2型糖尿病患者脂蛋白(a)水平变化及其相关因素分析

目的 :探讨 2型糖尿病患者脂蛋白 (a) [Lp(a) ]水平变化及其影响因素。方法 :应用免疫比浊法测定87例 2型糖尿病患者及 88例健康个体的Lp(a)浓度 ,行对照分析 ,并将 2型糖尿病患者的Lp(a)浓度与糖尿病病程、空腹血糖、糖化血红蛋白、胰岛素敏感指数、血清总胆固醇、甘油三酯等其它血脂项目分别作偏相关分析。结果 :糖尿病组的Lp(a)水平较对照组高 (P <0 0 5 ) ,糖尿病组的Lp(a)水平与上述诸因素均无相关性 (P >0 0 5 )。结论 :2型糖尿病患者的血清Lp(a)水平较正常人群高 ,糖尿病的病情或病程、胰岛素抵抗程度、其它血脂成分的变化对Lp(a)均无影响     

冠心病房颤患者不同伴发病变血清脂蛋白(a)的改变

目的观察冠心病房颤患者不同伴发病变血清脂蛋白 (a) [Lp(a) ]的变化。 方法采用ELISA法检测冠心病患者(44例 ,Ⅰ组 )、冠心病房颤伴发糖尿病 (40例 ,Ⅱ组 )或伴发高血压病 (41例 ,Ⅲ组 )或伴发慢性支气管炎 (慢支 )患者 (37例 ,Ⅳ组 )血清Lp(a)。 结果冠心病房颤伴糖尿病组血清Lp(a)水平显著高于冠心病组、冠心病房颤其他各组及正常对照组 (P <0 .0 1) ;冠心病组、冠心病房颤各组血清Lp(a)水平均显著高于正常对照组 (P <0 .0 1) ,而冠心病组及冠心病房颤伴发高血压病或伴慢支 3组患者血清Lp(a)水平无差异 (P >0 .0 5 )。 结论血清Lp(a)的增高可能是导致冠心病房颤血栓形成及脑梗死等并发症发生的原因之一 ,在冠心病房颤常见伴发病中 ,尤应注意伴发糖尿病时Lp(a)的变化。     

不同严重程度的高血压患者血清Lp(a)、HCY、UA水平的差异性

目的探究不同严重程度的高血压患者血清脂蛋白a[Lp(a)]、同型半胱氨酸(HCY)、尿酸(UA)水平的差异性。方法选取我院2016年2月～2017年9月原发性高血压患者108例(1级34例,2级38例,3级36例)为观察组,同期选取健康体检者35例为对照组。对比两组血清Lp(a)、HCY、UA水平及不同分级原发性高血压患者血清Lp(a)、HCY、UA水平。结果观察组血清Lp(a)、HCY、UA水平高于对照组(P0.05);不同分级原发性高血压患者血清Lp(a)、HCY、UA水平对比,差异显著,且随分级的升高而升高(P0.05)。结论不同严重程度的高血压患者血清Lp(a)、HCY、UA水平差异显著,对血清Lp(a)、HCY、UA进行监测对高血压预防诊疗具有重要意义。     

冠心病患者血清脂蛋白(a)水平临床分析

目的:评价血清脂蛋白(a)[Lp(a)]在冠心病(CHD)诊疗中的地位和作用。方法:取250例患者血清进行测定Lp(a)和总胆固醇(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),其中正常组63例,冠心病组89例,高血压病组52例,其它类心脏病组46例。结果:①冠心病组血清Lp(a)较其他3组均显著升高(P<0.01),高血压组和其它类心脏病组与正常组Lp水平比较,无显著统计学差异(P>0.05);②冠心病单支病变组、2支病变组、2支以上病变组各组间血清Lp(a)水平比较差异均有统计学意义;③冠心病非急性心肌梗死患者与急性心肌梗死患者血清Lp(a)浓度无明显差异(P>0.05);④多因素逐步回归分析表明,Lp(a)与TG、TC、HDL-C之间无显著相关。结论:高Lp(a)水平是冠心病的独立危险因子,对于预测冠心病的发生有一定的价值,但对于预测冠心病急性心血管病事件的发生却未见明显的优势。     

CRP及脂蛋白(a)联合检测与心绞痛的关系

目的:探讨心绞痛患者中CRP、脂蛋白(a)[Lp(a)]的联合检测及临床意义。方法:分别测定72例心绞痛患者(包括稳定型心绞痛42例和不稳定型心绞痛30例)和48例无冠心病患者及50例健康者的血清的CRP及血清Lp(a)的浓度做相关性分析并进行比较。结果:(1)心绞痛组血清Lp(a)的浓度及对照组的血清的CRP显著高于正常组,差异均有统计学意义(P0.05)。(2)无冠心病组的CRP与对照组差异无统计学意义(P0.05),而Lp(a)与对照组差异有统计学意义(P0.05)。结论:提示CRP在心肌损伤发病早期即出现异常增高,血清Lp(a)的浓度升高是冠心病心绞痛的独立危险因素,也是冠状动脉病变的一个预测因素,二者联合检测有利于冠心病心绞痛的预测诊断及预后。     

系统性红斑狼疮患者肾损害与血清脂蛋白(a)水平相关性分析

目的:研究系统性红斑狼疮患者血清脂蛋白(a)犤Lp(a)犦水平与其肾损害的相关性。方法:将48例狼疮肾炎患者根据24h尿蛋白定量(24hUpro)数值分为,<140mg组(A组)12例、140～500mg组(B组)16例和>500mg组(C组)20例,并与36例对照组比较。结果:B组和C组的血清Lp(a)较对照组升高,差异有显著性(P<0.01);而A组与对照组比较无统计学差异。B、C两组分别与A组比较,C组与B组比较,血清Lp(a)均升高,差异有显著性(P<0.01)。以Lp(a)为应变量,以24hUpro、TG、TC、HDL、LDL、Apo-A1、Apo-B为自变量,分别进行相关分析,结果表明,Lp(a)与24hUpro呈正相关(r=0.416,P<0.05),与其它血脂变化无明显相关性。结论:血清Lp(a)水平与系统性红斑狼疮患者的肾损害相关,Lp(a)水平随着肾损害的加重而升高。     

血清NO和Lp(a)检测在冠心病中的应用探讨

测定98例冠心病(CHD)患者及30名健康对照者血清NO及Lp(a)浓度,了解不同临床类型的冠心病患者血清中一氧化氮(NO)和脂蛋白(a)[Lp(a)]浓度变化.结果CHD患者血清NO异常率为75.5%,而Lp(a)的异常率68.4%.说明CHD患者血清NO水平下降,Lp(a)浓度升高,二者都为独立的危险因素,参与CHD的发生.联合检测血清NO和Lp(a)浓度有助于冠心病患者的筛选及预后观察.     

肝癌及其他肝病患者血清脂蛋白(a)水平分析

目的检测肝病患者血清脂蛋白(a)[Lp(a)]的水平,分析在不同程度肝细胞损伤情况下的Lp(a)表达规律。方法采用透射比浊法测定36例肝癌患者、28例中度肝硬化患者、68例慢性肝炎患者及60名健康对照者的Lp(a)水平,并对不同程度肝炎患者进行分组分析。结果各组肝病患者的Lp(a)水平均低于健康对照组(P<0.05),而各肝病组间比较差异无统计学意义(P>0.05);慢性肝炎组轻、中、重度间比较,轻度和重度Lp(a)水平差异具有统计学意义(P<0.05)。Lp(a)水平与年龄无明显相关性(r=0.055,P=0.439),Lp(a)水平在不同性别人群中的表达无统计学意义(P>0.05)。结论Lp(a)是肝脏损伤的间接指标,评价血清Lp(a)水平有助于评估肝脏疾病的肝功能,同时血清Lp(a)可作为临床判断肝细胞损害程度的指标之一。     

慢性肾衰Lp(a)检测的临床意义

目的：探讨脂蛋白（a)[Lp(a)]检测在慢性肾衰患者中的临床意义。方法：取60例慢性肾衰患者及30例正常人空腹肘静脉血，采用免疫比浊法测定血清Lp(a)含量。按血肌酐（Cr)水平及年龄段分组。结果：慢性肾衰患者Lp(a)含量显著高于正常对照组（P＜0．05），Lp(a)水平与鉴别、年龄、血肌酐水平无关。结论：Lp(a)作为一种肾毒性物质，可存在于较早期慢性肾衰患者中，Lp(a)检测有助于评估慢性肾衰患者心血管事件的危险性。     

慢性肾功能衰竭患者血清铁蛋白与血脂的相关性

目的探讨慢性肾功能衰竭患者血清铁蛋白与血脂的相关性。方法比较正常对照组及慢性肾功能衰竭(CRF)组血清铁蛋白(SF)、总蛋白(TP)、白蛋白(ALB)、同型半胱氨酸(Hcy)以及总胆固醇(TC)、甘油三酯(TG)、载脂蛋白AI(APOAI)、载脂蛋白B(APOB)、脂蛋白(a)[Lp(a)]、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平。结果 CRF组血清SF、Hcy、TG、TC、LDL-C、Lp(a)浓度均显著高于对照组(P=0.001),而TP、ALB、HDL-C和APOAI水平均显著低于对照组(P=0.025)。对照组中SF与ALB呈正相关(P=0.029);CRF组中SF与TG呈正相关(P=0.009),与APOAI呈负相关(P=0.008)。结论 CRF血清SF与其脂类代谢异常有关。     

慢性肾功能衰竭患者血清中载脂蛋白A5水平的临床研究

目的 探讨慢性肾功能衰竭(CRF)患者血清中载脂蛋白A5(ApoA5)水平及意义.方法 CRF患者77例分为糖尿病肾病组31例(A组)、非糖尿病肾病组46例(B组)、对照组35例(C组),用ELISA方法测定ApoA5、ApoA1、ApoB和ApoC3,同时测定肌酐(Cr)和白蛋白(Alb)、甘油三脂(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、脂蛋白a[Lp(a)],并分析各指标间的相关性.结果 A组血浆TG和Lp(a)水平均明显高于B组和C组(t分别=3.24、2.89、2.47、3.21,P均<0.05).B组LDL-C和ApoB水平明显低于A组和C组(t分别=2.71、3.62、4.20、3.58,P均<0.05).A、B组与C组相比,ApoC3水平明显增高(t分别=2.59、3.02,P均<0.05),HDL-C和ApoA1水平均明显降低(t分别=2.55、2.81、2.39、2.70,P均<0.05),ApoA5的水平明显减少(t分别=3.68、2.95,P均<0.05);血清ApoA5的水平与TG呈负相关(r =-0.37,P<0.05),与HDL-C和ApoA1均呈正相关(r 分别= 0.62、0.47,P均<0.05).结论 糖尿病肾病CRF患者中低水平的ApoA5可能对TG水平调节发挥重要作用.     

An application of apo(a) isoforms for the clinical assessment of Lp(a)

To examine whether or not Lp(a) is applicable as a diagnostic marker for atherosclerosis, we studied the correlation between Lp(a) levels and molecular weights of apo(a) isoforms in sera from both normal healthy adults and diabetic patients. Serum Lp(a) level was measured by turbidimetric immunoassay (TIA) and the molecular weight of apo(a) isoform was determined by Western blotting analysis. The serum Lp(a) levels of the diabetic patients (25.0 mg/dl +/- 2.2 [mean +/- SE], n = 54) were significantly higher than those of the normal subjects (14.4 mg/dl +/- 0.57, n = 500). With respect to the correlation between serum Lp(a) levels and the molecular weights of apo(a) isoforms, there was an inverse correlation in sera from normal subjects (n = 298), whereas there was no correlation in sera from the diabetic patients. Statistical significant inverse correlation (r = -0.91, y = 224.25 - 3.07x) was especially observed in 50 representative apo(a) isotypes from the normal subjects. By applying a standardized curve based on the significant inverse correlation to serum Lp(a) levels, 40.7% (22/54) of the diabetic patients were revealed to have an abnormally high value of serum Lp(a). Moreover, it was found that the significantly higher mean value of serum Lp(a) in the diabetic group was caused by the 22 patients with higher value of Lp(a). The present findings suggest that determination of apo(a) isoform size provides estimation of the serum Lp(a) value and that the inverse correlation curve between serum Lp(a) level and the molecular weight of apo(a) isoform may be applicable to the clinical use of Lp(a).     

Effect of insulin treatment on serum lipoprotein(a) in non-insulin-dependent diabetes

Abstract. In order to evaluate whether Lp(a), a lipoprotein that is potentially thrombogenic and atherogenic, is a potential risk factor for CAD in non-insulin-dependent diabetes (NIDDM), we compared the Lp(a) and its distribution in 145 NIDDM patients with that in 94 healthy control subjects. Furthermore, we studied the effect of insulin treatment on serum Lp(a) in 108 patients with NIDDM. Male and female NIDDM patients had similar Lp(a) concentrations to healthy controls (median value 167 mg L^-1, range 15–1550 mg L^-1 vs. 157 mg L^-1, range 15–919 mg L^-1, NS and 92, range 15–1190 mg L^-1 vs. 103 mg L^-1, range 15–842 mg L^-1, NS). Also, the cumulative distribution of Lp(a) did not differ between the NIDDM patients and healthy subjects. Insulin treatment increased Lp(a) in diabetics with a Lp(a) concentration of less than 300 mg ^-1L, but this effect was not related to the concomitant improvement in metabolic control (mean change (±SEM) of HbA_1c from 9.80±0.15 to 8.00±0.12; P < 0.001). In subjects with elevated Lp(a) concentrations (>300 mg L^-1) the Lp(a) concentration was unaffected by insulin, despite a similar improvement in glycaemic control. These results suggest that insulin may modulate the concentration of Lp(a).     

血清白细胞介素-18在慢性肾功能衰竭患者中的表达及其意义

目的 观察慢性肾功能衰竭(CRF)患者血清白细胞介素(IL)-18水平的变化及与相关指标的关系,探讨其临床意义.方法 入选的CRF患者60例,分为肾功能衰竭非透析组(肾衰组)18例、血透组22例、腹透组20例.另设正常对照组20例.用EusA方法 检测血清IL-18、肿瘤坏死因子(TNF)-α和超敏C-反应蛋白(hs-CRP)水平,常规实验室方法 检测血清白蛋白(ALB)、TC、TG和血肌酐(SCr),根据简化的肾病饮食改良(MDRD)公式计算肾小球滤过率(GFR).比较各组间的差别.结果 CRF患者的血清IL-18水平在肾衰组[(497.7±120.7)ns/L]、血透组[(538,1 ±113.2)ns/L]、腹透组[(565.7±122.1)ng/L]均较正常对照组[(163.9±42.2)ng/L]显著升高(均P<0.01),而腹透组明显高于肾衰组(P<0.05),血透组和肾衰组之间的差异无统计学意义(P>0.05).患者的血清IL-18水平与TNF-α、hs.CRP、SCr呈显著正相关(r值分别为0.636、0.436、0.367,均P<0.01),与GFR呈显著负相关(r=-0.515,P<0.05).结论 CRF患者无论透析还是非透析,其血清IL-18水平均显著升高,并与TNF-α、CRP、GFR等因素有关.因此IL-18可能是CRF患者亚临床炎症的一种标志物.     

Serum soluble Fas (CD95) and Fas ligand profiles in chronic kidney failure

Apoptosis, or programmed cell death, is an active form of cell death that is initiated by a number of stimuli and is intricately regulated. Apoptosis in both excessive and reduced amounts has pathophysiologic implications. Accelerated programmed cell death has been observed in leukocytes among patients with chronic renal failure (CRF). This has been ascribed in part to the retention of uremic toxins. The Fas/Fas ligand (FasL) system is a key regulatory apoptotic pathway. Membrane-bound Fas is a cell-surface receptor that transduces apoptosis after interaction with membrane-bound or soluble FasL (sFasL). By contrast, soluble Fas (sFas) binds sFasL and inhibits its activity. In an attempt to examine the balance between these soluble factors in uremia, we measured soluble sFas and sFasL levels in the serum of healthy control subjects and patients with various degrees of CRF and examined the distribution of the various molecular mass fractions of these proteins in uremic serum. In brief, serum was obtained from 15 healthy volunteers, 17 patients with CRF, 11 patients undergoing maintenance hemodialysis (HD), and 7 patients undergoing peritoneal dialysis (PD). Serum sFas and sFasL were measured by enzyme-linked immunosorbent assay, and their molecular distribution was determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by immunoblot. Compared with results in healthy control subjects, sFas levels were significantly higher in patients with CRF and in patients undergoing dialysis. There was a significant inverse correlation between sFas levels and creatinine clearance. Serum sFasL levels were not different among the four groups. However, the sFas-to-sFasL ratio was significantly lower in healthy control subjects as compared with patients with CRF and patients undergoing dialysis. Immunoblots and densitometric analyses of sFas and sFasL depicted a known 48-kd sFas, a known 27-kd sFasL, and a 60-kd sFas-sFasL protein aggregate signal. In conclusion, serum sFas levels are increased in patients with various degrees of CRF and may bind circulating sFasL, thereby minimizing mediation of cellular apoptosis.     

慢性肾功能衰竭患者高同型半胱氨酸血症与血清维生素B12、叶酸、脂蛋白(α)水平的关系

目的 探讨慢性肾功能衰竭(CRF)患者血清同型半胱氨酸(HCY)水平与其代谢因子叶酸、维生素B_(12)水平、血肌酐(SCr)及有关生化指标之间的关系。方法 本研究分为两组:正常对照组47例,慢性肾功能衰竭组46例。应用荧光偏振免疫分析(FPIA)方法测定血清HCY浓度,同时测定血清叶酸、维生素B_(12)、SCr、ALB、血脂、脂蛋白及瘦素(Leptin)浓度。结果 CRF患者血清HCY浓度(24.6±8.1)μmol/L比正常对照组(10.7±3.8)μmol/L,显著升高(P<0.001);CRF患者叶酸水平(14.5±8.8)ng/ml比正常人(5.5±2.5)ng/ml显著升高(P<0.001),血清维生素B_(12)(456±309)pg/ml比正常人(346±117)pg/ml明显升高(P<0.05);血清HCY浓度与叶酸、维生素B_(12)浓度呈明显负相关(分别为r=-0.586,P<0.01;r=-0.442,P<0.05);血清HCY浓度与SCr、Lp(a)浓度呈明显正相关,与瘦素及其它血脂水平无明显相关;血液透析患者透析后血清HCY水平(17.6±6.2)μmol/L比透析前(25.4±8.2)μmol/L明显下降(P<0.001)。结论CRF患者血清HCY水平比正常人明显升高;CRF患者肾功能、血清叶酸、维生素B_(12)水平是影响HCY水平的重要因素;血清脂蛋白(a)增高与高HCY血症密切相关;口服叶酸治疗不能满意纠正高HCY血症;血液透析可清除体内部分HCY。如何完全纠正CRF患者高HCY血症尚     

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。     

Calcium and strontium metabolic studies in patients on CAPD.

BACKGROUND: Strontium is known to affect calcium metabolism both experimentally and in clinical studies on conditions other than end-stage renal failure (ESRF) and continuous ambulatory peritoneal dialysis (CAPD). OBJECTIVE: To investigate Sr metabolism in relation to that of Ca in ESRF patients undergoing CAPD, and the possible influence of the duration of treatment. DESIGN: Cross-sectional observational study. SETTING: University medical center and Institute of Nuclear Physics. PATIENTS: Twenty-four patients on CAPD; 14 chronic renal failure (CRF) patients not on dialysis, and 52 healthy controls. MEASUREMENTS: Calcium and Sr content of serum, urine or dialysate effluent, and selected dietary products. RESULTS: Calcium and Sr are absorbed by the intestinal tract of healthy subjects with equal efficiency. Serum Ca levels were considerably lower in CRF patients than in healthy subjects and patients on CAPD (p < 0.001). Serum Sr was significantly higher in both CAPD and CRF patients than in healthy controls (p < 0.001). The Sr/Ca ratio in the sera of the healthy subjects was defined by the preferential excretion of Sr over Ca by the kidney. This preferential excretion was lost during renal failure. During treatment there was a tendency for the uptake of both Ca and Sr to increase. CONCLUSIONS: Strontium is accumulated in the body during renal failure and CAPD cannot restore normal levels. Considering the varying effects of different doses of Sr on bone metabolism experimentally, it would be interesting to determine by further studies the possible significance of the observed Sr accumulation for renal bone disease.     

血清脂蛋白(a) 水平与胆囊结石并发胆囊炎的相关性研究

目的　探讨血清脂蛋白(a) [lipoprotein(a), LP(a)] 在胆囊结石伴胆囊炎疾病中的临床意义。方法　收集2017 年3 月~2018 年9 月临床确诊为胆囊结石伴胆囊炎患者126 例和92 例胆囊炎患者的血清标本,以陕西省人民医院 健康体检中心的147 例健康体检者的血清标本作为对照组, 采用免疫透射比浊法并使用日立7170 全自动生化分析仪 检测受检者血清Lp(a) 水平。结果　胆囊结石伴胆囊炎患者组、单纯胆囊炎患者组和健康对照组血清中Lp(a) 分别为 369.2±258.5,168.6±110.3 和165.9±135.8 mg/L,胆囊结石伴胆囊炎患者组Lp(a) 水平均明显高于单纯胆囊炎患者 组和健康对照组（t=6.391,6.100, 均P<0.01）,而单纯胆囊炎患者组与健康对照组之间血清Lp(a) 水平差异无统计学 意义（t=0.261, P>0.05）。各实验组中男性受检者和女性受检者的血清Lp(a) 水平的差异均无统计学意义（t=0.100 6, P>0.05）;单纯胆囊炎男性患者和女性患者血清Lp(a) 水平与健康对照受检者的差异均无统计学意义（t=0.132 1,P>0.05）, 但是胆囊结石伴胆囊炎男性和女性患者血清Lp(a) 水平均明显高于单纯胆囊炎患者组和健康对照组（t=6.100~6.391, P<0.01）。结论　相比单纯胆囊炎患者,胆囊结石伴胆囊炎患者血清Lp(a) 水平会升高,Lp(a) 对临床诊断胆囊结石伴 胆囊炎有指导作用。