调脂治疗对冠心病患者餐后血管内皮功能的影响

目的　旨在通过高脂餐试验 ,研究调脂治疗对冠心病患者餐后血管内皮功能变化的影响。方法　 5 0例来源于我院心血管内科门诊和住院的冠心病患者。经饮食宣教 4周后 ,开始高脂餐试验和采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒张功能 (FMD)。随后将受试者随机分为常规治疗组和血脂康组。治疗 6周后重复上述检查。结果　治疗前两组高脂餐后 4h的FMD明显受损 (P <0 0 5 ) ,餐后血清甘油三酯 (TG)浓度明显升高 (P <0 0 5 ) ,两组间餐后甘油三酯曲线下面积 (TG AUC)差异无显著性。 6周后血脂康组餐前和餐后FMD有明显改善 (P <0 0 5 ) ,且空腹FMD和餐后FMD差异无显著性 ,而常规治疗组空腹FMD和餐后FMD较治疗前无明显变化 ,餐后FMD仍显著受损 (P <0 0 5 )。相关分析显示餐后TG AUC与餐后 4h内皮依赖性血管舒张功能下降值正相关 (r=0 32 2 ,P <0 0 5 )。治疗后TG AUC的变化与空腹和餐后FMD的变化显著相关 (P <0 0 1)。结论　高脂餐后冠心病患者血管内皮功能受损 ,可能与餐后血脂紊乱有关。提示血脂康调脂治疗有效改善冠心病患者空腹和高脂餐后血管内皮功能。     

低密度脂蛋白胆固醇/高密度脂蛋白胆固醇及甘油三酯/高密度脂蛋白胆固醇比值与冠心病关系的探讨

目的 :探讨低密度脂蛋白胆固醇 (LDL C) /高密度脂蛋白胆固醇 (HDL C)及甘油三酯 /HDL C比值与冠心病的关系。　　方法 :检测 3 42例经冠状动脉造影确诊的冠心病患者 (冠心病组 )和 2 0 2例冠状动脉造影正常者 (对照组 )的血脂中总胆固醇、甘油三酯、LDL C及HDL C含量 ,计算LDL C /HDL C及甘油三酯 /HDL C的比值。　　结果 :与对照组相比 ,冠心病患者的总胆固醇、LDL C及LDL C/HDL C比值明显增高 ,HDL C显著降低 ,有显著性差异 (P <0 0 5～ 0 0 0 1) ,而甘油三酯及甘油三酯 /HDL C比值两组间无显著差别。多元回归分析显示 ,冠心病的危险性与LDL C/HDL C比值呈正比 ,与甘油三酯及甘油三酯 /HDL C比值无显著相关。　　结论 :LDL C/HDL C比值对冠心病有一定的预测价值 ,而甘油三酯 /HDL C比值的预测价值尚待研究。     

老年冠心病患者餐后高甘油三酯血症与颈动脉及股动脉粥样硬化的关系

探讨餐后血脂代谢异常与动脉粥样硬化的关系。47例冠心病患者及30例对照组禁食12－14h后，均接受低脂实验餐负荷试验。分别于空腹及餐后4h采血测定血清甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A及载脂蛋白B的浓度。利用二维彩色多普勒超声，检测两组颈动脉内膜中层厚度及颈动脉、股动脉斑块的发生状况。与对照组相比，冠心病组空腹血清总胆固醇、载脂蛋白B浓度显著增高，冠心病组餐后4h血清甘油三酯、低密度脂蛋白胆固醇浓度显著增高（P＜0．05），餐后血清高密度脂蛋白胆固醇浓度显著降低（P＜0．05）。冠心病组颈总动脉内膜中层厚度、颈内动脉内膜中层厚度、颈动脉及股动脉斑块指数均较对照组增高（P＜0．01）。餐后血清甘油三酯与空腹血清甘油三酯浓度呈正相关。颈动脉斑块指数与空腹总胆固醇呈正相关。提示餐后高甘油三酯血症可能与动脉粥样硬化有关。     

血脂康降脂作用与血清一氧化氮关系的研究

目的 :探讨血脂康降脂治疗及预防冠心病的机制。方法 :测定 38例高胆固醇血症患者在服药前及服药后第 4、8周与 2 0例正常对照者的血脂及血清一氧化氮 (NO)水平。结果 :①治疗前高胆固醇组与对照组相比 ,血清总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C)明显升高 ,NO明显降低。②血脂康治疗 4周后 ,血清TC、LDL C明显下降 ,NO无改变 ,至第 8周 ,血清NO显著上升。③治疗后LDL C下降值与NO上升值呈负相关 (r=- 0 .6 9,P <0 .0 5 )。结论 :血脂康除有效降脂外 ,还能提高血清NO水平 ;血清NO水平随LDL C降低而上升 ,可能是降脂治疗及预防冠心病发生的重要机制之一     

阿托伐他汀对高脂血症患者颈动脉内膜中层厚度及凝血系统的影响

目的　观察阿托伐他汀调脂同时对高脂血症患者颈动脉内膜中层厚度 (IMT)及凝血系统的影响。方法　选择高脂血症患者 35例为血脂紊乱组 ,口服阿托伐他汀 10mg·qd ,12周 ,血脂正常者 35例为正常对照组 ,分别对血脂紊乱组治疗前及 12周后两组进行血脂总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)、IMT、纤维蛋白原 (FIB)、凝血酶时间 (TT)、活化部分凝血酶时间 (APTT)、凝血酶原时间 (PT)检查。结果　与治疗前比较 ,血脂紊乱组治疗 12周后的TC、TG、LDL C、FIB均有显著降低 (P均 <0 0 1) ,HDL -C显著升高 (P <0 0 5 ) ,颈动脉IMT显著变薄 (P <0 0 5 ) ,TT、APTT均有显著延长 (P均 <0 0 1)。PT显著升高 (P <0 0 5 )。TC、TG、LDL C、HDL C、IMT、FIB、PT均接近血脂正常组各指标 ,比较无显著差异 (P >0 0 5 )。TT、APTT均超出血脂正常组 ,比较有显著差异 (P <0 0 5 )。结论　阿托伐他汀在有效调脂同时可发挥其非调脂作用 ,逆转或延迟颈动脉IMT的进程 ,并改善凝血系统。     

血脂康对高脂血症患者低密度脂蛋白颗粒和氧化型低密度脂蛋白的影响

目的探讨血脂康对高脂血症患者低密度脂蛋白(LDL)颗粒和氧化型低密度脂蛋白(ox-LDL)的影响。方法连续入选未服用降脂药物治疗的受试人群40例(其中高脂血症患者20例,健康受试者20例),分为血脂康组(n=20例)和对照组(n=20例)。Lipoprint脂蛋白分类检测仪对LDL颗粒进行分类。治疗8周后比较两组治疗前后LDL颗粒和ox-LDL的变化。结果与治疗前相比,治疗后血脂康组的血清低密度脂蛋白胆固醇(LDLC)、总胆固醇(TC)、甘油三酯(TG)和载脂蛋白B的浓度显著降低(P0. 05),小颗粒LDLC的浓度和小颗粒LDL的百分比均降低(P0. 05)。经血脂康治疗后,ox-LDL的浓度显著降低(P0. 05)。结论血脂康治疗8周可显著改善高脂血症患者的血脂谱,并降低致动脉粥样硬化性小颗粒LDLC浓度和百分比,同时减少氧化应激反应。     

心血管事件高危患者餐后C反应蛋白质量浓度变化及辛伐他汀干预结果分析

目的 研究心血管事件高危患者高脂餐后血浆C反应蛋白(CRP)质量浓度的变化,探讨极短期辛伐他汀对血浆CRP质量浓度的影响。 方法 对肇庆市端州区人民医院于2003-10～2004-06 70例冠心病及其高危症患者随机分为辛伐他汀组(36例)和常规治疗组(34例),分别在常规治疗的基础上加服辛伐他汀(20mg/d)和安慰剂。治疗前和1周后接受高脂餐负荷试验,检测空腹和餐后4 h血浆CRP质量浓度和血脂水平。 结果 两组患者的餐后血浆甘油三酯和CRP质量浓度较空腹水平明显升高(P<0.05)。1周后常规治疗组的空腹和餐后血浆CRP质量浓度和血脂水平无显著     

急性白血病患者动态检测血脂变化的临床意义

目的　探讨急性白血病 (AL)患者血脂变化的临床意义。方法　用酶学法动态检测 6 8例AL患者化疗前、完全缓解期的空腹晨血血清总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)、甘油三酯 (TG)、载脂蛋白A1(apoA1)和载脂蛋白B(apoB)。结果　化疗前组TC、LDL C、HDL C、APOA1、APOB比对照组和完全缓解组明显降低 (P <0 0 5 ) ,而TG则比对照组和完全缓解组明显升高 (P <0 0 5 )。完全缓解组 6项指标与对照组相比无差异、若复发则再次出现上述改变。急性淋巴细胞白血病 (ALL)与急性非淋巴细胞白血病(ANLL)血脂水平无差别。外周血白细胞≥ 2 0× 10 9/L组较 <2 0× 10 9/L组血脂改变更显著。结论　动态监测AL的血脂水平有助于判断其疗效和预后。     

载脂蛋白E基因多态性对冠心病患者餐后甘油三酯代谢的影响

目的　探讨载脂蛋白 (Apo)E基因多态性对冠心病患者高脂餐后甘油三酯 (TG)代谢的影响。方法　 82例冠心病患者禁食 12h后接受高脂餐负荷试验。测定空腹和餐后 2、4、5、7h血清TG浓度。采用聚合酶链反应 (PCR)检测ApoE基因型。结果　 82例冠心病患者餐后 2、4、5、7h血清TG水平显著升高 (P <0 0 5 )。相关分析表明 :空腹TG水平与TG曲线下面积 (TG AUC)显著正相关 (r=0 4 36 ,P <0 0 5 )。ApoE 3/3(n =36 )、ApoE 3/4(n =2 5 )和ApoE2 /3(n =2 1)基因型患者的空腹血清TG水平差异无显著性。ε2和ε4携带者餐后血清TG水平以及TG AUC显著高于ε3/ε3携带者。结论　ApoE基因多态性影响冠心病患者餐后甘油三酯代谢。ε2和ε4等位基因与餐后富含甘油三酯脂蛋白代谢异常有关。     

2型糖尿病患者脂代谢紊乱与冠心病关系的探讨

目的　探讨 2型糖尿病患者脂代谢紊乱与冠心病的关系。方法　对 66例 2型糖尿病患者 (其中经冠脉造影确诊为冠心病者 45例 ,非冠心病者 2 1例 )进行全套血脂指标的测定并与对照组进行比较、分析。结果　与对照组相比 ,2型糖尿病并发冠心病患者高密度脂蛋白胆固醇(HDL C)水平降低 (P <0 .0 1) ,总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)及载脂蛋白B(ApoB)水平升高 (P <0 .0 5～ 0 .0 1) ,单纯 2型糖尿病患者TG、LDL C水平升高 ,HDL C水平降低 (P <0 .0 5～ 0 .0 1)。结论　HDL C水平的降低、TG、LDL C及ApoB水平的升高是 2型糖尿病并发冠心病的重要危险因素。尽早进行合理、有效的调脂治疗     

Effect of xuezhikang,a cholestin extract,on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease

The effect of xuezhikang on postprandial triglyceride (TG) level was investigated in patients with coronary heart disease (CHD) after a high-fat meal (800 cal; 50 g fat). Fifty CHD patients were randomly divided into two groups to accept xuezhikang (xuezhikang group) 1200 mg/day (600 mg twice daily) or not (control group) on the base of routine therapy which included aspirin, metoprolol and fosinopril and nitrates during the whole 6 weeks following-up. Xuezhikang significantly reduced fasting serum total cholesterol (TC) (-20%), low-density lipoprotein cholesterol (LDL-C, -34%), TG (-32%) and apoB (-27%) levels, and raised fasting high-density lipoprotein cholesterol (HDL-C, 18%) and apoA-I (13%) levels (P<0.001). The postprandial serum TG levels at 2, 4 and 6 h decreased 32, 38 and 43%, respectively, in xuezhikang group (P<0.001). The TG area under the curve over the fasting TG level (TG-AUC) significantly decreased in CHD patients accepted xuezhikang with normal (less than 1.7 mmol/l) and elevated (1.74 to 2.92 mmol/l) fasting TG levels by 45 and 50%, respectively (P<0.001). Routine therapy had no significant effect on the fasting and postprandial lipid and apolipoprotein levels. The change of TG-AUC was significantly related to the changes of fasting TG, TC, LDL-C, and HDL-C levels after the treatment, which were related to the changes of fasting apoA-I and apoB levels significantly (P<0.001). Xuezhikang was shown to be beneficial in the treatment of reflecting postprandial triglyceridemia in CHD patients with normal and mildly elevated fasting TG levels.     

冠心病患者摄入不同量脂肪餐后血脂水平的变化 及其对血管内皮功能的影响

目的探讨冠心病患者餐后血脂代谢情况及其对血管内皮功能的影响。 方法将40例血清总胆固醇(TC)水平不高的冠心病患者随机分为两组,禁食12小时后,分别接受高脂肪餐饮食(高脂餐组,n=20)和低脂肪餐饮食(低脂餐组,n=20)。于空腹、餐后2、4、5、7小时测定血清TC、血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),并同时于空腹状态及餐后4小时测定内皮依赖性及非依赖性血管舒张功能。 结果高脂餐组,餐后血清TG水平显著升高,TC、LDL-C、HDL-C无明显改变,内皮依赖性血管舒张功能由空腹状态的(3.38±2.34)%降至餐后4小时的(1.27±2.31)%,差异有非常显著意义(P＜0.01),内皮非依赖性血管舒张功能无明显改变,餐后4小时内皮依赖性血管舒张功能的受损程度与餐后2小时血清TG升高值呈显著性正相关(r=0.599,P＜0.01);低脂餐组餐后血脂水平、内皮依赖性及非依赖性血管舒张功能无明显改变。 结论冠心病患者进食高脂餐后内皮依赖性血管舒张功能明显受损,且与餐后血清TG的升高程度密切相关。     

Vitamin C preserves endothelial function in patients with coronary heart disease after a high-fat meal

BACKGROUND: It has been suggested that an oxidative mechanism is involved with the impaired endothelium-dependent vasodilatation that occurs after a high-fat meal. Hypothesis: The study was undertaken to evaluate the effect of a single oral dose of vitamin C (2 g) on postprandially impaired endothelium-dependent vasodilatation in patients with coronary heart disease (CHD). METHODS: This study included 74 patients with CHD and 50 subjects without CHD with risk factors. The two groups were divided into two subgroups that did or did not receive 2 g of vitamin C (CHD/VitC and CHD/control, n = 37; non-CHD/VitC and non-CHD/control, n = 25) after a high-fat meal (800 calories, 50 g fat). Serum levels of triglyceride, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in the fasting state and at 2, 4, 5, and 7 h after the high-fat meal were measured. Endothelial function was assessed in the brachial artery by high-resolution ultrasound at baseline and at 4 h postprandially. RESULTS: The postprandial serum triglyceride concentration increased significantly at 2-5 h after the high-fat meal in all groups. The fasting flow-mediated dilatation (FMD) (p < 0.02) and nitroglycerin-induced dilatation (NID) (p < 0.05) of patients with CHD were impaired compared with those of non-CHD subjects. Postprandial FMD was significantly aggravated in the non-CHD/control group (p < 0.01) and the CHD/control group (p < 0.001), but the postprandial FMD in patients and subjects taking vitamin C showed no significant change, although the CHD/VitC group had a mild tendency toward improvement (p = 0.064) and non-CHD/VitC group had a mild tendency toward aggravation (p = 0.852). The change of NID after a high-fat meal did not reach statistical significance in the four groups. The decrement of postprandial FMD correlated positively with the increment of 2-h serum triglyceride concentration in the patients without vitamin C (n = 62, r = 0.545, p < 0.001). CONCLUSIONS: The postprandial state after a high-fat meal is critical in atherogenesis, as it induces endothelial dysfunction through an oxidative stress mechanism. Vitamin C treatment has a promising benefit for patients with CHD.     

维生素C对高脂餐后内皮依赖性血管舒张功能的保护作用

目的探讨维生素C对高脂餐后内皮依赖性血管舒张功能变化的影响。方法74例冠心病患者被随机分为两组,分别在禁食12h后进食高脂餐与维生素C2g（A组,n＝37）或单纯的高脂餐（B组,n＝37）。分别采集餐前及餐后2、4、5、7h静脉血标本,用以测定血清甘油三酯(TG)、总胆固醇、低密度脂蛋白-胆固醇（LDL-C）、高密度脂蛋白-胆固醇（HDL-C）浓度。采用高分辨血管外超声法检测餐前及餐后4h肱动脉血流介导的内皮依赖性血管舒张功能和硝酸甘油介导的内皮非依赖性血管舒张功能。结果冠心病患者空腹状态的内皮依赖性血管舒张功能显著受损。服用维生素C2g（A组）餐后4h内皮依赖性血管舒张功能较餐前无显著变化［（3.63±0.59）%∶（4.51±0.49）%,P=0.064］;未服用维生素C2g（B组）餐后4h内皮依赖性血管舒张功能较餐前相比严重受损［（3.58±0.63）%∶（0.58±0.40）%,P<0.001］。高脂餐后硝酸甘油介导的内皮非依赖性血管舒张功能的变化无统计学意义［A组（19.48±1.38）%∶（20.25±1.21）%,P=0.498;B组（18.71±1.53）%∶（16.36±1.53）%,P=0.135］。两组受试者餐后2～7h血清TG浓度均显著升高。经相关分析结果显示B组受试者的餐后2h血清TG浓度增高值与餐后4h内皮依赖性血管舒张功能下降值显著正相关（r=0.395,P<0.02）。结论高脂餐后内皮依赖性血管舒张功能显著受损,大剂量维生素C对其有保护作用。     

The effect of short-term glycemic regulation with gliclazide and metformin on postprandial lipemia.

AIM: Exaggerated postprandial lipemia is now accepted as an independent risk factor in atherogenesis in type 2 diabetes mellitus. We investigated if better glycemic control improves fasting and postprandial lipid profile in type 2 diabetic patients in the short-term. METHODS: Thirty-two type 2 diabetic patients were studied before and after desired glycemic regulation with gliclazide and metformin. Basal levels of glucose, total cholesterol, high density lipoprotein, low density lipoprotein, triglyceride, insulin, and C-peptide were evaluated at fasting state. Afterwards, patients were given a standard 400-kcal mixed meal as a breakfast, contaning 35 % fat. At the 2nd and the 4th hours after the breakfast, postprandial glucose, triglyceride, insulin, and C-peptide levels were determined again. RESULTS: Significant decrease was observed in total cholesterol levels after better glycemic regulation (p<0.05). Besides, triglyceride levels decreased significantly from 175.36+/-17.85 mg/dl to 138.73+/-14.93 mg/dl at fasting state (p<0.05), from 197.26+/-20.85 mg/dl to 154.15+/-14.61 mg/dl at the 2nd hour after mixed meal (p<0.05), and from 209.63+/-28.54 mg/dl to 155.63+/-15.68 mg/dl (p<0.05) at the 4th hour after the mixed meal, when better glycemic profile was provided. Area under curve for triglyceride levels decreased significantly with the better glycemic regulation (p<0.01). CONCLUSIONS: Improved glycemic regulation can lower the raised fasting and postprandial triglyceride levels which are important atherosclerotic risk factors in diabetic patients even in short-term. Since this improvement in triglyceride levels comes early, diabetic patients can be evaluated for fasting and postprandial triglyceride levels in the first month of therapy.     

心血管事件高危患者餐后高敏C反应蛋白浓度变化及氟伐他汀干预的影响

目的 研究心血管事件高危患者高脂餐后血浆高敏C-反应蛋白(hsCRP)浓度的变化,探讨极短期氟伐他汀对血浆hsCRP浓度的影响。方法 43例冠心病及其等危症患者随机分为氟伐他汀组(22例)和常规治疗组(21例),分别在常规治疗的基础上加服氟伐他汀(40 mg/d)和安慰剂。治疗前和1周后接受高脂餐负荷试验,检测空腹和餐后4 h血浆hsCRP和血脂水平。结果 两组患者的餐后血浆甘油三酯和hsCRP浓度较空腹水平明显升高(P<0.05)。1周后,常规治疗组的空腹和餐后血浆hsCRP浓度与血脂水平无显著变化;氟伐他汀组的餐后血浆甘油三酯和hsCRP浓度较治疗前显著降低,但血浆hsCRP浓度降低与血脂的变化无显著相关。结论 极短期氟伐他汀治疗有效降低心血管事件高危患者餐后升高的血浆hsCRP浓度。     

Alterations in apolipoprotein B-48 in the postprandial state in NIDDM

Summary The intestine is a major site of cholesterol synthesis and produces apolipoprotein B-48, which is critical for intestinal cholesterol absorption and secretion. The purpose of this study was to examine postprandial changes in apolipoprotein B-48 in diabetes. Six non-insulin-dependent diabetic patients and six non-diabetic control subjects were given a high-fat meal (1300 kcal) and blood samples were taken pre- and postprandially, from which the triglyceride-rich lipoprotein fraction was isolated by ultracentrifugation (density<1.006 g/ml). Apolipoprotein B-48 was separated on 4–15% gradient gels and quantified as a percentage of the fasting concentration by densitometric scanning. Total protein, triglyceride and cholesterol in the triglyceride-rich lipoprotein fraction, blood glucose, and serum insulin were also measured. Diabetic patients exhibited a postprandial triglyceride-rich apolipoprotein B-48 profile significantly different from that of control subjects (p<0.05). The triglyceride and total protein concentration in the triglyceride-rich lipoprotein fraction mirrored the post-prandial profile and apolipoprotein B-48 in both groups. Significantly different patterns for triglyceride (p<0.02) and total protein (p<0.05) following the fat-rich meal were observed in the two groups. Fasting and postprandial triglyceride-rich lipoprotein cholesterol and total apolipoprotein B were significantly higher in diabetic patients than in control subjects (p<0.05). Since apolipoprotein B-48 is the structural protein of intestinally-derived lipoprotein particles, these studies suggest an abnormality in intestinal lipoprotein metabolism in diabetes.Abbreviations TRL Triglyceride-rich lipoprotein - Apo-B48 apolipoprotein B-48 - apo-B100 apolipoprotein B-100 - apo E apolipoprotein E - VLDL very low density lipoprotein - NIDDM non-insulin-dependent diabetes