视网膜中央静脉阻塞患者血脂六项联合检测的意义

目的：观察视网膜中央静脉阻塞患者血浆总胆固醇、甘油三酯、高密度脂蛋白、脂蛋白（a）、载脂蛋白A1、载脂蛋白B变化特点。方法：60例患者血浆TC、TG、HDL、Lp（a）、ApoA1、ApoB含量与40例对照组比较作统计学处理。结果：病变组TC、TG、Lp（a）明显高于对照组,HDL、ApoA1明显低于对照组。结论：血浆TC、TG、Lp（a）增加及HDL、ApoA1降低与该病密切相关。     

慢性阻塞性肺疾病患者血清脂蛋白（a）的测定及意义

目的分析慢性阻塞性肺疾病（COPD）患者血清脂蛋白（a）[Lp（a）]等脂质代谢特点及其与病情的相关性。方法检测80例COPD患者及30名正常人血清Lp（a）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆阍醇（HDL-C）、载脂蛋白AI（APOA1））及载脂蛋白B（APOB）的水平。结果慢支肺气肿组HDL-C降低、APOB升高;慢性肺心病组TG、TC、HDL-C、APOA1均降低,Lp（a）、APOB升高,APOA1／APOB比值降低。与对照组比较,差异均有显著性（P〈0．05）。结论COPD患者存在脂质代谢异常,在肺心病阶段脂质代谢紊乱较慢支肺气肿阶段更为明显。     

动脉硬化性脑梗死患者的胰岛素抵抗与血脂异常关系的研究

【目的】探讨动脉硬化性脑梗死（ACI）患者急性期和恢复期的胰岛素抵抗（IR）与血脂异常的关系。【方法】分别测定91例ACI患者急性期和恢复期的空腹血清葡萄糖（FSG）、胰岛素（FINS）、总胆固醇（CHO）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、脂蛋白a（LP（a））、载脂蛋白AⅠ（ApoAⅠ）和载脂蛋白B（ApoB）的浓度。胰岛素敏感性指数（ISI）采用FSG与FINS乘积的倒数的自然对数。并以40例健康同龄人作为对照。【结果】ACI患者急性期和恢复期的FSG、FINS、TG、CHO、LDL、ApoB、LP（a）的血清浓度显著高于健康对照组,ISI、ApoAⅠ和HDL水平显著低于健康对照组;急性期和恢复期的ISI与血清TG、ApoB浓度和BMI呈负相关,与血清HDL和ApoAⅠ浓度呈正相关,ISI与血清LDL、Lp（a）浓度不相关。体重指数与ISI负相关,与FINS浓度正相关。【结论】ACI患者的IR可致高甘油三酯血症、高ApoB血症和HDL血症。     

糖尿病患者尿γ-谷氨酰基转移酶与血清脂质的变化

目的探讨糖尿病患者尿γ-谷氨酰基转移酶（GGT）与血清脂质变化的关系。方法检测正常对照组90例，糖尿病患者205例，并将205例糖尿病患者根据尿GGT排泄量分为三组，分别和血清脂质的水平，对其相互关系进行分析。结果糖尿病患者组中总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-c）、载脂蛋白B、E（ApoB、ApoE）、脂蛋白（a）[Lp（a）]和尿GGT明显高于正常对照组差异有显著性意义（P〈0．05）。而高密度脂蛋白胆固醇（HDL—C）、载脂蛋白A。、ApoA，／ApoB明显低于尿GGT正常组差异有显著性意义（P〈0．05）。其中以ApoB及ApoA／ApoB比值变化最敏感。在糖尿病患者三组中，Ⅱ组（尿GGT／Cr（33．1—58．9U／mmol））和Ⅲ组（尿GGT／Cr〉58．9U／mmol）中TC、TG、LDL—c、ApoB、ApoE、Lp（a）明显高于尿GGT正常组差异有显著性意义（P〈0．05），而HDL—c、ApoA1、ApoA1／ApoB、明显低于尿GGT正常组差异有显著性意义（P〈0．05）。Ⅲ组（尿GGT／Cr〉58．9U／mmol）中TC、TG、LDL—c、ApoB、ApoE、Lp（a）明显高于Ⅱ组差异有显著性意义（P〈0．05）。而HDL—c、ApoA，、ApoA1／ApoB、明显低于Ⅱ组差异有显著性意义（P〈0．05）。尿GGT排泄量与血脂水平明显呈正相关。结论糖尿病患者伴有脂质代谢紊乱并与尿GGT的排泄量、肾功能的损害相平行。     

血脂水平对老年糖尿病并发脑梗死影响分析

目的 探讨血脂控制水平对老年糖尿病并发脑梗死的影响。方法 以本院神经科1998年1月至2005年5月收治的老年糖尿病合并脑梗死34例（脑梗死组）及内分泌科同期收治的老年糖尿病无脑梗死34例（非脑梗死组）为研究对象,分析老年糖尿病患者血脂水平与脑梗死发生的关系。结果 总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、脂蛋白（a）[LP（a）]、载脂蛋白A1[ApoA1]、载脂蛋白B[ApoB]各项在两组之间比较均有显著差异。结论 在老年糖尿病患者中血脂升高尤其是LDL和Lp（a）升高易发生脑梗死。积极控制老年糖尿病患者的血脂水平对脑梗死有积极预防作用。     

老年腔隙性脑梗死与血脂相关性研究

目的探讨老年腔隙性脑梗死（LI）与血脂代谢的关系。方法检测110例老年LI患者血清血脂6项指标水平,并与对照组75例结果进行比较。具体检测的指标：三酰甘油（TG）、总胆固醇（TC）、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A1（ApoA1）及载脂蛋白B100（ApoB100）。结果老年LI组TG、TC、LDL—C、ApoB100水平显著高于对照组,HDL—C、ApoA1显著低于对照组,P均〈0．05。结论老年LI患者存在脂质代谢紊乱,其中TG、TC、LDL—C及ApoB100水平与疾病呈正相关,HDL—C、ApoA1水平与疾病呈负相关。     

脂蛋白、载脂蛋白与超敏C反应蛋白联合检测在冠心病诊断中的意义

目的 探讨冠心病(CHD)患者血清中脂蛋白Lp(a)、载脂蛋白(ApoA1、ApoB、ApoE)及超敏C反应蛋白(hs-CRP)的表达水平与冠心病严重程度的相关性.方法 在该院随机选取137例健康者及148例冠心病患者,并对血清脂蛋白Lp(a)、载脂蛋白(ApoA1、ApoB、ApoE)、超敏C反应蛋白(hs-CRP )进行统计学分析.结果 与健康组相比,冠心病患者血清中脂蛋白Lp(a)、载脂蛋白ApoE、超敏C反应蛋白(hs-CRP)均有不同程度的升高(P<0.05),而年龄、性别,ApoA1、ApoB、ApoA1/ApoB水平均差异无统计学意义(P>0.05).结论 血清中Lp(a)、ApoE、hs-CRP是CHD发病的重要危险因素,与CHD的发生、发展及预后密切相关,联合检测对冠心病具有较高的临床诊断价值.     

老年急性冠脉综合征患者血脂单项和血脂比值检测的临床价值

目的 探讨血脂比值对老年急性冠脉综合征(ACS)的临床诊断价值.方法 检测241例老年急性冠脉综合征患者和181例对照者的血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、载脂蛋白(Apo)A1、ApoB和脂蛋白a[LP(a)]水平,计算TC/HDL、LDL/HDL、TG/HDL和ApoB/ApoA1比值,进行统计学分析.结果 老年ACS组TG、TC/HDL和LDL/HDL显著高于对照组;HDL和ApoA1水平显著低于对照组.ApoA1是老年ACS独立的保护因素(P=0.012,OR=0.390,95%CI为0.188~0.811).结论 血脂比值可作为老年人ACS的预测指标,对于老年ACS的早期预防和诊断具有一定的临床价值.     

冠心病患者血清同型半胱氨酸及血脂水平分析

目的探讨冠心病患者血清同型半胱氨酸及血脂水平变化的临床意义。方法分别测定118例冠心病患者血清同型半胱氨酸（Hcy）及三酰甘油（TG）、总胆固醇∽）、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A1（ApoAD、载脂蛋白B（ApoB）、脂蛋白a[Lp（a）】和游离脂肪酸（NEFA）水平,并与108例健康对照组比较。结果冠心病患者血清Hcy水平（19．75±9．76）μmol/L显著高于对照组（11．85±2．48）μmol／L（P〈0．01）。冠心病组有较明显的脂类代谢障碍,其血清TG、Lp（a）、NEFA均显著高于对照组①（0．01）,HDL—C和ApoAl结果均显著低于对照组（P〈0．01）。而TC和LDL-C、ApoB与对照组比较（P〉0．05）,无明显差异。结论冠心病患者血清HDL—C和ApoAl水平明显降低,血清Hcy升高是CHD的一个危险因素。与血脂指标联合检测时,可进一步提高其对冠心病的预防、诊断和治疗价值。     

脑梗死与脑出血患者急性期血脂及血清脂蛋白的临床观察

【目的】观察脑梗无与脑出血患者急性期血脂与血清脂蛋白间的差异。【方法】回顾性分析307例脑出血与485例脑梗死患者急性期血清甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDI-C）、载脂蛋白A1（ApoA1）、载脂蛋白B（ApoB）、脂蛋白a[lp（a）]、ApoA1／ApoB之间的异同。【结果】两组间TG、HDL-C、ApoA1／ApoB有显著差异。【结论】脑出血与脑梗无血脂代谢异常有所不同。     

冠心病患者血清同型半胱氨酸水平的临床意义

目的探讨血清同型半脱氨酸（HCY）水平与冠心病、血脂、载脂蛋白及脂蛋白（a）之间的关系。方法收集经冠状动脉造影确诊的冠心病患者87例,非冠心病患者52例,用化学及免疫比浊法检测患者血脂、载脂蛋白、脂蛋白（a）,用高效液相色谱法检测血清HCY水平。结果实验结果发现冠心病患者血清HCY水平（20．06±7．16μmol／L）明显高于非冠心病组（11．33±4．17μmol／L）,P＜0.01。结论冠心病患者血清HCY水平与血脂、载脂蛋白、脂蛋白（a）没有明显相关关系,提示血清HCY是冠心病的一个新的独立的危险因素。     

Decrease of lipoprotein(a) with improved glycemic control in IDDM subjects.

OBJECTIVE: Recently, lipoprotein(a) [Lp(a)] has been identified as a major risk factor for coronary heart disease. There are few data available on the influence of metabolic control on plasma Lp(a) concentrations in subjects with insulin-dependent diabetes mellitus (IDDM), a group at high risk for coronary heart disease. RESEARCH DESIGN AND METHODS: We examined the effects of improved metabolic control on plasma lipid and lipoproteins and Lp(a) concentrations in 12 subjects before and after 21 days of tight metabolic control. RESULTS: Glycosylated hemoglobin declined from 8.4 to 6.9% (P less than 0.001), and Lp(a) declined from 29.7 to 27.1 mg/dl (P = 0.022). There were no significant differences in total, low-density lipoprotein, or high-density lipoprotein cholesterol, although the decline in triglyceride concentrations were borderline statistically significant. The distribution of apolipoprotein(a) isoforms in IDDM patients was not unusual, and the apolipoprotein(a) isoform phenotypes did not change with improved metabolic control. Lp(a) concentrations were also significantly higher than in a population-based control group of nondiabetic subjects from the San Antonio Heart Study. CONCLUSIONS: Although the number of subjects was small and the degree of improvement in metabolic control was modest, the results suggest that improved metabolic control may decrease the risk of coronary heart disease mediated by Lp(a) in IDDM.     

冠心病患者经皮冠状动脉介入治疗1年后发生支架内再狭窄影响因素分析

目的 探讨冠心病患者经皮冠脉介入(percutaneous coronary intervention, PCI) 治疗1年后发生再狭窄的影响因素。方法 2016年1月至2018年5月于兰州市第一人民医院心血管科复查的行PCI治疗术后1年发生再狭窄的冠心病患者54例,另选择同期复查未发生再狭窄患者30例作为对照,检测糖化血红蛋白（HbA1c）、肌红蛋白（Myo）、尿酸（UA）、同型半胱氨酸（Hcy）、总胆红素（TBIL）、γ 谷氨酰转肽酶（GGT）、甘油三酯（TG）、总胆固醇（TC）、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A1（APOA1）、载脂蛋白B（APOB）、脂蛋白a［Lp（a）］,进行心肌梗死溶栓危险（TIMI）评分;分析介入治疗1年后发生再狭窄的危险因素。结果 与无再狭窄组比较,再狭窄组UA及MYO明显增高,差异有统计学意义（P<0.05）;logistic回归分析发现UA、TBIL及Myo增高是行PCI治疗的冠心病患者1年后发生再狭窄的独立危险因素,APOA增高是其保护因素。结论 UA、TBIL及Myo增高是行PCI治疗的冠心病患者1年后发生再狭窄的独立危险因素,APOA增高是其保护因素。     

冠心病患者D二聚体的影响因素探讨

目的　探讨不同类型冠心病患者血浆D二聚体的水平及其影响因素。方法　对 12 4例不同类型的冠心病患者与 2 6例正常人分别采用酶联免疫吸附法测定血浆D二聚体和脂蛋白 (a)的水平 ;酶法测定甘油三酯、总胆固醇和高密度脂蛋白胆固醇的浓度 ,并计算出低密度脂蛋白胆固醇浓度 ;免疫散射比浊法测定载脂蛋白A1和载脂蛋白B浓度 ,同时检测其空腹血糖 ;测量其收缩压、舒张压、体重指数 ,并计算其吸烟指数。结果　D二聚体与甘油三酯、载脂蛋白B和脂蛋白 (a)呈明显正相关关系 (r =0 .393,0 .6 5 0和 0 .5 79,P <0 .0 0 1) ;与总胆固醇、收缩压、舒张压和空腹血糖亦呈正相关关系 (r =0 .2 35 ,0 .2 2 6 ,0 .195和 0 .198,P =0 .0 0 9,0 .0 12 ,0 .0 30和 0 .0 2 6 ) ;与载脂蛋白A1和高密度脂蛋白胆固醇呈负相关 (r =- 0 .4 96 ,- 0 .178,P <0 .0 0 1和P =0 .0 4 7)。结论　多种冠心病危险因子对冠心病患者的D二聚体水平有影响 ,其中载脂蛋白B和脂蛋白 (a)为独立影响D二聚体水平的危险因子。     

The impact of hyperhomocysteinemia as a cardiovascular risk factor in the prediction of coronary heart disease.

Coronary heart disease often occurs in the absence of traditional risk factors. Consequently, epidemiological studies exploring novel risk factors are necessary to improve the prediction of coronary heart disease. This study evaluated five promising markers of cardiovascular risk: homocysteine, C-reactive protein, fibrinogen, lipoprotein(a) (Lp(a)), free apolipoprotein(a) (apo(a)) and Lp(a) phenotypes. The study included 135 patients with angiographically confirmed atherosclerosis. The control group consisted of 93 sex- and age-matched individuals. The Mann-Whitney U-test was used for group comparison. New risk factors were evaluated by binary logistic regression. The odds ratios were calculated continuously for homocysteine in dependence on C-reactive protein. Low density lipoprotein (LDL)-cholesterol was nearly identical in controls and patients. Homocysteine, C-reactive protein, fibrinogen, high density lipoprotein (HDL)-cholesterol and Lp(a) discriminated highly significantly between both groups. The continuously calculated odds ratio for homocysteine demonstrated a distinct influence of C-reactive protein. In the group with high C-reactive protein levels, homocysteine levels above 9.6 micromol/l resulted in a markedly elevated risk (odds ratio 12), in the group with C-reactive protein levels below 5 mg/dl, a comparable risk increase was observed at a homocysteine level of 16.6 micromol/l. This data strongly suggests that plasma homocysteine helps identify individuals at risk, especially among those with elevated C-reactive protein levels.     

Screening and therapeutic management of lipoprotein(a) excess: review of the epidemiological evidence, guidelines and recommendations

Lipoprotein(a) (Lp(a)) is a low density lipoprotein-like particle in which apolipoprotein B100 is covalently linked to the unique apolipoprotein(a). There is a mounting body of evidence suggesting a role of Lp(a) in the development and progression of several vascular diseases, such as coronary heart disease, ischemic stroke, abdominal aortic aneurysm and venous thromboembolism, so that prominent scientific societies have recently endorsed guidelines and recommendations that increasingly encourage the screening and the therapeutic management of Lp(a) excess. In this article, we review the epidemiologic evidence, guidelines and recommendations concerning the relationship between increased plasma Lp(a) levels and risk of cardiovascular disease or venous thromboembolism by systematically retrieving the most relevant articles from electronic databases. Although uncertainty still remains regarding the opportunity to screen for hyperlipoproteinemia(a), it seems inopportune as yet to measure plasma Lp(a) levels in asymptomatic persons, while its measurement might be of clinical significance in selected categories of patients at intermediate or high cardiovascular risk. The measurement of Lp(a) should be performed by using immunometric, harmonized and size-insensitive techniques and results reported in total lipoprotein mass rather than in traditional units. It is uncertain if Lp(a) genotyping or phenotyping add any additional information for the cardiovascular disease risk stratification. Although the optimal therapeutic management of Lp(a) excess is still controversial, a general agreement exists that very high Lp(a) levels should be lowered in patients with multiple cardiovascular risk factors, preferably with nicotinic acid therapy (e.g., 1.0-3.0 g/day).     

Dissociation-enhanced lanthanide fluorescence immunoassay of lipoprotein(a) in serum.

Lipoprotein(a), a human serum lipoprotein structurally related to low-density lipoprotein (LDL), contains in addition to apolipoprotein B (apo B) apolipoprotein(a) [apo(a)], a glycoprotein with a strong homology to plasminogen. Lp(a) is a risk factor for coronary heart disease and ischemic cerebrovascular disease. Several immunological techniques are used to quantify Lp(a) in human serum, including radioimmunoassays, rocket immunoelectrophoresis, and enzyme-linked immunosorbent assays. Only the last method is suitable for large-scale clinical studies. We describe another solid-phase immunoassay, based on the dissociation-enhanced lanthanide fluorescence system Delfia (Wallac Oy), and outline the technical details. A polyclonal antiserum directed against Lp(a) was used as the capture antibody. Two kinds of detection antibodies were applied, a polyclonal antiserum against apo B and the polyclonal antiserum against Lp(a). The results agree excellently with the values estimated by rocket immunoelectrophoresis. This assay is easily established, measures Lp(a) in a wide concentration range, and is suitable for screening large populations.     

Concentration of Lp(a) and other apolipoproteins in predialysis, hemodialysis, chronic ambulatory peritoneal dialysis and post-transplant patients.

Serum levels of lipids, lipoprotein(a) Lp(a) and other apolipoproteins were determined in 47 predialysis patients, 40 hemodialysis (HD) patients, 39 chronic ambulatory peritoneal dialysis (CAPD) patients, 11 patients after kidney transplantation and 47 healthy subjects as reference group. The predialysis, HD, and CAPD patients had disturbances in the concentration of serum triglyceride (TG), high density lipoprotein (HDL)-cholesterol, apolipoprotein AI (apoAI), total apoCIII, apoCIII present in the particles without apoB (apoCIII non B), and Lp(a) and HDL-cholesterol, low density lipoprotein (LDL)-cholesterol/HDL-cholesterol, HDL-cholesterol/apoAI, apoAI/apoB, and apoAI/apoCIII ratios. Predialysis patients had significantly lower concentrations of HDL-cholesterol and total apoE levels than CAPD patients and total apoE level than HD patients. Moreover, both HD and CAPD patients had significantly increased levels of apoB containing apoE (apoB:E) and apoB containing apoCIII (apoB:CIII). The concentrations of serum TG, total cholesterol, LDL-cholesterol, apoB, Lp(a) in CAPD patients were statistically higher than in HD patients. The patients after transplantation demonstrated normalization of lipid and lipoprotein parameters and lipoprotein ratios except serum levels of TG, total apoCIII, apoCIII non B and the apoAI/apoCIII ratio. We concluded that abnormal lipid and lipoprotein concentrations in patients with uremia may be the cause of their high risk of atherosclerosis, but posttransplant patients exhibited improved levels of serum lipids, Lp(a) and other lipoprotein parameters and lipoprotein composition, which could be an index of decreased atherogenic status.     

慢性幽门螺杆菌感染与冠心病发病及其危险因素的关系

目的：探讨幽门螺杆菌感染与冠心病及多种危险因素的关系,观察幽门螺杆菌感染对脂质代谢、血管内皮功能、炎症介质及血清免疫学的影响.方法：应用酶联免疫吸附试验法测定冠心病组（100例）和非冠心病组（100例）血清幽门螺杆菌抗体,确证慢性幽门螺杆菌感染,分别应用酶联免疫吸附试验法及放射免疫法测定冠心病组内皮素-1.结果：（1）冠心病组血清幽门螺杆菌抗体阳性率明显高于非冠心病组（57%vs32%, P〈0.05）;（2）冠心病组慢性幽门螺杆菌感染者血浆内皮素-1水平明显高于非幽门螺杆菌感染者（P〈0.05）.结论：幽门螺杆菌慢性感染与冠心病有关,可能是冠心病发病的独立危险因索; 幽门螺杆菌慢性感染者血浆内皮素水平显著升高,可能是其导致冠心病的发病机制之一.     

Predictors of lipoprotein(a) levels in a European and South Asian population in the Newcastle Heart Project

BACKGROUND: Understanding of the higher susceptibility of South Asians to coronary heart disease is limited. One explanation is the combination of high prevalence of insulin resistance with higher lipoprotein(a) levels. MATERIALS AND METHODS: Lipoprotein(a) levels and genotypes in three South Asian groups aged 25-74 years (Indian, Pakistani, Bangladeshi) were compared with a European population in a cross-sectional study. Biochemical measurements included lipids, apolipoprotein A1 and B, glucose, insulin and fibrinogen. Insulin sensitivity was calculated using the homoeostasis model assessment method (HOMA). RESULTS: There was no significant difference in lipoprotein(a) levels between South Asian and European men. South Asian women combined had higher lipoprotein(a) levels than European women, a difference probably resulting from higher lipoprotein(a) levels in Pakistani women compared with Indian and Bangladeshi women. Fasting insulin and HOMA were negatively associated with Lp(a) in South Asians though the associations were statistically significant only in men. There were only modest associations between most cardiovascular risk factors and Lp(a). Twenty-seven apolipoprotein(a) size alleles were detected in the three South Asian groups ranging from 16 to 43 kringle-IV repeats. The apolipoprotein(a) size polymorphism explained 23% of the variability in lipoprotein(a) levels in South Asians. CONCLUSIONS: There were few nongenetic predictors of lipoprotein(a) levels in South Asians and Europeans. The lack of difference in Lp(a) between the South Asian and European men and the fact that differences between the women seemed to be confined to the Pakistani group offer little support to the hypothesis that higher Lp(a) levels contribute to the increased risk of heart disease in South Asians. Our findings do not support the hypothesis that susceptibility to heart disease in South Asians results from a combination of high insulin resistance and high Lp(a) levels.