅｃｅｐ－ｔｏｒ Ｉｓ ｎｏｔ ｒｅｑｕｉｒｅｄ ｆｏｒ　ｎｏｒｍａｌ ｃａｔａｂｏｌ…     

心肌梗塞和脑梗塞脂蛋白(a)、血小板、蛋白激酶C变化

目的研究脂蛋白（ａ）［Ｌｐ（ａ）］、血小板（ＰＬＴ）及其蛋白激酶Ｃ（ＰＫＣ）在血栓性疾病中的变化及其作用。方法心肌梗塞、脑梗塞和健康对照组各２４例，分别检测血清Ｌｐ（ａ）、总胆固醇（ＴＣ）、高密度脂蛋白胆固醇（ＨＤＬＣ）、低密度脂蛋白胆固醇（ＬＤＬＣ）、甘油三酯（ＴＧ）、载脂蛋白ＡＩ（ａｐｏＡＩ）、载脂蛋白Ｂ（ａｐｏＢ）、血小板（ＰＬＴ）及其膜和浆蛋白激酶Ｃ（ＭＰＫＣ和ＰＰＫＣ），对检测结果做统计学分析。结果心梗组和脑梗组Ｌｐ（ａ）、ＴＧ、ａｐｏＢ均明显增高，ＨＤＬＣ则明显降低，与健康对照组的差异有非常显著性或显著性意义；ＰＬＴ计数和ＭＰＫＣ活性增高、ＰＰＫＣ活性减低，与健康对照组相比，在心梗组呈差异有非常显著（Ｐ＜００１），在脑梗塞组差异有意义（Ｐ＜００５）。结论心肌梗塞和脑梗塞时除ＴＧ和ａｐｏＢ增高，ＨＤＬＣ减低外，Ｌｐ（ａ）、ＰＬＴ及ＭＰＫＣ增高（ＰＰＫＣ减低），在血栓早（前）期起重要作用，对心梗和脑梗的发病起促进作用     

脑供血不足患者脂蛋白(a)变化(附33例分析)

目的观察33例经TCD证实的脑供血不足患者血清脂蛋白(a)[Lp(a)]浓度变化.方法采用ELISA双抗体夹心法检测患者组和正常对照组血清Lp(a)浓度.结果患者组血清LP(8)浓度显著高于正常对照组(P＜0.05),在性别间差异并无显著性.结论血清Lp(a)浓度与动脉粥样硬化所致缺血性脑血管疾病密切相关.     

脂蛋白(a)与年轻人脑梗死的关系

背景一些流行病学和动物试验显示高脂蛋白(a)与动脉硬化和脑梗死相关,但是高脂蛋白(a)是否为年轻人脑梗死潜在的危险因素一直存在争议.目的调查脂蛋白(a)与年轻人脑梗死的关系.设计非随机对照的实验研究.地点和对象1995-01/2001-07湘雅医院神经内科住院的16～45岁的脑梗死患者.方法对年龄低于45岁的脑梗死患者及性别年龄匹配的对照组进行血清脂蛋白(a)和其他血脂成分的测定,询问其他可能的危险因素.主要观察指标血清脂蛋白(a)和其他血脂成分及其他可能的危险因素.结果脑卒中患者和对照组血清脂蛋白(a)水平差异未见显著性,脑卒中患者的三酰甘油显著高于对照组(P＜0.001),高脂蛋白(a)的OR值为1.547(95%CI 0.601～3.982),而高三酰甘油血症和高血压的OR值分别为2.597(95%CI 1.149～5.381)和4.639(95%CI1.949～11.040).结论脂蛋白(a)可能不是年轻人脑梗死的危险因素,高三酰甘油血症和高血压则是重要的危险因素.     

不同年龄脑梗死与血脂水平的相关性研究

AIM: To investigate the relationship between the patients with cerebral infarction(CI) in different ages and blood lipid levels.METHODS:The serum concentration of blood lipid levels were measured in 211 patients with CI and 144 control cases.RESULTS: The level of lipoprotein(a)[Lp(a)] in the young adults with CI and the levels of triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL C), apolipoproteinB100(ApoB100) and Lp(a) in the subgroup of mid adults with CI were much higher than corresponding controls. The levels of TC, LDL C ApoB100 and Lp(a) in the subgroup of olds were significantly higher when compared with the corresponding controls, while the high density lipoprotein cholesterol(HDL C) level was lower. Multiple linear regression showed that age had positive correlation to TC and ApoB100 and negative correlation to HDL C. CONCLUSION: There are different disturbances of blood lipid metabolism in the patients with CI in different ages.The serum Lp(a) levels may be an independent risk factor for CI.     

骨创伤患者血清脂蛋白（a）的变化及临床意义探讨

目的探讨骨创伤患者血清脂蛋白（a）[Lp（a）]的变化及临床意义。方法用免疫比浊法动态检测骨创伤患者（受伤24 h、72 h、1周、1个月）的血清Lp（a）水平,并与健康对照组和疾病对照组的血清Lp（a）水平作比较,观察骨创伤患者的血清Lp（a）的动态变化。结果12.5%的正常人血清Lp（a）水平超过300 mg/L,中位数（范围）为95.5（30.3-435.9）mg/L。受伤24 h、72 h、1周、1个月时采集静脉血,分别有33.3%、35.7%、38.1%、16.6%骨创伤患者的血清Lp（a）水平超过300 mg/L,中位数（范围）分别为145.5（36.3-1 260.8）、203.4（42.1-1 119.8）、164.9（39.0-1 007.6）、103.9（32.1-596.4）mg/L,受伤24 h、72 h、1周时骨创伤患者的血清Lp（a）水平明显高于对照组（P〈0.05）,1个月后骨创伤患者的血清Lp（a）水平基本恢复正常,与健康对照组比较无明显差异（P〉0.05）;疾病对照组中,术前有10%的患者血清Lp（a）水平超过300 mg/L,中位数（范围）为97.9（22.4-436.4）mg/L,术后24 h、72 h、1周、1个月时采集静脉血,分别有20%、30%、20%、15%手术患者的血清Lp（a）水平超过300 mg/L,中位数（范围）分别为142.9（26.9-800.1）、172.0（50.6-890.8）、143.9（39.8-808.1）、110.6（29.6-600.4）mg/L;疾病对照组与健康对照组相比,术后72 h的血清Lp（a）水平明显高于健康对照组（P〈0.05）,疾病对照组术后其余时段的血清Lp（a）水平与健康对照组比较无明显差异（P〉0.05）;疾病对照组术后与骨创伤组相同时段的血清Lp（a）水平比较无明显差异（P〉0.05）,但是疾病对照组术后的血清Lp（a）水平峰值低于骨创伤组。结论创伤患者的血清Lp（a）水平明显升高,约1个月后基本恢复正常,骨创伤患者的血清Lp（a）峰值高于疾病对照组术后的血清Lp（a）峰值。     

类风湿关节炎患者天然、氧化脂蛋白（a）水平

目的分析类风湿关节炎(RA)患者天然、氧化脂蛋白(a)[Lp(a)]水平及其与炎症的关系,探讨Lp(a)在RA患者心血管病发生中的意义。方法选择RA患者56例,其中活动性24例,非活动性32例;正常对照60例。对受检者天然、氧化Lp(a)水平以及炎症指标进行检测。结果活动性RA患者天然、氧化Lp(a)水平均高于非活动性RA患者和对照组,而非活动组和对照组间无变化。血沉和C反应蛋白均分别与天然、氧化Lp(a)呈正相关。结论RA患者天然、氧化Lp(a)水平发生显著变化,炎症反应对Lp(a)代谢具调节作用,参与动脉粥样硬化的发生、发展。     

Atherogenic forms of dyslipidaemia in women with polycystic ovary syndrome

Objective: Dyslipidaemia is very common in patients with polycystic ovary syndrome (PCOS) but, beyond plasma lipids, atherogenic lipoprotein (Lp) and apolipoprotein (apo) alterations are still ill defined. Design: We measured concentrations of apoB, Lp(a) and small, dense low‐density lipoprotein (LDL) in 42 patients with PCOS [age: 28 ± 7 years, body mass index (BMI): 27 ± 5 kg/m²] vs. 37 age‐ and BMI‐matched healthy controls. Methods: Elevated Lp(a) levels considered were those > 30 mg/dl while elevated apoB concentrations were those > 100 g/l. Results: Polycystic ovary syndrome showed increased triglycerides levels (p = 0.0011) and lower high‐density lipoprotein (HDL)‐cholesterol concentrations (p = 0.0131) while total‐ and LDL cholesterol were similar. PCOS also showed smaller LDL size (p = 0.0005), higher levels of total small, dense LDL (p < 0.0001), higher concentrations of Lp(a), as considered as absolute values (p = 0.0143) and log‐transformed (p = 0.0014), while no differences were found in apoB levels. Elevated Lp(a) concentrations were found in 24% of PCOS, while elevated apoB levels were relatively uncommon (14%). Spearman correlation analysis revealed that Lp(a) concentrations were weakly correlated only with HDL‐cholesterol levels (r = ?0.378, p = 0.0431). In addition, 36% of patients with PCOS with normal plasma lipid profile showed elevated levels of Lp(a), apoB or small, dense LDL. Conclusions: Atherogenic Lp abnormalities may be found in one‐third of women with PCOS who have a normal lipid pattern. Future prospective studies are needed to test to which extent such atherogenic forms of dyslipidaemia may contribute to the increased cardiovascular risk in young women with PCOS.     

Correlation research between the patients with cerebral infaction in different ages and blood lipid levels

INTRODUCTIONInthepaper,wehopetoinvestigatetherelationshipbetweencerebralinfarctionindifferentagesandbloodlipidlevelsbythedeterminationsandcomparisonsofbloodlipidlevelsatthepatientswithcerebralin-farctionindifferentages.MATERIALSANDMETHODSMaterialsAccordingtothecriteriainstitutedbytheFourthNationalMeetingofCerebralVesselDisease,211patients(agedfrom19to80,mean58±13,124maleand87female)withcerebralinfarction(CI)inourhospitalfromJanuary1998toJuly2000wereselect-ed.Allcasesweredeterm…     

Apolipoprotein(a) gene polymorphisms (TTTTA)n and G/A-914 affect Lp(a) levels in ischemic heart disease patients from Serbia

OBJECTIVES: Lipoprotein(a) (Lp(a)) concentration is determined primarily by the apolipoprotein(a) (apo(a)) gene. The pentanucleotide (TTTTA)n repeat and G/A-914 polymorphisms are in the 5' promoter region of the apo(a) gene. To elucidate whether these polymorphisms affect Lp(a) levels, a total of 211 Serbian adults were investigated. DESIGN: One hundred and eleven patients with ischemic heart disease and 100 healthy controls were genotyped and Lp(a) levels determined. RESULTS: Lp(a) concentrations differed according to the (TTTTA)n genotypes: among those having at least one allele 8, patients had significantly higher Lp(a) values than controls. A decreasing trend of Lp(a) values was associated with the -914A allele in controls but the opposite was true in patients. Patients with genotype TTTTA allele 8/AA-914 had significantly higher Lp(a) values than those without allele 8/AA (p < 0.05). The >8>8/GG genotype was not detected. Significant linkage disequilibrium between (TTTTA)n and G/A-914 polymorphism (p < 0.001) was found. In multivariate regression analysis, the G/A-914 polymorphism significantly (p < 0.05) affected Lp(a) levels in patients, after taking into account the (TTTTA)n polymorphism. CONCLUSION: These results indicate that (TTTTA)n and G/A-914 polymorphisms affect Lp(a) levels in ischemic heart disease as a consequence of the linkage disequlibrium.     

高血压性脑出血急性期血浆D-二聚体、纤维蛋白原的变化及意义

目的探讨高血压性脑出血(hypertensive cerebral hemorrhage,HICH)患者急性期血浆D-二聚体(D-dimer)、纤维蛋白原(fibrinogen,FIB)的动态变化及临床意义。方法采用磁珠法对60例高血压性脑出血患者血浆D-二聚体、FIB水平进行检测,并与40例健康人进行比较。结果高血压性脑出血患者发病后24小时及第3天,血浆D-二聚体水平显著升高,第3、7天纤维蛋白原水平显著升高,与正常对照组比较均有显著性差异(P<0·05)。预后不佳组血浆D-D水平明显升高,与预后佳组比较有显著性差异(P<0·01)。而且预后不佳组均为血肿破入脑室或蛛网膜下腔者。结论高血压性脑出血患者急性期血浆D-二聚体水平明显升高,提示在发病早期可能存在暂时性的、纤溶活性增高的倾向。血浆D-D水平的高低与出血部位、病人的预后有关。     

Correlation of lipoprotein(a) levels and myocardial stress thallium scintigraphy pattern in different entities of CHD severity

BACKGROUND: Higher levels of lipoprotein(a) confer an increased risk for coronary heart disease (CHD). Apo-E genotype (APO-E) also plays a role, the APO-E epsilon 4 allele being associated with CHD. Furthermore, higher Lp(a) concentrations are correlated with APO-E epsilon 4 allele presence. The study was performed to investigate the relationship of Lp(a) and APO-E with the functional status of coronary arteries as evaluated by myocardial scintigraphy. PATIENTS AND METHODS: We studied 70 patients (27 F and 43 M; mean age: 55 +/- 6 yrs.) consecutively referred for CHD, and 50 normal sex and age-matched controls. Total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apo-AI, apo-B, Lp(a) levels (ELISA), Lp(a) isoforms (Immuno Blotting) and APO-E (PCR) were measured in all subjects. Only CHD patients underwent a myocardial tomographic stress thallium scintigraphy (201Tl-SPECT); the SPECT pattern was classified as follows: no perfusion defects (unstable angina group = 1), reversible defects at stress images (ischemia group = 2), fixed defects (infarction group = 3). RESULTS: Lp(a) medians were significantly higher than controls in group 1 (p < 0.05), 2 (p < 0.001) and 3 (p = 0.00). Low molecular weight isoforms (B, S1, S2) were significantly more frequent in all CHD-patients vs. controls (p < 0.05), whereas APO-E genotypes did not differ among controls and patients. Multiple regression analysis showed family history (p < 0.001) to be the only independent predictive variable of CHD severity correlated to the scintigraphic pattern. CONCLUSION: Among the considered biological parameters in our patients only Lp(a) plasma levels are related to the entity of ischemic cardiac wall damage as evaluated by 201Tl-SPECT.