女性原发性高血压患者绝经前后脂蛋白(a)及血脂水平变化的研究

目的　观察女性原发性高血压患者绝经前后脂蛋白 (a) [L p(a) ]及血脂水平的变化 ,探讨其对女性冠心病发病情况可能存在的影响。方法　女性原发性高血压患者 12 1例 ,测定 L p(a)、总胆固醇 (TC)、三酰甘油 (TG)、低密度脂蛋白胆固醇 (L DL- C)和高密度脂蛋白胆固醇 (HDL- C)。对比绝经前后 L p(a)及血脂水平的变化 ,并与女性健康体检者 (对照组 )进行对比。结果　高血压组 L p(a)、TC、TG、L DL - C均显著高于对照组 ,而 HDL - C及 HDL - C/TC则明显低于对照组 ,在所有原发性高血压患者中 ,绝经后的患者 L p(a)、TC、TG、L DL - C显著高于绝经前患者 ,而 HDL - C/ TC则前者低于后者。结论　绝经后原发性高血压患者 L p(a)、TC、L DL - C均明显高于绝经前患者 ,而HDL- C/ TC则低于绝经前患者 ,提示绝经后女性原发性高血压患者 L p(a)及血脂水平增高与内源性雌激素水平下降有关 ,是绝经后冠心病发病率明显上升的重要原因。     

脂蛋白(a)与心血管疾病的关系

脂蛋白(a)[Lp(a)]结构类似于低密度脂蛋白(LDL),高水平Lp(a)是一种公认的心血管疾病危险因子。体内存在氧化型Lp(a)更易于促进动脉粥样硬化的发生发展。Lp(a)中的载脂蛋白(a)[apo(a)]存在异质性,研究显示其危险性可能是由于apo(a)等位基因水平差异引起的,而且apo(a)的多态性影响到Lp(a)水平的临床测定,如何降低apo(a)对结果的影响还需要更多深入研究。目前针对高Lp(a)水平的人群尚无统一的治疗标准,但降脂治疗有益于预防心脑血管疾病的发生。     

血浆脂蛋白(a)与冠状动脉粥样硬化程度的关系

目的:了解血浆脂蛋白(a)[(Lp(a)]、载脂蛋白AI(apoAI)、载脂蛋白B(apoB)水平在冠心病患者的变化,观察Lp(a)与冠状动脉粥样硬化程度之间的关系。方法:将冠心病患者498例按疾病发展进程进行分类,即稳定型心绞痛207例,不稳定型心绞痛184例,心肌梗死107例。另设健康对照组150例。同时以免疫透射比浊法对血浆中Lp(a),apoAI,apoB水平进行检测。结果:冠心病患者血中Lp(a)、apoB水平明显高于健康对照组P<0.05。结果表明,随着冠状动脉粥样硬化的严重程度逐步增加,血中Lp(a)、apoB逐步上升,两者呈正相关,r=0.4596,P<0.05。结论:Lp(a)与冠状动脉粥样硬化程度有着密切联系,是一个独立的致冠心病危险因子。     

脂蛋白(a)水平影响因素及其与长寿的关系

<正>脂蛋白(Lp)(a)是一种独特的血浆脂蛋白大分子复合物,由富含胆固醇的低密度脂蛋白(LDL)样微粒通过载脂蛋白(Apo)B100与Apo(a)由一个二硫键交链在一起。它于1963年由挪威学者Berg~([1])首先发现并命名报道后,有多项研究相继证实其为动脉粥样硬化的危险因素,高Lp(a)水平是心血管疾病的独立危险因子,就如同低密度脂蛋白胆固醇(LDL-C)一     

小剂量尼尔雌醇对绝经后妇女脂蛋白(a)和血脂的调脂疗效

目的 :观察小剂量、长效尼尔雌醇对绝经后妇女脂蛋白 (a)〔 Lp(a)〕和血脂的影响。方法 :选择绝经 2年以上的妇女 54例 ,随机分为治疗组和对照组。治疗组每月服尼尔雌醇 1次 ,每次 2mg。结果 :治疗组 3个月后 HDL- C、apo- AI明显升高 ,LDL- C降低 ,Lp(a)治疗半年后开始下降 ,治疗 9个月后与对照组相比有显著性差异 ,1年后降低仍较显著 ,TC、TG无明显改变。对照组前后无明显改变。结论 :尼尔雌醇副作用轻 ,同时减轻绝经期妇女的更年期综合征症状。对高 Lp(a)、高LDL- C或者低 HDL- C水平的绝经妇女可作为最初单一预防冠心病的药物使用     

2型糖尿病患者血清脂蛋白(a)水平及其与冠心病的关系

目的　探讨 2型糖尿病患者血清脂蛋白 (a) [Lp(a) ]水平及其与冠心病的关系。方法　选择 90例 2型糖尿病及 6 8例健康对照者测定其血清Lp(a)、总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)水平 ;计算低密度脂蛋白胆固醇 (LDL C)水平及TC、TG、LDL C与HDL C比值。结果　 (1)糖尿病组血清Lp(a)水平与对照组比较差异无显著性意义 (P >0 .0 5 )。 (2 )将 2型糖尿病患者分为糖尿病伴冠心病和单纯糖尿病亚组后发现 :①糖尿病伴冠心病亚组血清Lp(a)水平明显高于单纯糖尿病亚组 [(2 3.78± 2 3.73)mg/dlvs (13.31± 10 .6 6 )mg/dl;P <0 .0 1]及对照组 [(2 3.78± 2 3.73)mg/dlvs (16 .2 8± 17.95 )mg/dl;P <0 .0 5 ];②糖尿病伴冠心病亚组血清Lp(a)水平与LDL C呈正相关关系 (r =0 .32 16 ,P <0 .0 5 )。结论　 2型糖尿病患者血清Lp(a)水平增高可能与冠心病发病有密切关系。     

血清脂蛋白(a)与冠心病患者SYNTAX评分的相关性研究

目的:探讨冠心病患者血清脂蛋白(a)水平与反映冠状动脉病变严重程度的SYNTAX评分的关系。方法:回顾性分析104例行冠状动脉造影检查的冠心病患者,根据SYNTAX评分结果分为低危组(0~22分)40例、中危组(23~32分)37例和高危组(≥33分)27例,采用Spearman相关性分析和多元线性回归分析脂蛋白(a)水平与SYNTAX评分的相关性。结果:高危组脂蛋白(a)水平与中、低危组比较显著增高(4.95±1.45)vs.(4.81±1.23)vs.(4.70±1.30)mg/L(P<0.05)。Spearman相关分析显示:高血压、糖尿病、吸烟和脂蛋白(a)与SYNTAX评分呈正相关(P<0.05)。多元线性回归分析显示:糖尿病、吸烟和脂蛋白(a)与SYNTAX评分呈正相关(P<0.05)。结论:血清脂蛋白(a)水平与SYNTAX评分正相关,随着血清脂蛋白(a)水平的升高,冠状动脉病变严重程度加重,可作为判断冠状动脉病变严重程度的参考指标之一。     

脂蛋白(a)与动脉粥样硬化研究进展

脂蛋白(a)由低密度脂蛋白和载脂蛋白(a)组成.高血浆脂蛋白(a)水平是动脉粥样硬化和心血管疾病的独立危险因素.脂蛋白(a)不但能参与动脉粥样硬化斑块的形成,还能影响抗炎机制和血管壁中促凝与抗凝因子的平衡.血浆脂蛋白(a)水平的个体差异很大,主要受遗传因素控制.血浆脂蛋白(a)水平对药理和非药理因素都不敏感,临床上缺乏高效安全降低脂蛋白(a)水平的治疗方法.近年,科研工作者发现反义寡核苷酸链和人工合成的肽链等可以降低脂蛋白(a)水平,但用于临床治疗还需进一步研究.本文拟对近年来脂蛋白(a)与动脉粥样硬化研究的新进展进行综述.     

冠心病患者血浆脂蛋白(a)水平变化观察

为探讨脂蛋白(a)[LP(a)]与冠心病(CAD)的相关性，2001～2003年，我们检测了96例CAD患者的血浆LP(a)水平。现报告如下。     

进展性冠心病伴Lp(a)升高患者血脂净化治疗1例

冠心病是威胁人类健康的第一杀手, 脂蛋白(a)[Lp(a)]升高与冠心病残余风险及不良预后有关, 血脂净化治疗可大幅降低Lp(a)水平, 改善远期预后。本文报道1例进展性冠心病伴Lp(a)升高患者血脂净化治疗的经历, 以期为此类疾病的治疗提供经验和证据。     

Lipoprotein(a) serum levels and vascular diseases in an older Caucasian population cohort. Italian Longitudinal Study on Aging (ILSA)

OBJECTIVE: To investigate elevated lipoprotein(a) [Lp(a)] levels as a risk factor for stroke, myocardial infarction, angina, intermittent claudication, and combination of the above in a cohort of unselected older individuals. DESIGN: Population cohort from one of the eight centers participating in the Italian Longitudinal Study on Aging (ILSA). SETTING: General community. PARTICIPANTS: A subsample of 446 subjects (M/F: 231/ 215, mean age: 74.5 +/- 5.7 years) of the original, randomly selected, population cohort of 704 individuals, 65 to 84 years of age, free-living or institutionalized in the Impruneta Municipality, area of Florence, Italy. MEASUREMENTS: Conventional vascular risk factors and vascular diseases defined following a two-step procedure (screening phase and confirmation on positives) using standard and validated criteria. Lp(a) levels determined by an ELISA method. RESULTS: No association was observed between elevated Lp(a) levels alone and any of the examined vascular diseases (stroke, myocardial infarction, angina, and intermittent claudication). In contrast, examining the interactions between elevated Lp(a) and conventional vascular risk factors, when elevated Lp(a) was combined with a history of smoking, a marked increase in the risk of vascular diseases combined (odds ratio [OR]: 4.12; 95% confidence interval [CI]: 1.27-13.40) was observed, much higher than that expected based on the additive effect of smoking and elevated Lp(a) alone. CONCLUSIONS: With the cautions due to the cross-sectional design of the study and the limited statistical power, these results suggest a possible synergistic effect between elevated Lp(a) levels and other pro-atherogenic factors such as smoking on the risk of vascular diseases in older individuals.     

老年缺血性心脑血管疾病患者脂蛋白（a）的观察

本文测定１６２例老年住院患者和３８例健康老人血清脂蛋白（ａ）［Ｌｐ（ａ）］水平。分析结果显示老年冠心病（ＣＨＤ）、脑梗塞（ＣＭ）患者Ｌｐ（ａ）浓度明显高于健康组和其他疾病组（Ｐ＜０．０１或Ｐ＜０．０５）。高Ｌｐ（ａ）血症的检出率ＣＨＤ组、ＣＭ组亦分别高于健康组及其他疾病组（Ｐ＜０．０１或Ｐ＜０．０５）。Ｌｐ（ａ）水平不受饮食和降脂药物等影响。认为脂蛋白（ａ）是缺血性心脑血管疾病的独立危险因素之一。提出Ｌｐ（ａ）可作为临床缺血性心脑血管疾病的重要预测指标。     

Lp(a) lipoprotein and lipids in patients with rheumatoid arthritis: serum levels and relationship to inflammation

Objectives Changes in lipid profiles, Lp(a) lipoprotein, and acute phase reactants are associated with early atherosclerosis in rheumatoid arthritis (RA). The associations of Lp(a) levels with atherosclerotic disorders, diabetes, RA, and renal diseases suggest that Lp(a) might be involved in autoimmune reactions.Methods Eighty-seven women with RA diagnosed according to American Rheumatism Association criteria (mean age 45.4±9.4 years) were recruited and 50 healthy women (mean age 44±10.7 years) included as a control group. Serum Lp(a), total cholesterol (TC), triglyceride (TG), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), and C-reactive protein levels were analyzed.Results In the RA and C groups, serum Lp(a) levels were 39.2±20.6 mg/dl and 14.8±9.7 mg/dl, respectively (P<0.001). The TC levels were 188.4±41.8 mg/dl and 185.3±19.3 mg/dl (P>0.05), TG levels were 124.5±50.1 mg/dl and 94.6±24.9 mg/dl (P<0.01), HDL-C levels were 40.0±7.4 mg/dl and 52.8±4.8 mg/dl (P<0.01), and LDL-C levels were 123.4±24.6 mg/dl and 113.3±21.1 mg/dl (P>0.05). While serum CRP levels showed a positive correlation with Lp(a), they correlated negatively with HDL-C levels (r=0.83 and P<0.0001, r=–0.49 and P<0.0001, respectively). It was meaningful that Lp(a) correlated negatively with serum HDL-C level (r=–0.36, P<0.001).Conclusions It is suggested that higher serum Lp(a), lower HDL-C, higher TG level, and a high ratio of TC/HDL-C might show high risk of atherosclerosis. Inflammation in RA may cause changes in HDL-C and Lp(a) metabolisms.     

脂蛋白(a)与其他脂蛋白和载脂蛋白相关性研究

目的探讨冠心病患者血浆脂蛋白(a)与HDL-C、LDL-C、载脂蛋白(apo)A-Ⅰ、apoB的相关性,评价血脂异常与冠心病的相关性。方法选择因胸痛入院的患者1011例,经冠状动脉造影确诊为冠心病患者613例作为冠心病组,非冠心病患者398例作为对照组。测定脂蛋白(a)、apoA-Ⅰ、apoB、HDL-C和LDL-C,进行相关性分析,并计算apoB/apoA-Ⅰ比值。结果冠心病组的脂蛋白(a)、LDL-C及apoB水平较对照组明显升高(P=0.000);冠心病组脂蛋白(a)水平与LDL-C、apoB呈显著正相关(r=0.135、r=0.168,P0.01),与HDL-C、apoA-Ⅰ无相关性。对照组脂蛋白(a)与LDL-C、apoB呈显著正相关(r=0.201、r=0.236,P0.01),与HDL-C、apoA-Ⅰ无相关性。apoB/apoA-Ⅰ是诊断冠心病最显著的独立危险因素(OR=31.577,95% CI:8.324～11 9.788,P=0.000),其次为脂蛋白(a)(OR=19.446,95% CI:3.831～98.716,P=0.000)。结论脂蛋白(a)与LDL-C、apoB呈正相关,提示三者均为动脉粥样硬化的危险因素;apoB/apoA-Ⅰ和脂蛋白(a)为冠心病的独立危险因素。     

Pronounced lowering of serum levels of lipoprotein Lp(a) in hyperlipidaemic subjects treated with nicotinic acid

Thirty-one consecutive unselected hyperlipidaemic patients were treated daily with 4 g of nicotinic acid for 6 weeks. The concentrations in serum of lipoprotein Lp(a), and the major lipoprotein classes, were determined before and after the treatment. Nicotinic acid significantly reduced the serum levels of Lp(a) in the whole patient group. Linear regression analysis showed a strong negative relationship between the percentage reduction of Lp(a) and the serum triglyceride level before treatment (r = -0.78), which implied that for patients with a serum triglyceride concentration above 7.5 mmol l-1 there was a rise of Lp(a). The average individual percentage decrease of the concentration of Lp(a) was calculated after the exclusion of four patients who had serum triglyceride levels above 10 mmol l-1. The decrease was 38% with a 95% confidence interval of 28-47%. The absolute decrease of Lp(a) was correlated with the pretreatment levels of Lp(a) (r = 0.91). Within the whole group of patients there was a linear relationship between the percentage decrease of Lp(a) and that of LDL cholesterol (r = 0.88). This latter strong relationship might be due to an inhibition of the synthesis of the protein common to the two lipoproteins, apolipoprotein B.     

Lipoprotein (a) and vascular disease in diabetic patients

Summary In order to assess the potential role of lipoprotein(a) as a risk factor for cardiovascular disease in diabetes mellitus, plasma concentrations were measured in a large group (n=500) of non-insulin-dependent (NIDDM, n=355) and insulin-dependent (IDDM, n=145) patients. Concentrations of lipoprotein (a) were compared in diabetic patients with (n=153) or without (347) documented vascular disease (ischaemic heart disease, peripheral vascular disease or macroangiopathy). They were significantly higher (p<0.05) in patients with ischaemic heart disease (mean [interquartile range] 15.5 (5.0–38.0) vs 9.0 (4.5–26.0) mg/dl) or macroangiopathy (13.0 (5.0–38.0) vs 9.0 (4.0–25.0) mg/dl) compared to patients without manifestations of vascular disease. In addition, stepwise logistic regression analysis identified lipoprotein (a) levels 30 mg/dl as being independently associated with the presence of cardiovascular disease. Lipoprotein (a) was an independent risk factor for ischaemic heart disease and macroangiopathy in this group of IDDM and NIDDM patients.Abbreviations Lp(a) lipoprotein (a) - LDL low density lipoproteins - CVD cardiovascular disease - IHD ischaemic heart disease - PVD peripheral vascular disease - HDL high density lipoproteins     

血透与腹透患者血清脂蛋白(a)的变化及意义

目的观察血透(HD)与腹透(PD)患者之间脂蛋白(a)[lipoprotein(a),Lp(a)]及脂质水平影响的差别及其临床意义.方法对68例HD患者及50例PD患者的临床及实验室资料作研究,比较两种透析方式对血Lp(a)及脂质水平影响的差别,分析血Lp(a)与其他相关因素特别是与心脑血管事件的关系.结果HD与PD患者血Lp(a)水平均较对照组呈显著性升高(P＜0.05),其中PD组较HD组更高(P＜0.01);HD组血Tch较对照组及PD组均呈显著性下降(P＜0.05)、血HDL-C较对照组呈显著性下降(P＜0.01);PD组血TG较对照组及HD组均呈显著性升高(P＜0.05);血ApoA、ApoB100与对照组间无统计学差异.HD与PD患者血Lp(a)水平与超声心动图异常(P＜0.05)、ECG异常(P＜0.001)及心脑血管事件的发生(P＜0.01)、24h腹水蛋白质浓度(P＜0.01)、血Tch及LDL-C浓度(P＜0.05)、纤维蛋白原(P＜0.05)呈正相关;而与血浆白蛋白浓度(P＜0.05)、24h腹水Lp(a)浓度(P＜0.05)呈负相关.结论HD与PD患者普遍存在严重的脂质代谢变化,其中以血Lp(a)、TG、HDL-C变化尤为显著,PD组由于长期吸收大量葡萄糖,因此脂质代谢紊乱更为明显.Lp(a)有可能是HD、PD患者并发心脑血管事件的危险因素之一.     

Lp(a) levels in patients undergoing aorto-coronary bypass surgery.

The aims of this study were to evaluate plasma lipid, apoprotein and Lp(a) levels in patients with severe coronary atherosclerosis undergoing aorto-coronary bypass surgery (BP) and to relate these parameters to the involvement of one or more vessels. Seventy-seven male patients and 77 cardiovascular disease-free controls, matched for sex, age and body weight were studied. Higher triglyceride and apo B levels with lower HDL-cholesterol and apo A-I levels were found in BP patients in comparison with the controls. Lp(a) levels were slightly, but not significantly, increased. Moreover BP patients presented a significantly higher prevalence of HDL-cholesterol levels below 35 mg dl-1 (49.3% vs 22.1%) and Lp(a) levels above 70 mg dl-1 (10.4% vs 1.3%) than the controls. When patients were divided according to the number of coronary vessels involved (one, two or three), no significant difference was found, with a trend to increase in Lp(a) mean levels and in prevalence of Lp(a) levels above 30 and 70 mg dl-1 in more severely diseased patients. These results suggest that patients with severe coronary artery disease undergoing aorto-coronary bypass surgery show low HDL-cholesterol levels with high triglyceride levels. Moreover Lp(a) levels above 70 mg dl-1 are highly associated with severe coronary vessel stenosis.     

Association of elevated lipoprotein(a) levels and coronary heart disease in NIDDM patients. Relationship with apolipoprotein(a) phenotypes

Summary Non-insulin-dependent diabetes mellitus (NIDDM) is a strong and independent risk factor for coronary heart disease. We assessed the potential relationship between plasma Lp(a) levels, apo(a) phenotypes and coronary heart disease in a population of NIDDM patients. Seventy-one patients with coronary heart disease, who previously have had transmural myocardial infarction, or significant stenosis on coronary angiography, or positive myocardial thallium scintigraphy, or in combination, were compared with 67 patients without coronary heart disease, who tested negatively upon either coronary angiography, myocardial thallium scintigraphy or a maximal exercise test. The prevalence of plasma Lp(a) levels elevated above the threshold for increased cardiovascular risk (>0.30 g/l) was significantly higher (p=0.005) in patients with coronary heart disease (33.8%) compared to the control group (13.4%). The relative risk (odds ratio) of coronary heart disease among patients with high Lp(a) concentrations was 3.1 (95% confidence interval, 1.31–7.34;p=0.01). The overall frequency distribution of apo(a) phenotypes differed significantly between the two groups (p=0.043). However, the frequency of apo(a) isoforms of low apparent molecular mass (700 kDa) was of borderline significance (p=0.067) between patients with or without coronary heart disease (29.6% and 16.4%, respectively). In this Caucasian population of NIDDM patients, elevated Lp(a) levels were associated with coronary heart disease, an association which was partially accounted for by the higher frequency of apo(a) isoforms of small size. In multivariate analyses, elevated levels of Lp(a) were independently associated with coronary heart disease (odds ratio 3.48, p=0.0233).Abbreviations NIDDM Non-insulin-dependent diabetes mellitus - IDDM insulin-dependent diabetes mellitus - CHD coronary heart disease - Lp(a) lipoprotein(a) - apo(a) apolipoprotein(a) - apoB apolipoprotein B - HMGCoA reductase hydroxymethylglutaryl coenzyme A reductase     

Genetic basis and pathophysiological implications of high plasma Lp(a) levels.

Lipoprotein(a) or Lp(a) is a genetic variant of plasma low density lipoproteins (LDL) containing apoB100 covalently linked to apolipoprotein(a) or apo(a), the specific marker of Lp(a). Lp(a) is heterogeneous in size and density, accounting in part for the marked size polymorphism of apo(a), 300 to 800 kDa. The apo(a) size polymorphism is related to the different number of kringle repeats which are structurally similar although not identical to the kringle 4 of plasminogen. Recent studies on a genomic level have indicated that the apo(a) gene contains at least 19 different alleles varying in length between 48 and 190 kb, partially impacting on the plasma levels of Lp(a). High plasma levels of Lp(a) have been found to be associated with an increased prevalence of premature atherosclerotic cardiovascular disease by mechanism(s) yet to be established. Both atherogenic and thrombogenic potentials have been postulated and have been related to the LDL-like and plasminogen-like properties of Lp(a), respectively.