心肌梗塞患者血脂、载脂蛋白A_1、B_(100)及脂蛋白(a)的研究

本文对８２例心肌梗塞（ＭＩ）患者和３０例健康人血清血脂、载脂蛋白及脂蛋白（ａ）进行测定，结果发现ＴＧ、ＴＣ与对照组无显著性差异，而ＨＤＬ、ＡｐｏＡ１明显降低，ＡｐｏＢ１００及Ｌｐ（ａ）明显升高。指出高ＡｐｏＢ１００、Ｌｐ（ａ）及低ＨＤＬ与低ＡｐｏＡ１是心肌梗塞的危险因素。     

东北5城市脑血管病脂蛋白（α）和其它脂类水平的研究

报道４１例脑出血，４７例脑梗塞患者脂蛋白（α）［Ｌｐ（α）］及胆固醇（Ｃｈ）、甘油三酯（ＴＧ），高密度脂蛋白（ＨＤＬ）、载脂蛋白Ａ－Ⅰ（ＡｐｏＡ－Ⅰ）和载脂蛋白Ｂ（ＡｐｏＢ）的水平，并与４９例健康对照者作比较。结果发现：脑梗塞组Ｌｐ（α）、ＡｐｏＢ及ＴＧ升高，ＨＤＬ及ＡｐｏＡ－Ⅰ下降；脑出血组Ｌｐ（α）、ＡｐｏＢ及ＴＧ上升，Ｃｈ及ＨＤＬ下降明显。脑梗塞组ＬＰ（α）与ＴＧ呈显著正相关，而脑出血组Ｌｐ（α）与Ｃｈ呈显著负相关。脑梗塞组Ｌｐ（α）、ＴＧ的异常检出率分别高达６８．０９％、６３．８３％，脑出血组ＨＤＬ的异常检出率高达５３．６６％。本研究结果提示，Ｌｐ（α）和其它脂类代谢异常是脑血管病患者最常见和重要的致病因素。     

对儿童脂蛋白（a）预示冠心病危险的探讨

作者检测４４例有冠心病（ＣＨＤ）家族史儿童的血清脂蛋白（ａ）（Ｌｐ（ａ）浓度，并将其分为一级亲属组，二级亲属组再分别与无ＣＨＤ家族史儿童组进行比较，结果显示：前者的Ｌｐ（ａ）均值比后者明显为高（Ｐ〈０．０１），两者的分面频率也有显著性差异（Ｐ〈０．０１），而一级亲属组与二级亲属组相比则无差别，此外还对载脂蛋白（ＡｐｏＡＩ，ＡｐｏＢ），年龄及性别与Ｌｐ（ａ）浓度的关系进行了观察，结果均无相关性，因而     

老年冠心病患者血胰岛素水平与血脂及血糖的关系

观察老年冠心病患者血胰岛素水平与血清脂质的关系,对９７年老年冠心病患者及４８例老年对照组的血脂、血糖及胰岛素进行了测定。老年冠心病患者血清甘油三脂（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）水平显著高于对照组;而高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）水平极显著低于对照组（Ｐ〈０．０１）;血清胆固醇（ＴＣ）、载脂蛋白ＡＩ（ＡｐｏＡＩ）、载脂蛋白Ｂ（ＡｐｏＢ）及脂蛋白（ａ）「Ｌｐ（ａ）」水平两组比较无显著性差异;老年冠心病组血胰岛素（ＩＮＳ）水平高于对照组,其差异有极显著性意义;而空腹血糖（ＦＰＧ）水平显著高于对照组;胰岛素敏感性指数（ＩＳＩ）冠心病组显著低于对照组。     

肾移植患者血清脂类水平测定的意义

目的：为了探讨肾移植后病人脂类代谢紊乱和并发心血管疾病的因素。方法：分析了４９ 例肾移植（ Ｒ Ｔ）病人血清中的脂类各组分水平,并与慢性肾功能衰竭（ Ｃ Ｒ Ｆ） 透析病人、正常健康人群作比较。结果： Ｒ Ｔ 病人血清总胆固醇（ Ｔ Ｃ） 、甘油三酯（ Ｔ Ｇ） 、低密度脂蛋白胆固醇（ Ｌ Ｄ Ｌ－ Ｃ） 、载脂蛋白 Ｂ（ａｐｏ Ｂ） 均明显高于 Ｃ Ｒ Ｆ 和健康组,而高密度脂蛋白胆固醇（ Ｈ Ｄ Ｌ－ Ｃ） 、载脂蛋白 Ａ Ｉ（ａｐｏ Ａ Ｉ） 则无显著性差异。同时通过年龄分组统计发现, Ｒ Ｔ 病人＞３０ 岁组的 Ｔ Ｃ、 Ｌ Ｄ Ｌ－ Ｃ、ａｐｏ Ｂ 三项指标已明显改变。结论：提示肾移植治疗会提前和加速脂类代谢的紊乱, Ｃｓ Ａ 等可能是导致上述后果的主要原因。     

TG、ApoB、HDL-C预示NIDDM发生脑梗塞可能性探讨

目的：探讨非胰岛素依赖性糖尿病（ＮＩＤＤＭ）患者发生脑梗塞的血脂预示因素。方法：对正常人组、非ＮＩＤＤＭ脑梗塞组、ＮＩＤＤＭ无脑梗塞组、ＮＩＤＤＭ脑梗塞组进行血糖、糖化血红蛋白Ａ１ｃ、血脂、纤维蛋白原的测定，并加以比较。结果：甘油三酯、载脂蛋白Ｂ、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）在ＮＩＤＤＭ脑梗塞组与ＮＩＤＤＭ无脑梗塞组间有显著差异，低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）各组间无显著差异，其余指标ＮＩＤＤＭ脑梗塞组与非ＮＩＤＤＭ脑梗塞组无显著差别。结论：ＮＩＤＤＭ患者是发生脑梗塞的高危人群，其中甘油三酯、载脂蛋白－Ｂ显著升高，ＨＤＬ－Ｃ显著降低，可能是预示ＮＩＤＤＭ患者发生脑梗塞的重要预示因素，总胆固醇、载脂蛋白Ａ１、脂蛋白（ａ）、纤维蛋白原可能仅是次要危险因素。     

绝经后期女性冠心病患者雌激素及血脂测定的临床意义

为探讨绝经后期女性血清脂质及雌激素与冠心病（ＣＨＤ）的关系,对６３例绝经后期女性冠心病患者及４５例非冠心病（对照组）,进行了血清总胆固醇（ＴＣ）、甘油三脂（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、载脂蛋白ＡＩ（ＡｐｏＡＩ）、载脂蛋白Ｂ１００（ＡｐｏＢ１００）、脂蛋白（ａ）［ＬＰ（ａ）］和雌二醇（Ｅ２）测定,并进行了相关性分析。绝经后期女性ＣＨＤ、血清ＴＣ、ＴＧ、     

单纯性肥胖症儿童血脂、载脂蛋白A1、B100的研究

通过对单纯性肥胖儿童血脂,载脂蛋白Ａ１,Ｂ１００的研究,以初步了解其脂质代谢紊乱的状况,并探讨其动脉粥样硬硬化危险性增加的可能机制。对筛选出的肥胖儿童及其正常儿童各４９名,测定其血清甘油三酯（ＴＧ）,总胆固醇（ＴＣ）,高密度脂蛋胆固醇（ＨＤＬ－ｃｈ）,低密度脂蛋白胆固醇（ＬＤＬ－ｃｈ）,极低密度脂蛋白胆固醇（ＶＬＤＬ－ｃｈ）,载脂蛋白Ａｌ（ａｐｏＡ１）;载脂蛋白Ｂ１００（ａｐｏＢ１００）。     

早期糖尿病患者血清唾液酸及载脂蛋白的研究

检测２０例早期Ⅱ型糖尿病（ＮＩＤＤＭ）患者血清唾液酸（ＳＡ）,载脂蛋白（Ａｐｏ）ＡＩ、Ｂ、ＣⅠ、ＣⅡ,脂蛋白（ａ）［Ｌｐ（ａ）］、胆固醇（ＴＣ）、甘油三酯（ＴＧ）、空腹血糖（ＦＰＧ）水平,与１３０例健康组比较,其ＳＡ、ＡｐｏＢ、ＡｐｏＡⅠ／ＡｐｏＢ比值、ＴＣ、ＴＧ、ＦＰＧ有极显著性意义（Ｐ＜０．０５～０．０１）,而ＡｐｏＡⅠ、ＡｐｏＣⅠ、ＣⅡ和Ｌｐ（ａ）差异虽然不显著（Ｐ＞０．０５）,但前两者有下降趋势,后两者有升高趋势。结果显示,ＮＩＤＤＭ患者早期可能已发生了细胞代谢紊乱、脂质代谢异常及血液循环障碍     

冠心病患者的血清apoB水平及与营养的关系

以１０１名男性冠心病（ＣＨＤ）患者和１００名健康对照为研究对象。分别进行了体格测量、生活史询问、膳食史调查并抽取血样作常规血脂和载脂蛋白Ｂ（ａｐｏＢ）测定。结果表明,冠心病组和对照组的平均ａｐｏＢ水平分别为（８７７±１２９）ｍｇ／Ｌ和（８００±９５）ｍｇ／Ｌ;研究还表明,体重指数和腰围／臀围比值（ＷＨＲ）均与ａｐｏＢ水平具有密切关系,此外,喜食肥肉也与ａｐｏＢ水平升高有关,而ＶＣ摄入量则与ａｐｏＢ水平降低有关。     

对儿童脂蛋白(α)预示冠心病危险的探讨

作者检测44例有冠心病(CHD)家族史儿童的血清脂蛋白(a)[Lp(a)]浓度,并将其分为一级亲属组、二级亲属组再分别与无CHD家族史儿童组进行比较。结果显示:前者的Lp(a)均值比后者明显为高(P<0.01);两者的分布频率也有显著性差异(P<0.01)。而一级亲属组与二级亲属组相比则无差别。此外还对载脂蛋白(Apo AI、Apo B)、年龄及性别与Lp(a)浓度的关系进行了观察,结果均无相关性。因而作者认为,高Lp(a)个体与CHD家族史密切相关,对CHD的防治应从儿童期开始。     

Relationship of lipoprotein(a) levels to physical activity and family history of coronary heart disease

OBJECTIVES: This study evaluated the association of physical activity with serum lipoprotein(a) [La(a)] levels in individuals according to whether they had a family history of coronary heart disease (CHD). METHODS: Lp(a) levels in 332 healthy Spanish men aged 20 to 60 years were measured. Physical activity and family history of CHD were assessed. RESULTS: For men with a family history of CHD, the odds ratio for Lp(a) levels above the median value was 0.13 (95% confidence interval = 0.03, 0.50) in very active men (energy expended in physical activity > 300 kcal/day) compared with active men (energy expended in physical activity < 300 kcal/day). CONCLUSIONS: Regular daily physical activity in individuals with a family history of CHD could be useful for controlling Lp(a) levels.     

The relationship of reported parental history to the incidence of coronary heart disease in the Western Collaborative Group Study.

The relationship of a reported parental history of coronary heart disease (CHD) to the incidence of CHD was determined in this prospective study of CHD in an intake population of 39-59-year old men. Reported parental history of CHD was found to be associated with level of schooling, the type A behavior pattern, serum cholesterol and beta/alpha lipoprotein ratio. Men with reported parental history had an increased incidence of angina pectoris in both age defined by symptomatic myocardial infarction and sudden coronary death. Adjustment then was made simultaneously for the confounding effects of the risk factors found to be associated with the prevalence of parental history of CHD. After such adjustment a reported parental history of CHD was still found to have a significant association (p = 0.01) with the combined incidence of symptomatic myocardial infarction and angina pectoris in subjects under 50 years of age.     

冠心病危险因素的临床评价

目的 探讨冠心病危险因素与冠状动脉病变的关系。方法 对341例冠状动脉造影患者可能伴有的危险因素进行询问和检测。结果 (1)冠状动脉造影显示有病变者214例,冠状动脉造影显示无病变者127例。两组的年龄、糖尿病病史、高脂血症史、冠心病家族史、吸烟史、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇／高密度脂蛋白胆固醇比率(TC／HDL-C)、脂蛋白(a)[Lp(a)]、纤维蛋白原(Fbg)、高敏C反应蛋白(hs-CRP)比较,差异均有显著性。(2)冠状动脉造影显示有病变者其病变积分与危险因素的相关性依次排列为hs-CRP、Lp(a)、TC／HDL-C、Fbg、高脂血症史、TC、LDL-C和甘油三酯(r=0．338、0．250、0．241、0．207、0．167、0．147、0．140和0．139)。(3)对冠状动脉造影患者与危险因素应用ROC曲线分析结果依次为hs-CRP、TC／HDL-C、Lp(a)、Fbg、LDL-C、高脂血症史,其ROC曲线下面积比分别是0．810、0．669、0．626、0．625、0．619和0．618。结论 高脂血症史是冠心病发生的预告信号,脂质检查项目中对冠心病的预测作用以TC／HDL-C和Lp(a)为优;提示当前冠状动脉炎性损伤以hs-CRP为优。     

Parental history of coronary heart disease, hypertension, diabetes, and stroke: Relationship to coronary heart disease risk factor variables in their adult children

Relationships of parental (familial) history of coronary heart disease, stroke, hypertension, and diabetes to major coronary heart disease (CHD) risk factors were examined in 738 adults (average age, 40 years) in the Cincinnati Lipid Research Clinics Princeton School study. Men reporting parental CHD had higher plasma triglyceride and higher systolic and diastolic blood pressure than comparison group men reporting no parental CHD, stroke, hypertension, or diabetes. Women reporting parental CHD had higher plasma triglycerides than comparison group women reporting no parental CHD, stroke, hypertension, or diabetes. Men reporting stroke in one parent had higher total plasma cholesterol and triglyceride levels than comparison men. Women reporting stroke in one parent had higher triglyceride levels than comparison group women. Women reporting hypertension in one parent had higher mean triglyceride and systolic blood pressure than comparison women. Men and women reporting diabetes in one parent had higher triglyceride than comparison adults. Matching men whose fathers had died of CHD with those whose fathers were free of CHD revealed significant increments in triglyceride levels, systolic, and diastolic blood pressure in the men with positive family history of CHD. Matching women whose fathers had died of CHD with those whose fathers were free of CHD revealed higher total plasma cholesterol, low-density lipoprotein cholesterol, and Quetelet index. In men, categorical assessment by CHD risk factor levels (low, intermediate, high), revealed that plasma triglycerides and systolic blood pressure were positively associated with a parental history of CHD, while high-density lipoprotein cholesterol was inversely related. In women, similar observations were made for triglycerides. Family history is a practical tool for identification of risk to CHD, hypertension, stroke, and diabetes. Serial risk factor measurements in offspring from CHD-, hypertension-, stroke-, and diabetes-positive families should have considerable utility in early recognition and documentation of CHD risk factor levels which, in turn, should facilitate primary intervention designed to ameliorate or prevent the development of CHD.     

肝病患者血清脂蛋白(a)水平及临床意义

目的 :探讨肝病患者血清脂蛋白 (a)的水平。方法 :采用单克隆抗体浊度法测定了 341例肝病患者和 98例健康者的脂蛋白 (a)水平 ,并与总胆红素、丙氨酸氨基转移酶含量进行比较。结果 :各组肝病患者的脂蛋白 (a)平均水平均低于健康对照组。其中慢性迁延性肝炎、肝硬化、急性黄疸型肝炎、原发性肝癌的降低有非常显著差异 (P <0 .0 1)。慢性活动性肝炎的降低亦有显著性差异 (P <0 .0 5 )。急性无黄疸型肝炎和继发性肝癌的降低则无显著性意义 (P >0 .0 5 ) ;脂蛋白 (a)与总胆红素之间无明显相关 (r =0 .2 5 5 6 ) ,脂蛋白 (a)与丙氨酸氨基转移酶间则有反比关系 (r =- 0 .882 6 )。结论 :血清脂蛋白 (a)可作为肝细胞损害程度的临床判断指标之一     

Lipoprotein (a). A new risk factor for coronary artery disease

Lp(a) may represent a link between the fields of atherosclerosis and thrombosis. Elevated Lp(a) levels > 300 mg/l have been associated with the presence of atherosclerotic disease. This prospective study initiated in 1995 and, until June 1999 enrolled 218 subjects divided in two groups: G1: subjects with/without angiographically proven coronary artery disease(CAD), n = 124 and GII: controls, n = 94 The objective of this study was to assess the influence of high Lp(a) serum levels on the CAD. Secondary end point was to demonstrate a correlation between the level serum Lp(a) and the severity of angiographic coronary findings. we found that The cases had significantly (p = 0.004) higher Lp(a) levels than the controls and that correlation exist between the value of Lp(a) serum levels and severity of angiographic findings. However, we do recommend Lp(a) screening for patients with early CA1:) or a family history of CAD.     

Screening results for subclinical coronary artery calcification in asymptomatic individuals in relation to a detailed parental history of premature coronary heart disease

A parental history of premature coronary heart disease (CHD) is an established risk factor for CHD events in descendants. The study aim was to investigate whether subclinical coronary artery calcification (CAC) differs between asymptomatic individuals (a) without a parental CHD history, (b) with a parental history and (c) without knowledge of parental CHD history. The inclusion of individuals without knowledge of parental CHD history is a new approach. We also differentiated between CHD of mother and father to gain insight into their individual contributions. Data was obtained for 4,301 subjects aged 45–75 years free of overt CHD from the baseline screening of the population-based Heinz Nixdorf Recall study. CAC, measured by electron-beam computed tomography, was modeled conducting logistic regressions. Model 1 included family history, Model 2 was adjusted for age (and gender) and Model 3 added common CHD risk factors. The CAC score was dichotomized using the age and sex-specific 75th percentile. The odds ratio (OR) for CAC ≥ age and sex-specific 75th percentile was 1.33 among individuals with parental premature CHD history (95 % confidence interval [95 %CI]: 1.08, 1.63), which did not change after full adjustment (OR 1.40, 95 %CI: 1.13, 1.74). Individuals with an unknown biological father or mother had a high chance of elevated CAC scores (fully adjusted; father: OR 1.38, 95 %CI: 1.01, 1.90, mother: OR 1.86, 95 %CI: 0.90, 3.84) compared to the reference group. The current study showed an association between parental CHD history and CAC independent of common CHD risk factors. This association affirms the use of parental CHD history in cardiovascular risk assessment among asymptomatic adults in routine practice. The observation that individuals who did not know their mother or father are prone to increased CAC scores needs further confirmation in large scale studies.     

Prospective association of lipoprotein(a) concentrations and apo(a) size with coronary heart disease among men in the Multiple Risk Factor Intervention Trial

In this nested case-control study, lipoprotein (a) [Lp(a)] concentrations and apo(a) isoform size were measured in serum samples obtained from men participating in the prospective Multiple Risk Factor Intervention Trial (MRFIT). Serum from men aged 35 to 57 years and stored for up to 20 years were analyzed for Lp(a) levels (n=736) and isoform size (n=487), respectively. Cases involved nonfatal myocardial infarctions (MI; n=98), documented during the active phase of the study that ended on February 28, 1982 and coronary heart disease (CHD) deaths (n=148) monitored through 1990. Median Lp(a) levels did not differ between cases and controls and mean apo(a) size did not vary between cases and controls in the entire study population. When adjusted for age and Lp(a) concentration, logistic regression analysis indicated that small apo(a) isoforms were associated with CHD deaths among smokers (OR 3.31; 95% CI 1.07-10.28).     

载脂蛋白A5 c.553G>T基因多态性与新疆汉族人群冠心病相关性研究

目的 研究新疆汉族人群载脂蛋白A5(ApoA5)c.553G＞T多态性与冠心病及血脂水平的相关性.方法 采用聚合酶链反应-限制性片段长度多态性方法,检测486例冠心病患者和501例对照的ApoA5 c.553G＞T多态性,同时测定血脂水平.结果 ApoA5 c.553G＞T的不同基因型在冠心病组和对照组分布频率的差异具有统计学意义(x2=8.757,P=0.013).通过非条件logistic回归校正年龄、性别、吸烟史、血脂、高血压和糖尿病史等影响因素后,T等位基因携带者(TT+GT基因型)的个体患冠心病的风险是GG型的1.753倍(OR=1.753,95%CI:1.030～2.983,P＜0.05).冠心病组和对照组c.553G＞T基因型亚组间甘油三酯(TG)水平的差异有统计学意义(t=-5.242,P＜0.01;t=-3.499,P=0.001),T等位基因携带者较GG型有更高的TG水平;冠心病组T等位基因携带者较GG型有更高的胆固醇(TC)水平(t=-2.465,P=0.014).结论 ApoA5c.553G＞T多态性对新疆汉族人群血清TG、TC水平有影响,且与冠心病的发生有一定相关性,T等位基因可能是冠心病的一个危险因素.

Abstract：

Objective The aim is to investigate the association between coronary heart disease (CHD) and c.553G＞T polymorphism of apolipoprotein A5 (ApoA5) gene and the influence of serum lipid level in the Hah ethnic population of Xinjiang. Methods The polymorphism of ApoA5 gene in 486 patients with CHD and 501 controls was analyzed by methods of polymerase chain reaction and restriction fragment length polymorphism analysis. Level of serum lipid in each patient was detected at the same time. Results There was significant difference in the distribution of genotypes between CHD group and controls group ( x2 = 8.757, P= 0.013 ). Non-conditioned logistic regression analyses, after adjusted for age, gender, smoking, total serum cholesterol, presence of hypertension and diabetes, revealed that individuals who carried T allele (TT + GT genotype) had an increased risk of CHD, compared to GG genotype (OR= 1.753,95%CI: 1.030-2.983, P＜0.05 ). There was also a remarkable difference noticed in the level of serum triglyceride by genotypes in CHD group and control group (t=5.242, P＜0.01; t=-3.499, P=0.001 ). Individuals in the two groups who carried T allele had higher level of serum triglyceride than those carried GG genotype. Individuals in CHD group who carried T allele had higher level of serum total cholesterol than those carried GG genotype (t=-2.465, P=0.014). Conclusion It seemed that the c.553G＞T polymorphism of ApoA5 gene had influenced on the level of serum triglyceride and the total cholesterol among Han population in Xinjiang. c.553G＞T polymorphism was associated with the development of CHD, while T allele might be an influencing risk factor on CHD.