伴有高脂蛋白a血症的ACS患者采用瑞舒伐他汀钙和烟酸治疗的效果

【】目的 探讨伴有高脂蛋白a血症的急性冠脉综合征(ACS)患者应用瑞舒伐他汀钙和烟酸治疗的效果及对内皮功能的影响。方法 选取2015年6月至2016年7月在我院治疗的合并高脂蛋白a血症的ACS患者178例,随机分为观察组(n=80)和对照组(n=98),观察组给予瑞舒伐他汀钙和烟酸治疗,对照组给予瑞舒伐他汀钙治疗,观察两组患者治疗前后血脂、脂联素(APN)、内皮祖细胞(EPCs)及血流介导的内皮依赖性舒张功能(FMD)水平。结果 两组治疗后3个月总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)和Lp(a)均较治疗前降低,而高密度脂蛋白(HDL-C)较治疗前升高(p＜0.05)；观察组治疗后3个月TG、LDL-C和Lp(a)明显低于对照组,而HDL-C明显高于对照组(p＜0.05)；两组治疗后3个月APN、EPCs及FMD均较治疗前升高(p＜0.05)；观察组治疗后3个月APN、EPCs及FMD分别为(210.40±40.27)mg/L、(0.050±0.002)%和(6.01±0.70),明显高于对照组,差异比较有统计学意义(p＜0.05)；两组患者无严重不良反应发生。结论 伴有高脂蛋白a血症的ACS患者应用瑞舒伐他汀钙和烟酸治疗有较好的效果,能有效降低脂蛋白(a)水平,改善血管内皮功能。     

The lipoprotein fraction between VLDL and LDL detected by biphasic agarose gel electrophoresis reflects serum remnant lipoprotein and Lp(a) concentrations

We analyzed lipoprotein profiles in 616 Japanese by biphasic agarose gel electrophoresis using Chol/Trig Combo(TM) to yield HDL, VLDL, LDL and CM fractions which were stained with cholesterol and triglyceride reagents, respectively. To further evalute the pattern of electrophoresis, we analyzed the fraction between VLDL and LDL to confirm the possibility of a MidBand by using an automatic-five-fraction function. The cholesterol concentrations in MidBand (MidBand-C) showed a good correlation to remnant-like particle-cholesterol (RLP-C) (r = 0.95) in 23 consecutive samples (TC < 220 mg/dl, Lp(a) < 30 mg/dl). However, MidBand-C concentrations of subjects with high Lp(a) levels (Lp(a) > 30 mg/dl) were also high compared to RLP-C concentrations. The average MidBand-C levels in elderly normolipidemic control subjects (TC < 220, TG < 150) were 5.2 +/- 2.4 mg/dl in 30 males (mean age, 70 +/- 10 years) and 5.4 +/- 2.0 mg/dl in 40 females (64 +/- 11 years). The average MidBand-C levels of normolipidemic patients with coronary artery diseases (CAD; TC < 220, TG < 150) were 9.4 +/- 4.1 mg/dl in 126 males (mean age, 66 +/- 10 years) and 9.1 +/- 4.0 mg/dl in 44 females (67 +/- 10 years). These levels were significantly higher than control values (p < 0.0001). Areas under ROC curves were greater for MidBand-C than for TC, LDL-C and TG when used to discriminate between the patients with CAD and normolipidemic control subjects for each sex. There results suggest that the MidBand-C level may be useful as an indicator of risk for CAD.     

Normal VLDL metabolism despite altered lipoprotein composition in type 1 diabetes mellitus

OBJECTIVES: Patients with type 1 diabetes are at increased risk of cardiovascular disease, which may be related to abnormal lipid metabolism. Secretion and clearance of VLDL apolipoprotein B100 (apoB) are important determinants of plasma lipid concentrations and are known to be influenced by hormones, including insulin and growth hormone. PATIENTS: This study examined overnight VLDL apoB metabolism and VLDL composition in six lean patients with type 1 diabetes during euglycaemia (controlled by a varying insulin infusion) and in six age-, sex- and BMI-matched control subjects. METHODS: VLDL apoB kinetics were determined using a primed constant 1-13C leucine infusion, and VLDL apoB enrichment was measured by gas-chromatography mass-spectrometry. Fasting lipid profile, IGF-I, IGFBP-3, overnight GH profiles and free insulin concentrations were also assessed. RESULTS: Fasting concentrations of triglycerides (TG), total cholesterol (TC), HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C) were similar in both groups. The VLDL apoB secretion and metabolic clearance rates were not significantly different between the two groups, but the VLDL-TGNLDL apoB and the VLDL-CNLDL apoB ratios were significantly increased in those with diabetes (P < 0.02 and P < 0.03, respectively). Total IGF-I concentrations were similar between the two groups; however, the GH area under the curve and free insulin concentrations were increased in patients with type 1 diabetes (GH: diabetes: 94.8 +/- 15.1 vs. controls: 45.6 +/- 10-6, mU/L/h, P < 0.04; free insulin: diabetes: 78.4 +/- 5.0 vs. controls: 28.3 +/- 3.26, pmol/l, P < 0.001). IGFBP-3 concentrations were lower in diabetic patients (diabetes: 2,454.2 +/- 68.7 vs. controls: 3,219.4 +/- 76.4, ng/ml, P < 0.001). In the control group overnight GH secretion correlated negatively with fasting TC (P < 0.01) and LDL-C (P < 0.03) concentrations, whereas free insulin concentrations correlated positively with fasting TG concentrations (P < 0.009). No significant correlations were found in the patients with diabetes. CONCLUSION: This study suggests that in euglycaemic conditions patients with type 1 diabetes mellitus have normal VLDL apoB kinetics but altered VLDL composition. The altered VLDL composition may be associated with accelerated atherogenesis. We speculate that the disrupted hormonal balance and, in particular, the increased GH secretion might be responsible for the compositional changes of VLDL particles in type 1 diabetes mellitus.     

Acarbose lowers serum triglyceride and postprandial chylomicron levels in type 2 diabetes

AIM: This study was designed to examine the therapeutic effect of acarbose on serum triglyceride (TG), free fatty acid (FFA), very low-density lipoprotein (VLDL) and chylomicron (CM) in the meal tolerance test (MTT) before and after acarbose treatment in type 2 diabetes mellitus (DM2). METHODS: Effects of acarbose on postprandial lipid metabolism were examined in DM2 patients. The subjects with normotriglyceridaemia (TG > or = 1.7 mmol/l, n = 60) were divided to three groups (A, B and C), and DM2 patients with hypertriglyceridaemia (TG > 1.7 mmol/l, n = 20) were designated group D. Group A was a control, and group B was designed to examine the one-dose effect of acarbose (100 mg) on lipid levels in MTT using the balanced food of 400 kcal. In groups C and D, acarbose 300 mg/day was administered for 8 weeks, and MTT with the one-dose acarbose administration was performed. We determined the levels of fasting and postprandial levels of glucose, insulin, FFA and TG-rich lipoproteins such as CM and VLDL. RESULTS: Acarbose treatment lowered plasma glucose levels and insulin secretion. In comparison among study groups A, B and C, acarbose significantly lowered serum TG levels in postprandial state. In group D, after the 8-week acarbose administration, fasting or postprandial FFA, TG and VLDL levels were also lowered. Interestingly, postprandial increase in CM was suppressed by acarbose administration in group B, C or D. CONCLUSIONS: Acarbose lowers postprandial TG and CM levels in DM2 with either normotriglyceridaemia or hypertriglyceridaemia. Improvement of insulin resistance with acarbose may also reduce fasting TG levels in DM2 with hypertriglyceridaemia. Acarbose is a beneficial therapeutic agent to reduce TG levels in DM2 patients, thereby leading to suppression of cardiovascular events.     

醋柳黄酮对高脂血症的疗效观察

目的：观察醋柳黄酮对高脂血症的疗效。方法：将98例高脂血症患者随机分为治疗组(50例，醋柳黄酮片10mg tid po)和对照组(48例，常规药物治疗)，疗程均为3个月。结果：治疗组血胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(apoB)、载脂蛋白A(apoA)均较治疗前下降，高密度脂蛋白胆固醇(HDL-C)较治疗前升高(P＜0．05)，与对照组相比有显著性差异(P＜0．05)，醋柳黄酮对TC、TG、HDL-C的总有效率分别为78％、56％、56％，较对照组有显著性差异(P＜0．05)。结论：醋柳黄酮能有效地降低TC、TG、LDL-C，升高HDL-C。     

普罗布考与阿托伐他汀合用对急性冠状动脉综合征的调脂及抗氧化作用

目的 观察普罗布考与阿托伐他汀联合治疗对急性冠状动脉综合征患者血脂、血清氧化型低密度脂蛋白水平及对氧磷酶1活性的影响.方法 38例急性冠状动脉综合征患者随机分为对照组(n=20,阿托伐他汀10mg/d)和治疗组(n=18,阿托伐他汀10 mg/d+普罗布考1 000 mg/d),随访4周.两组在治疗前后分别测定血清总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、血清氧化型低密度脂蛋白水平及对氧磷酶1活性.结果 治疗4周后,对照组低密度脂蛋白胆固醇降低15.4%、高密度脂蛋白胆固醇上升13.7%(P<0.05),血清总胆固醇、甘油三酯略有下降但未达到统计学意义(P>0.05);治疗组血清总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯分别下降28.1%、28.5%、14.2%(P<0.01)和23.3%(P<0.05);与对照组相比,治疗组血清总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇下降更为明显(P<0.01).治疗后,两组血清氧化型低密度脂蛋白水平均明显降低,对氧磷酶1活性均明显升高(P<0.01);而治疗组血清氧化型低密度脂蛋白水平和对氧磷酶1活性的变化比对照组更为明显(P<0.01).治疗前的血清氧化型低密度脂蛋白水平、对氧磷酶活性及两者治疗后的变化值与血脂各指标之间均无相关关系(P>0.05),而对氧磷酶活性与血清氧化型低密度脂蛋白水平呈显著负相关(r=-0.669,P<0.01).结论 阿托伐他汀与普罗布考合用具有协同降胆固醇作用和抗氧化作用,但普罗布考降高密度脂蛋白胆固醇的作用不能被阿托伐他汀抵消.     

枳实对高脂血症患者血脂和内皮功能的影响

目的探讨枳实对高脂血症患者血脂及内皮功能的影响。方法 80例高脂血症患者随机分成枳实组、常规组。所有患者分别于入选第2日、用药8周末取空腹静脉血,行血三酰甘油(TG)、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)、一氧化氮(NO)、内皮素(ET-1)测定。另选本院同期健康体检40名作为正常对照组,要求采血前两周未服用任何药物。结果高脂血症患者血NO水平显著低于正常组,ET-1水平明显高于正常组(P<0.01)。治疗8周末两病例组血HDL-C、NO水平显著升高、TG、TC、LDL-C、ET-1水平明显降低,枳实组效果显著优于常规组(P<0.01),但两组的NO、ET-1水平与正常组仍有明显差别(P<0.01)。结论枳实能够改善高脂血症患者血脂含量及内皮功能。     

Rate of production of plasma and very-low-density lipoprotein (VLDL) apolipoprotein C-III is strongly related to the concentration and level of production of VLDL triglyceride in male subjects with different body weights and levels of insulin sensitivity

Overweight individuals with reduced insulin sensitivity often have mild to moderate hypertriglyceridemia. To investigate the role of apolipoprotein (apo)C-III metabolism in the etiology of hypertriglyceridemia in these individuals, we investigated 10 male subjects with different body weights (body mass index, 24-34 kg/m(2)) and insulin sensitivity (homeostasis model assessment, 4.7-35.0). Total plasma and very-low-density lipoprotein (VLDL) apoC-III kinetics, as well as VLDL triglyceride (TG) and VLDL apoB kinetics, were measured with iv injected stable isotopes. The apoC-III, TG, and apoB levels in VLDL ranged from 2.9-18.2 mg/dl, 0.49-2.89 mmol/liter, and 6.7-29.3 mg/dl, respectively. Mean production rates (PRs) were: VLDL apoC-III, 20.2 +/- 4.1 micromol/d (range, 8.0-44.8); VLDL TG, 26.9 +/- 4.6 mmol/d (range, 10.2-51.1); and VLDL apoB, 4.4 +/- 0.8 micromol/d (range, 1.5-9.1). VLDL apoC-III PRs were significantly correlated with body mass index, homeostasis model assessment, and plasma TG (r = 0.66, P < 0.05; r = 0.80, P < 0.01; r = 0.95, P < 0.001, respectively). Similar correlations were found for plasma apoC-III PRs (r = 0.70, P < 0.05; r = 0.67, P < 0.05; r = 0.80, P < 0.01, respectively). Fractional catabolic rates (FCRs) were not significantly related to metabolic variables. VLDL TG levels were strongly related to VLDL apoC-III levels (r = 0.99, P < 0.001) and VLDL apoC-III PRs (r = 0.94, P < 0.001). VLDL apoC-III levels were more strongly correlated with VLDL TG PRs (r = 0.81, P < 0.01) than with VLDL TG FCRs or VLDL apoB FCRs (r = -0.53, P = 0.12; r = -0.37, P = 0.29). These results suggest that increased hepatic production of VLDL apoC-III is characteristic of subjects with higher body weights and lower levels of insulin sensitivity and is strongly related to the plasma concentration and level of production of VLDL TG.     

Effects of lovastatin therapy on very-low-density lipoprotein triglyceride metabolism in subjects with combined hyperlipidemia: evidence for reduced assembly and secretion of triglyceride-rich lipoproteins.

We have previously reported decreased production rates of the major apolipoprotein B (apoB)-containing lipoproteins, very-low-density lipoproteins (VLDL), and low-density lipoproteins (LDL) in patients with combined hyperlipidemia (CHL) during treatment with lovastatin. In the present study, we determined the effects of lovastatin therapy on VLDL triglyceride (TG) metabolism. Plasma VLDL turnover was determined in six CHL patients, before and during lovastatin therapy. 3H-triglyceride-glycerol-specific activity data derived from injection of 3H-glycerol were analyzed by compartmental modeling. The effects of lovastatin on VLDL TG metabolism were compared with those previously determined on VLDL apoB metabolism in these subjects. Lovastatin therapy was associated with decreased concentrations of VLDL TG in five of six patients and decreased VLDL apoB concentrations in all six. VLDL TG production rates (PR) decreased in five patients, with the mean for the group decreasing from 14.1 +/- 7.1 to 10.3 +/- 4.0 mg/kg/h (P less than .05). VLDL apoB PR also decreased in five patients, with the mean decreasing from 21.8 +/- 20.3 to 12.2 +/- 9.0 mg/kg/d (P = .11). Changes in VLDL TG concentrations during lovastatin treatment were correlated with changes in VLDL apoB concentrations (r = .74, P = .09) and in VLDL TG PR (r = .91, P = .01). Changes in VLDL TG PR were also related to changes in VLDL apoB PR (r = .62, P = NS). There were no consistent changes in the fractional catabolic rates of either VLDL TG or VLDL apoB during lovastatin therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum lipids, “double pre-beta lipoproteinemia,” and distribution of the apo-very-low-density (VLDL) lipoprotein peptides in hypothyroid patients before and after substitution therapy

Thirty-six hypothyroid patients had total thyroidectomy for cancer. Thirty of them were studied before and during hormone replacement therapy, 1-1 .1 μg/kg triiodothyronine (T₃) per day. Mean treatment period was 90 days. During treatment mean serum total cholesterol (TC), triglycerides (TG), the ratio of TC to TG in very-low-density lipoprotein and the prevalence of the “double pre-beta VLDL lipoproteinemia” (Double-PBL) were significantly reduced as compared to the pretreatment values. The VLDL peptides were separated by isoelectric focusing (IEF) in polyacrylamide gel. The relative content of apolipoprotein E (arginine-rich apoprotein) and the $\text{E}\text{C}\text{-peptides}$ ratio were significantly reduced after T₃ therapy. On the contrary, the content of C_II peptide was significantly increased. Apoprotein E was positively correlated with serum TC. The proportion of the intermediate density lipoprotein fraction, evaluated by agarose gel electrophoresis, consistently decreased after treatment. The results of our study suggest that thyroid hormones affect the metabolism of remnant lipoproteins.     

Influence of mild to moderately elevated triglycerides on low density lipoprotein subfraction concentration and composition in healthy men with low high density lipoprotein cholesterol levels

Epidemiologic studies have shown that a dyslipoproteinemia with low concentrations of high density lipoprotein (HDL) cholesterol and elevated serum triglycerides (TG) is associated with a particularly high incidence of coronary artery disease. This lipid profile is associated with increased concentrations of small, dense low density lipoprotein (LDL) particles. To evaluate the role of mild to moderately elevated TG on the LDL subfraction profile in patients with low HDL cholesterol, concentration and composition of six LDL subfractions was determined by density gradient ultracentrifugation in 41 healthy men (31+/-9 years, body mass index (BMI) 25.1+/-3.9 kg/m2) with equally low HDL cholesterol levels < 0.91 mmol/l but different TG levels: TG < 1.13 mmol/l, n = 16; TG = 1.13-2.26 mmol/l, n = 13: TG = 2.26-3.39 mmol/l, n = 12. Those men with moderately elevated TG levels between 2.26 and 3.39 mmol/l had significantly higher concentrations of very low density lipoprotein (VLDL), intermediate low density lipoprotein (IDL), and small, dense LDL apoB and cholesterol than men with TG < 1.13 mmol/l. With increasing serum TG, the TG content per particle also increased in VLDL, IDL as well as total LDL particles while the cholesterol and phospholipid (PL) content decreased in VLDL and IDL, but not in LDL particles. LDL subfraction analysis revealed that only large, more buoyant LDL particles (d < 1.044 g/ml) but not the smaller, more dense LDL, were enriched in TG. Small, dense LDL particles were depleted of free cholesterol (FC) and PL. This study has shown that in men with low HDL cholesterol levels mild to moderately elevated serum TG strongly suggest the presence of other metabolic cardiovascular risk factors and in particular of a more atherogenic LDL subfraction profile of increased concentration of small, dense LDL particles that are depleted in surface lipids.     

凯西莱联合双环醇治疗非酒精性脂肪性肝炎的临床研究

目的探讨凯西莱联合双环醇片（白赛诺）治疗非酒精性脂肪性肝炎（NASH）的疗效。方法将60例NASH患者随机分为观察组与对照组,观察组30例给予凯西莱联合双环醇治疗,对照组30例单纯用凯西莱治疗。疗程均为24周。治疗前后测定两组患者ALT、TBiL、TC、TG及肝／脾CT比值。结果两组患者治疗后ALT、TBiL、TC、TG均下降,肝／脾cT比值均升高,观察组比对照组改善更明显,差异均有统计学意义（P均〈0．01）。结论凯西莱联合双环醇治疗NASH效果良好,值得临床应用。     

老年2型糖尿病患者颈动脉粥样硬化与相关危险因素分析

目的 探讨老年2型糖尿病患者颈动脉硬化与其相关危险因素.方法 老年2型糖尿病组(260例)和对照组(206例),分别记录两组患者的年龄、性别、体重指数(BMI)、血压(BP)、糖尿病病程、空腹血糖(FPG)、餐后2 h血糖(PPG)、糖化血红蛋白(HbA1c)、C反应蛋白(CRP)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆同醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)等,并同时进行颈动脉彩色多普勒超声检查,测量颈动脉内膜.中层厚度及动脉粥样硬化斑块的大小、位置及数量.采用Logistic回归模型分析颈动脉粥样硬化与各因素的相关性.结果 (1)糖尿病组颈动脉内膜-中层明显增厚者241例(92.6%),对照组43例(20.8%);糖尿病组颈动脉粥样硬化斑块者212例(81.3%),对照组42例(20.3%);糖尿病组颈动脉狭窄为89例(34.2%),对照组3例(0.01%).糖尿病组颈动脉血管病变与对照组比较差异有统计学意义(χ2值分别为249.06、173.32、77.92,均P<0.01);(2)糖尿病组FPG、PPG、TC、TG、LDL-C、ApoB和CRP与对照组比较差异有统计学意义(t值分别为16.99、15.82、15.92、6.43、10.84、3.69、17.09,均P<0.05);而HDL-C、ApoA则降低(t值分别为4.54、37.74,均P<0.05).糖尿病合并颈动脉病变较无颈动脉病变者HbA1c、TG、LDL-C、ApoB和CRP升高(t值分别为3.02、3.26、3.79、9.06、2.50,均P<0.01);(3)Logistic分析显示年龄、性别、病程、LDL-C、HDL-C、TG、收缩压和CRP等因素是老年2型糖尿病患者颈动脉病变发生的独立危险因素(OR值分别为1.063、1.925、1.081、1.039、0.138、1.865、5.145、5.663,均P<0.05).结论 老年2型糖尿病颈动脉病变与多种危险因素有关,早期较好地干预、控制这些危险因素对预防及治疗具有重要的临床意义.     

益气活血开窍法对缺血性中风患者血脂和血黏度的影响

目的探讨益气活血开窍法对缺血性中风恢复期患者血脂和血黏度的影响。方法选取120例缺血性中风恢复期患者,随机分为治疗组和对照组,各60例。对照组采用常规西药疗法,治疗组在西药常规治疗基础上采用益气活血开窍方治疗。观察两组患者神经功能缺损和生活行为能力评分、血脂及血黏度的变化。结果与治疗前比较,两组治疗后神经功能缺损评分和生活行为能力评分明显降低,三酰甘油(TG)、总胆固醇(TC)、全血高切黏度、全面低切黏度、血浆比黏度显著降低(P<0.01);治疗后治疗组神经功能缺损评分和生活行为能力评分明显低于对照组(P<0.01);TG、TC、全血高切黏度、低切黏度明显低于对照组(P<0.05)。结论益气活血开窍法可调节缺血性中风恢复期患者血脂代谢,降低血黏度,提高缺血性中风恢复期患者神经功能,改善生活行为能力。     

大蒜素对老年高脂血症患者血脂及体质量指数的影响

目的 探讨大蒜素对老年高脂血症患者体质量指数（BMI）及血脂水平的影响。方法 选择门诊就诊血脂异常的老年患者,将符合标准160例患者分为试药组（n=80）和安慰剂组（n=80）,试药组予大蒜素胶囊,安慰剂组服用安慰剂胶囊;观察两组治疗前后一般状况、BMI、血清总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇（HDL-C）、肝、肾功能等的变化。结果 127例患者完成治疗,其中试药组65例,安慰剂组62例;试药组TC（4.8±1.3）mmol/L、TG（1.4±1.1）mmol/L、LDL-C（2.6±0.7）mmol/L、BMI(25.1±5.2)均显著低于安慰剂组（均P<0.05）,HDL-C（1.5±0.7）mmol/L显著高于安慰剂组（P<0.05）。结论 大蒜素能有效降低老年高脂血症患者血脂水平。     

利拉鲁肽联合胰岛素泵对2型糖尿病伴代谢综合征患者代谢指标的影响

目的探讨利拉鲁肽联合胰岛素泵对2型糖尿病（T2DM）伴代谢综合征（MetS）患者的临床疗效及代谢指标的影响。 方法选择2019年1月至2020年2月于江门市人民医院接受治疗的2型糖尿病伴MetS患者共60例,随机分为联合组和对照,其中联合组采用利拉鲁肽联合胰岛素泵治疗,对照组采用胰岛素泵治疗,比较两组患者的入院时及治疗2周、12周后的体质指标,以及血糖、糖化血红蛋白（HbA1c）及总胆固醇（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）水平。 结果两组患者治疗前的平均BMI、腰围、血压水平对比差异无统计学意义（P>0.05）,治疗12周联合组的BMI和腰围水平显著低于治疗前,且低于对照组（P<0.05）,两组患者治疗前的空腹和餐后2h的血糖水平,C肽水平和HbA1c对比差异无统计学意义（P>0.05）,联合组的C肽水平在治疗2周、12周时显著高于对照组（P<0.05）,且联合组的HbA1c水平在治疗2周、12周时显著低于对照组（P<0.05）,两组患者治疗前的平均TC、TG、LDL-C、HDL-C水平对比差异无统计学意义（P>0.05）,联合组在干预2周时的TC、LDL-C水平及干预12周时的TC、TG、LDL-C水平均显著低于对照组,而HDL-C水平显著高于对照组,差异具有统计学意义（P<0.05）。 结论利拉鲁肽联合胰岛素泵可以有效改善T2DM合并MetS患者的体重,提高血糖控制效果,并改善血脂水平。     

老年短暂性脑缺血发作患者血清生化指标和血脂水平变化及意义

目的探讨老年短暂性脑缺血发作(TIA)患者血清同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)和血脂水平变化及意义。方法选择老年TIA患者142例,根据ABCD2评分分为低危组42例,中危组45例,高危组55例,另选取同期健康体检者40例作为对照组。比较各组Hcy、hs-CRP和血脂水平,各因素与TIA后短期脑卒中发生风险的关系。结果各组血清Hcy、hs-CRP、TC、TG、HDL-C和LDL-C水平比较,差异有统计学意义(P <0.01)。低危组、中危组和高危组血清Hcy、hs-CRP、TC、TG、LDL-C水平明显高于对照组,HDL-C水平明显低于对照组,差异有统计学意义(P<0.05);中危组、高危组血清Hcy、hs-CRP、TC、TG、LDL-C水平明显高于低危组,HDL-C水平明显低于低危组,差异有统计学意义(P<0.05);高危组血清Hcy、hs-CRP、TC、TG、LDL-C水平明显高于中危组,HDL-C水平明显低于中危组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,TIA患者病情严重程度与血清Hcy、hs-CRP、TC、TG及LDL-C水平呈正相关(r=0.404,r=0.919,r=0.182,r=0.325,r=0.183,P<0.05),与HDL-C水平呈负相关(r=-0.186,P<0.05)。结论 Hcy、hs-CRP及血脂水平与TIA患者风险程度密切相关,具有一定的临床诊断价值。     

Dyslipoproteinemia in patients with active rheumatoid arthritis: effects of disease activity, sex, and menopausal status on lipid profiles

OBJECTIVE: To investigate the lipid profiles in patients with active rheumatoid arthritis (RA) and to assess the relationship of inflammatory disease activity markers, sex, and menopausal status with lipid profiles. METHODS: Three groups of patients with active RA (n = 184) were studied: men (n = 61, mean age 50.8 +/- 4.81 yrs), premenopausal women (n = 58, mean age 39.2 +/- 2.44 yrs), and postmenopausal women (n = 65, mean age 60.4 +/- 2.14 yrs), and healthy controls (n = 161): men (n = 65, mean age 50.9 +/- 3.42 yrs), premenopausal women (n = 47, mean age 40.3 +/- 1.66 yrs), and postmenopausal women (n = 49, mean age 61.3 +/- 3.16 yrs). We measured fasting plasma levels of total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), lipoprotein (a) [LP(a)], apolipoprotein A1 (apo A1), apolipoprotein B (apo B), and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). RESULTS: Male RA patients had significantly higher apo B/apo A1 and LP(a) and lower HDL-C than male controls. Female RA patients had significantly higher TC, LDL-C, and LP(a) than female controls. Premenopausal RA patients had significantly higher LDL-C, TC/HDL-C, LDL-C/HDL-C, and apo B/apo A1 and lower TG and HDL-C than premenopausal controls. Postmenopausal RA women had significantly higher TG and LP(a) and lower TC than postmenopausal controls. Female RA patients had higher HDL-C, apo A1, and TC/HDL-C and lower apo B/apo A1 than male RA patients. Postmenopausal RA patients had significantly higher TC, TG, TC/HDL-C, apo B, LP(a), and LDL-C/HDL-C than premenopausal RA patients. CRP correlated positively with TC/HDL-C, LDL-C/HDL-C, and apo B/apo A1 and negatively with HDL-C in male RA patients. In female RA patients CRP had positive correlation with TC/HDL-C and LDL-C/HDL-C and negative correlation with HDL-C. CONCLUSION: These findings suggest that patients with active RA have altered lipid profiles and that disease activity, sex, and menopausal status affect lipid profiles, and these would be expected to change the pattern of atherosclerotic events in RA.     

冠心病患者脂蛋白(a)及三酰甘油/高密度脂蛋白胆固醇比值变化的研究

目的　探讨冠心病 (CHD)病情程度与脂蛋白 (a) [L p(a) ]及三酰甘油 /高密度脂蛋白胆固醇 (TG/ HDL- C)比值的关系。方法　测定 138例 CHD患者血清 L p(a)及 TG/ HDL- C比值 ,并与对照组健康人 82例相比较 ,分析 L p(a)及 TG/ HDL - C比值的临床意义。结果　 L p(a)浓度及 TG/ HDL - C比值在稳定型心绞痛组及不稳定型心绞痛组明显高于对照组 (分别 P<0 .0 5 ,P<0 .0 1) ,CHD组中两指标在慢性充血性心力衰竭 I°组、 °组、 °组呈上升的趋势 ,同时 L p(a)与 TG呈正相关 (r=0 .30 8,P<0 .0 1)。结论　 L p(a)及 TG/ HDL - C比值联合监测有助于 CHD的早期发现 ,了解病情程度     

健脾化痰通脉方治疗冠心病血脂异常30例临床观察

目的 观察健脾化痰通脉方对冠心病血脂异常患者临床症状及血脂水平的影响.方法 将60例冠心病血脂异常患者随机分为治疗组和对照组各30例,在常规治疗的基础上,治疗组给予健脾化痰通脉方,每日一剂,分早晚两次温服;对照组给予辛伐他汀20 mg,于每晚睡前口服.疗程均为8周.疗程结束时比较两组中医症状积分变化及血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等指标.结果 健脾化痰通脉方能明显改善冠心病血脂异常患者胸闷、胸痛、气短、体胖多痰、身体困重等临床症状,与对照组比较差异有统计学意义(P<0.05或P<0.01);且能明显改善患者各项血脂指标(P<0.01),实验室指标总有效率为73.33%,与对照组比较疗效接近,差异无统计学意义(P>0.05).结论 健脾化痰通脉方能明显改善冠心病血脂异常患者临床症状及各项血脂指标,并具有较高的安全性.