Lipoprotein predictors of cardiovascular events in statin-treated patients with coronary heart disease. Insights from the Incremental Decrease in End-points through Aggressive Lipid-lowering Trial (IDEAL)

Background. Few studies have looked into the ability of measurements of apolipoprotein B (apoB) and apolipoprotein A-1 (apoA-1) or apoB/apoA-1 to predict new coronary heart disease (CHD) events in patients with CHD on statin treatment.

Aims. In the IDEAL trial, to compare lipoprotein components to predict CHD events and to what degree differences in those parameters could explain the observed outcome.

Methods. We compared the ability of treatment with atorvastatin 80 mg/day to that of simvastatin 20–40 mg/day to prevent CHD events in patients with CHD and used Cox regression models to study the relationships between on-treatment levels of lipoprotein components to subsequent major coronary events (MCE).

Findings. Variables related to low-density lipoprotein cholesterol (LDL-C) carried more predictive information than those related to high-density lipoprotein cholesterol (HDL-C), but LDL-C was less predictive than both non-HDL-C and apoB. The ratio of apoB to apoA-1 was most strongly related to MCE. However, for estimating differences in relative risk reduction between the treatment groups, apoB and non-HDL-C were the strongest predictors.

Interpretation. The on-treatment level of apoB/apoA-1 was the strongest predictor of MCE in the pooled patient population, whereas apoB and non-HDL-C were best able to explain the difference in outcome between treatment groups. Measurements of apoB and apoA-1 should be more widely available for routine clinical assessments.     

缺血性脑血管病病人血浆LCAT 活性与脂蛋白和红细胞膜脂质成分的相关性研究

目的:探讨缺血性脑血管病（ischemic cerebrovascular disorders,ICVD）病人血浆卵磷脂-胆固醇酰基转移酶（LCAT）活性与脂蛋白和红细胞膜脂质成分含量的相互关系。方法:采用改良的Nagaski酶学方法-外加底物法测定103例ICVD病人和60例健康者血浆LCAT活性,并检测血浆高密度脂蛋白胆固醇（HDL-C）及其亚组分（HDL2-C、HDL3-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1和B（apoA1,apoB）、红细胞膜胆固醇（RBCM-C）和红细胞膜磷脂（RBCM-PL）的含量变化。结果:ICVD病人血浆LCAT活性、HDL-C、HDL2-C及apoA1含量明显降低,血浆LDL-C、apoB、RBCM-C及RBCM-C/RBCM-PL比值显著增高,与对照组相比差异有显著性（P<0.05）,血浆LCAT活性分别与HDL-C、HDL2-C及apoA1水平呈正相关（P<0.05、P<0.05、P<0.05）,而与LDL-C（和RBCM-C呈负相关（P<0.05）。结论:ICVD病人脂质代谢异常与血浆LCAT活性降低有关。     

Hyperinsulinemia and insulin resistance in pathogenesis of atherosclerosis and ischemic heart disease

AIM: To confirm the pathogenetic relationship of hyperinsulinemia, insulin resistance, and coronary disease. MATERIAL AND METHODS: Thirty-nine coronary patients (male) were examined using lipid loading test, bicycle ergometry, coronarography, and measurements of insulin, cholesterol (CS), triglycerides (TG), very low density lipoproteins (VLDL), low density lipoproteins (LDL), high density lipoprotein (HDL) CS, apoA-1, and apoB. RESULTS: Blood levels of CS, TG, VLDL, LDL, HDL CS, apoA-1, apoB, and insulin were measured before and 3, 6, and 9 h after lipid loading in 39 coronary patients and 20 normal subjects. Coronarography showed initially high levels of insulin in coronary patients with pronounced changes. Insulin level drastically increased after insulin loading; increases in TG and apoB levels were the most pronounced, while the concentrations of HDL CS and apoA-1 decreased and did not normalize 6 h after lipid loading. CONCLUSION: The results confirmed the relationship between hyperinsulinemia, insulin resistance, and coronary disease.     

Plasma lipid composition and LDL oxidation.

Low-density lipoprotein (LDL) oxidation in vivo depends on lipid composition and on plasma antioxidant status. The aim of our study was to investigate the relationship between plasma lipid composition and LDL oxidation and, in particular, to explore whether LDL-cholesterol/triglycerides ratio (LDL-C/TG) and LDL-cholesterol/high-density lipoprotein (HDL)-cholesterol ratio (LDL-C/HDL-C) can be used as predictive parameters of LDL oxidation in vivo. In 87 volunteers over a wide range of age plasma lipids and LDL oxidation were studied. Blood was collected after 12 h overnight fast. LDL oxidation was estimated by the level of conjugated diene (BDC) in the lipid fraction isolated from plasma after gradient ultra-centrifugation. The results were expressed as micromol/l (BDC/l) to evaluate the level of oxidized LDL, and as nmol of BDC for mg of LDL-cholesterol (BDC/LDL-C) for the evaluation of LDL oxidation degree. BDC/l correlated significantly with age, total and LDL-C, apolipoprotein B and TG, while BDC/LDL-C negatively correlated with total cholesterol, apolipoprotein B, LDL/TG and LDL/HDL ratios. Age of subjects significantly correlated with total and LDL-C and apolipoprotein B. TG have a significant inverse correlation with HDL-C. Our results support the hypothesis that among the several factors involved in LDL oxidation the most important determinants are LDL/TG. Plasma triglycerides appear to be very important even when circulating cholesterol levels are within normal limits. Moreover, we found that the LDL/HDL ratio is also very important with regard to the putative protective role of HDL against LDL oxidation in vivo. In conclusion, plasma lipid parameters must be evaluated not only for their absolute values but also for their mutual ratios as expression of plasma lipid homeostasis. Both LDL/TG and LDL/HDL ratios can be used as predictive parameters of in vivo LDL oxidation.     

Changes in serum lipoproteins and high-density lipoprotein composition during isotretinoin therapy

Oral isotretinoin has been reported to increase serum total triglycerides (TG), cholesterol (TC), phospholipids (TPL), apoprotein B (apo B), and to reduce high-density lipoprotein cholesterol (HDL-C). To investigate the effects of isotretinoin on HDL, we measured HDL-C, HDL phospholipids (HDL-PL), apoprotein A1 (apo A-1), and HDL-C subfractions (HDL2-C and HDL3-C) in 24 healthy, male patients receiving a 16-week course of isotretinoin (1.0 mg/kg/day) for treatment of severe acne vulgaris. Patients were placed on a constant diet and fasting lipid parameters were measured every 4 weeks. Analysis of the data from the 20 patients who completed the study confirmed the reported increase in TG, TC, LDL-C, apo B, and LDL-C/HDL-C (all p less than 0.01) observed during isotretinoin therapy. Reduction occurred in HDL-C (p less than 0.05) and HDL2-C (p less than 0.01) while HDL3-C remained unchanged, indicating that the effect of isotretinoin is on the HDL2-C subfraction. Apo A-1 and HDL-PL did not change significantly, suggesting that the reduction in HDL-C represents cholesterol depletion of the HDL particle rather than a reduction in HDL mass. After discontinuing isotretinoin, serum lipid parameters returned to baseline levels.     

非酒精性脂肪肝患者血清非高密度脂蛋白胆固醇水平检测分析

目的了解非酒精性脂肪肝患者血清非高密度脂蛋白胆固醇(non-HDL-C)代谢水平,评价其临床应用价值。方法通过对单位体检者的影像学检查及肝功能、血糖、血脂等血清生化指标检测,并对其中非酒精性脂肪肝与体检健康者(对照组)进行比较。结果脂肪肝总检出率为9.15%,男性检出率12.50%,显著高于女性的5.99%(P<0.05);男性患者丙氨酸转氨酶(ALT)、间接胆红素(IBil)、甘油三酯(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A1(apoA1)、non-HDL-C、apoB100/apoA1、LDL-C/HDL-C、apoB100/HDL-C、总胆固醇/高密度脂蛋白胆固醇(TC/HDL-C)等与对照组比较差异具有统计学意义(P<0.05或P<0.01),女性患者天冬氨酸转氨酶(AST)、总胆红素(TBil)、直接胆红素(DBil)I、Bil、葡萄糖(Glu)、TC、TG、LDL-C、apoA1、non-HDL-C、apoB100/apoA1、LDL-C/HDL-C、apoB100/HDL-C、TC/HDL-C与对照组比较差异具有统计学意义(P<0.05或P<0.01);non-HDL-C与TC、LDL-C、TG、HDL-C、apoA1、apoB100、apoB100/apoA1、TC/HDL均显著相关(r=0.411~0.989,P<0.01)。结论非酒精性脂肪肝普遍具有脂类代谢异常和肝脏受损特点,non-HDL-C的检测有助于全面了解非酒精性脂肪肝脂类代谢状况。     

维持性血液透析对血清胆红素与血脂水平的影响

目的 探讨维持性血液透析(MHD)对慢性肾功能衰竭(CRF)尿毒症期患者血清胆红素与血脂水平的影响及临床意义.方法 42例CRF尿毒症期患者分别于血液透析前及持续血液透析半年后测定血清总胆红素(TB),直接胆红素(DB)、间接胆红素(IB)、总胆固醇(TC)、三酰甘油(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A1(apoA1)、载脂蛋白B(apoB)及血红蛋白(Hb)浓度、红细胞(RBC)计数,并与健康对照组进行比较.结果 尿毒症组血液透析前TB、DB、IB、Hb、RBC等指标均低于健康对照组(P＜0.01或P＜0.05),血清TG、LDL-C和apoB明显高于对照组(P＜0.01或P＜0.05),HDL-C明显低于对照组(P＜0.01),TC和apoA1虽略高于对照组,但差异无统计学意义(P＞0.05);而透析后TB、DB、IB较透析前下降(P＜0.01或P＜0.05),TC、TG、HDL-C,LDL-C、apoA1、apoB、Hb与RBC无明显变化(P＞0.05).结论 血液透析患者血清胆红素水平的下降、血脂代谢的紊乱是心脑血管并发症的主要危险因素.     

Fractional esterification rate of cholesterol and ratio of triglycerides to HDL-cholesterol are powerful predictors of positive findings on coronary angiography

BACKGROUND: We examined the predictive value of various clinical and biochemical markers for angiographically defined coronary artery disease (aCAD). Specifically, we assessed the value of the ratio of plasma triglyceride (TGs) to HDL-cholesterol (HDL-C) and the fractional esterification rate of cholesterol in plasma depleted of apolipoprotein B (apoB)-containing lipoproteins (FER(HDL)), a functional marker of HDL and LDL particle size. METHODS: Patients (788 men and 320 women) undergoing coronary angiography were classified into groups with positive [aCAD(+)] and negative [aCAD(-)] findings. Patient age, body mass index, waist circumference, blood pressure (BP), medications, drinking, smoking, exercise habits, and plasma total cholesterol (TC), LDL-cholesterol (LDL-C), HDL-unesterified cholesterol, HDL-C, TGs, FER(HDL), apoB, log(TG/HDL-C), and TC/HDL-C were assessed. Lipids and apoproteins were measured by standard laboratory procedures; FER(HDL) was determined by a radioassay. RESULTS: Members of the aCAD(+) group were older and had a higher incidence of smoking and diabetes than those in the aCAD(-) group. The aCAD(+) group also had higher TG, apoB, FER(HDL), and log(TG/HDL-C) and lower HDL-C values. aCAD(+) women had greater waist circumference and higher plasma TC and TC/HDL-C. aCAD(+) men, but not women, had higher plasma LDL-C. In the multivariate logistic model, the significant predictors of the presence of aCAD(+) were FER(HDL), age, smoking, and diabetes. If only laboratory tests were included in the multivariate logistic model, FER(HDL) appeared as the sole predictor of aCAD(+). Log(TG/HDL-C) was an independent predictor when FER(HDL) was omitted from multivariate analysis. CONCLUSIONS: FER(HDL) was the best laboratory predictor of the presence of coronary atherosclerotic lesions.     

高血压病人血脂和脂蛋白水平变化与肾损害关系

目的　探讨高血压病人血脂、脂蛋白水平变化与肾脏损害的关系。方法　随机取 94例高血压住院病人 ,分为高血压未发生肾损害组 (n =40 )、高血压早期肾损害组 (n =3 6)、高血压临床肾损害组 (n =18) ,以 98例血压正常者作为对照 ,检测血清总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)、载脂蛋白A1及B(apoA1、apoB)、脂蛋白 (a) [Lp(a) ] ,进行比较分析。 结果　高血压病人血清TC、TG、LDL C、apoB、Lp(a)水平明显高于正常对照组 ,差异有显著性意义 (P均 <0 .0 1) ;HDL C水平明显低于正常人对照组 (P <0 .0 5 )。TC、LDL C、apoB水平随高血压肾功能损害的加重呈现升高的趋势 ,高血压临床肾损害组病人血清Lp(a)水平及异常率明显高于高血压早期肾损害和未发生肾损害患者组 ,差异有显著性意义 (P <0 .0 5 ,P <0 .0 1) ,其余各指标异常率三组间差异均无显著性意义。结论　高血压病人存在着明显的脂质异常 ,高血压肾损害与脂质代谢紊乱相关联 ,肾损害可加重脂质代谢紊乱。     

Effects of lipids and lipid-lowering therapy on hemostatic factors in patients with myocardial infarction.

BACKGROUND: The risk of cardiovascular disease (CVD) is associated with specific hemostatic markers and lipid profiles, and evidence indicates that there are associations between lipid profiles and the levels of certain hemostatic factors. The disturbances in hemostasis and the risk of CVD can be ameliorated by lipid-lowering therapy. OBJECTIVE: We investigated the associations of lipid profiles with factor (F)VIIa, von Willebrand factor (VWF), D-dimer and plasminogen activator inhibitor-1 (PAI-1), and examined whether lipid-lowering statin therapy would affect the levels of these hemostatic markers. PATIENTS AND METHODS: This cross-sectional study analyzed 1045 postmyocardial infarction patients. RESULTS: In multivariate regression analyses (without adjusting for clinical covariates) HDL-cholesterol (HDL-C) and HDL size were independent and significant predictors of FVIIa; HDL size was a predictor of VWF; HDL size, HDL-C and LDL size were predictors of D-dimer; and triglyceride and HDL size were predictors of PAI-1. After adjusting for clinical covariates, HDL-C, lipoprotein (Lp)(a), apolipoprotein B (apoB) and warfarin were independent and significant predictors of FVIIa; HDL size, age, diabetes mellitus, insulin, race and warfarin were predictors of VWF; HDL-C, HDL size, LDL size, age, warfarin, hypertension and gender were predictors of D-dimer; and triglyceride, HDL size, body mass index, insulin and hypertension were predictors of PAI-1. Patients on statin therapy had significantly lower levels of D-dimer than those who were not on this therapy. CONCLUSION: There are significant associations of lipid profiles with hemostatic factors, the directions of which suggest novel pathways by which dyslipidemia may contribute to coronary heart disease.     

血清非高密度脂蛋白胆固醇水平对冠心病的临床诊断价值

目的：探讨血清非高密度脂蛋白胆固醇以及载脂蛋白B水平对冠心病的临床应用价值。方法检测118例冠心病（CHD）患者血清三酰甘油（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（apoAl）和载脂蛋白B（apoB）水平,并计算出非高密度脂蛋白胆固醇（non-HDL-C）及apoB/apoA1比值,分析各血脂指标与冠心病的关系。结果 CHD患者血清TG、non-HDL-C和apoB/apoA1比值均高于对照组（P〈0.01）,HDL-C和apo Al水平均低于对照组（P〈0.01）,差异有统计学意义。 HDL-C和apoA1的诊断灵敏度明显高于TC和LDL-C,而non-HDL-C、apoB以及apoB/apoA1的特异度均较高。结论血清non-HDL-C及apoB/apoA1比值的升高与心血管事件发生危险性明显正相关,其预警价值高于传统指标LDL-C和TC,与冠状动脉粥样硬化病变关系密切,尤其对于LDL-C和TC已经达标者控制其non-HDL-C和apoB水平在冠心病的防治中有重要意义。     

Atherogenic forms of dyslipidaemia in women with polycystic ovary syndrome

Objective: Dyslipidaemia is very common in patients with polycystic ovary syndrome (PCOS) but, beyond plasma lipids, atherogenic lipoprotein (Lp) and apolipoprotein (apo) alterations are still ill defined. Design: We measured concentrations of apoB, Lp(a) and small, dense low‐density lipoprotein (LDL) in 42 patients with PCOS [age: 28 ± 7 years, body mass index (BMI): 27 ± 5 kg/m²] vs. 37 age‐ and BMI‐matched healthy controls. Methods: Elevated Lp(a) levels considered were those > 30 mg/dl while elevated apoB concentrations were those > 100 g/l. Results: Polycystic ovary syndrome showed increased triglycerides levels (p = 0.0011) and lower high‐density lipoprotein (HDL)‐cholesterol concentrations (p = 0.0131) while total‐ and LDL cholesterol were similar. PCOS also showed smaller LDL size (p = 0.0005), higher levels of total small, dense LDL (p < 0.0001), higher concentrations of Lp(a), as considered as absolute values (p = 0.0143) and log‐transformed (p = 0.0014), while no differences were found in apoB levels. Elevated Lp(a) concentrations were found in 24% of PCOS, while elevated apoB levels were relatively uncommon (14%). Spearman correlation analysis revealed that Lp(a) concentrations were weakly correlated only with HDL‐cholesterol levels (r = ?0.378, p = 0.0431). In addition, 36% of patients with PCOS with normal plasma lipid profile showed elevated levels of Lp(a), apoB or small, dense LDL. Conclusions: Atherogenic Lp abnormalities may be found in one‐third of women with PCOS who have a normal lipid pattern. Future prospective studies are needed to test to which extent such atherogenic forms of dyslipidaemia may contribute to the increased cardiovascular risk in young women with PCOS.     

Differing associations of lipid and lipoprotein disturbances with the macrovascular and microvascular complications of type 1 diabetes.

OBJECTIVE: Cardiovascular disease (CVD) is increased in patients with type 1 diabetes, but lipid and lipoprotein patterns remain favorable. In contrast, nephropathy is associated with an adverse distribution. We compared the associations and predictive power of lipid and lipoprotein disturbances with these complications. RESEARCH DESIGN AND METHODS: A nested case-control study from the EURODIAB cohort of 140 case subjects with evidence of at least one complication and 84 control subjects with no complications were analyzed. Conventional and unconventional lipid and lipoprotein fractions, including apolipoprotein (apo)-A1, lipoprotein (Lp)-A1, LpA1/A2, apoB, and LDL particle size were measured centrally. RESULTS: CVD was only associated with increased LDL cholesterol (3.6 vs. 3.0 mmol/l, P = 0.02). In contrast, albuminuria was associated with elevated cholesterol, triglyceride, LDL, and apoB and with diminished LDL particle size. No disturbances in HDL and related lipoproteins were noted. In normoalbuminuric patients, CVD was not associated with any significant changes in lipids. CVD in macroalbuminuric patients was associated with increased triglyceride level (2.37 vs. 1.07 mmol/l, P = 0.001; P = 0.02 for CVD/albuminuria interaction) and LDL cholesterol (5.4 vs. 3.3 mmol/l, P = 0.005; P = 0.004 for interaction). Independent associations were observed for total cholesterol and for LDL particle size and albuminuria. CONCLUSIONS: Abnormalities in lipid and lipoprotein disturbances are more closely related to albuminuria than to CVD in patients with type 1 diabetes. Measurement of conventional parameters provide sufficient risk information. ApoB and LDL particle size offer limited extra information. HDL metabolism remains undisturbed in the presence of complications. These changes reflect associations with glycemic control, which is the key to understanding lipid and lipoprotein disturbances.     

血浆卵磷脂-胆固醇酰基转移酶与红细胞膜脂质成分的相关性探讨

目的 探讨缺血性脑血管病(ischemic cerebrovascular disorders,ICVD)患者血浆卵磷脂-胆固醇酰基转移酶(LCAT)活性与红细胞膜脂质成分含量的相关性。方法 采用酶学方法分别测定105例ICVD患者和65例健康对照者血浆LCAT活性,并同时检测血清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和载脂蛋白B(apoA1,apoB)、红细胞膜胆固醇(RBCM-CH)和红细胞膜磷脂(RBCM-PL)含量。结果 ICVD患者LCAT活性、HCL-C及apoA1含量明显低于对照组(P<0.05),LDL-C、apoB、RBCM-CH及RBCM-CH／RBCM-PL比值显著高于对照组(P<0.05),并且LCAT活性分别与HDL-C、及apoA1呈正相关(P<0.01、P<0.05),而与LDL-C和RBCM-CH呈负相关(P<0.05)。结论 ICVD患者脂质代谢方面的异常可能与血浆LCAT活性降低有关。     

Dyslipidemia is a strong predictor of myocardial infarction in subjects with chronic kidney disease

Abstract

Aim. To evaluate dyslipidemia as predictor of myocardial infarction (MI) in subjects with or without chronic kidney disease (CKD). Methods. In 142,394 middle-aged Swedes referred for laboratory evaluation, glomerular filtration rates (GFR) were estimated using the Modification of Diet in Renal Disease study equation. CKD was defined as GFR 15–60 mL/min/1.73 m². Subjects were stratified into presence or absence of CKD, and lipid measures were related to MI using Cox's proportional hazards regression. Results. During 12 years of follow-up there were 5,466 MIs. The adjusted hazard ratio for MI for the highest versus the lowest quartile of the apolipoprotein (apo) B/apoA-1 ratio among individuals without CKD was 2.88 (95% confidence interval 2.54–3.26) and for those with CKD 3.35 (2.25–4.91). The corresponding estimates for the total cholesterol/high-density lipoprotein (HDL) cholesterol ratio were 3.13 (2.78–3.52) and 3.54 (2.43–5.17), respectively. Receiver operator characteristics analyses showed an advantage in the prediction of MI for the apoB/apoA-1 ratio as compared to conventional lipids (P < 0.0001). Conclusions. The ratio of apoB/apoA-1, the ratio of total cholesterol/HDL cholesterol, and non-HDL cholesterol were all strong predictors of myocardial infarction, both among subjects with and without renal dysfunction, with a possible advantage for the apoB/apoA-1 ratio.     

2型糖尿病患者血清小而密低密度脂蛋白胆固醇水平与脂类代谢异常及胰岛素抵抗的关系

目的探讨2型糖尿病患者血清小而密低密度脂蛋白胆固醇（sdLDL-C）水平与脂类代谢异常及胰岛素抵抗的关系。方法 193例2型糖尿病患者按胰岛素抵抗情况分为胰岛素抵抗组144例与非胰岛素抵抗组49例。采用奥林巴斯AU2700全自动生化仪检测血清小而密低密度脂蛋白（sdLDL-C）、三酰甘油（TG）、总胆固醇（TC）、空腹血糖（FBG）等,采用化学发光法检测空腹胰岛素（FIN）、C肽,并计算胰岛素抵抗指数（HOMA-IR）等。结果 2型糖尿病患者中,与非胰岛素抵抗组相比,胰岛素抵抗组TG、TG/高密度脂蛋白（HDL）、TC/HDL、sdLDL-C水平显著升高（P〈0.05）,而HDL、载脂蛋白A（apo AⅠ）、脂蛋白（Lpa）水平显著降低（P〈0.05）;对2型糖尿病患者sdLDL-C、胰岛素抵抗指数进行多元逐步回归分析,sdLDL-C与TG（Log）、LDL-C/HDLC及TG/HDL-C（Log）呈正相比关性（r=0.638、0.601、0.290,P〈0.01）,与TG/HDL（Log）和LDL-C/apoB呈负相关关系（r=-0.589、-0.342,P〈0.01）;HOMA-IR与TG/HDL和sdLDL-C呈正相关关系（r=0.281、0.250,P〈0.01）,而与TC呈负相关（r=-0.233,P〈0.01）。结论 SdLDL-C能较好地反映2型糖尿病患者胰岛素抵抗对脂类代谢的影响,TG/HDL-C、LDL-C/HDL-C等提供的重要临床信息应在以后的临床应用中得到进一步认识和重视。     

载脂蛋白B与A-1比值对预测血管疾病风险的价值

目的评价、比较载脂蛋白B与A-1比值（apoB/apoA-1）和其他5种血脂指数在心脑血管疾病风险预测中的价值,探讨apoB/apoA-1比值警示界线的划分。方法分析测量3 972例受试者血脂水平,计算：血浆致动脉硬化指数、动脉硬化指数以及低密度脂蛋白、胆固醇、三酰甘油分别与高密度脂蛋白的比值和apoB/apoA-1比值;分别依年龄、性别、apoB/apoA-1阈界进行分组比较。结果同性别不同年龄段apoB/apoA-1比值比较,〉60岁组女性最高（P〈0.01）,40～60岁组男性最高（P〈0.01）;年龄〉60岁者,apoB/apoA-1在阈界0.9时男、女阳性率分别为20.7%,25.8%;不同性别6项指数比较,男性apoB/apoA-1明显高于女性（P〈0.01）;以apoB/apoA-1阈界0.9分组比较各项血脂指数,apoB/apoA-1差异最大（F=2 909.01）。结论在预测心脑血管疾病上apoB/apoA-1比值优于其他血脂指数,是预测心脑血管疾病风险敏感、准确的指数,apoB/apoA-1≥0.9为警示界线。     

Decreased plasma concentrations of apolipoprotein M in sepsis and systemic inflammatory response syndromes

ABSTRACT: INTRODUCTION: Apolipoprotein M (apoM) is present in 5% of high-density lipoprotein (HDL) particles in plasma. It is a carrier of sphingosine-1-phosphate (S1P), which is important for vascular barrier protection. The aim was to determine the plasma concentrations of apoM during sepsis and systemic inflammatory response syndrome (SIRS) and correlate them to levels of apolipoprotein A-I (apoA1), apolipoprotein B (apoB), HDL-, and low-density lipoprotein (LDL)-cholesterol. METHODS: Plasma samples from patients with (1), severe sepsis with shock (n = 26); (2), severe sepsis without shock (n = 44); (3), sepsis (n = 100); (4), infections without SIRS (n = 43); and (5) SIRS without infection (n = 20) were analyzed. The concentrations of apoM, apoA1, and apoB were measured with enzyme-linked immunosorbent assays (ELISAs). Total, HDL-, and LDL-cholesterol concentrations were measured with a commercial HDL/LDL cholesterol test. RESULTS: ApoM concentrations correlated negatively to acute-phase markers. Thus, apoM behaved as a negative acute-phase protein. Decreased values were observed in all patient groups (P < 0.0001), with the most drastic decreases observed in the severely sick patients. ApoM levels correlated strongly to those of apoA1, apoB, HDL, and LDL cholesterol. The HDL and LDL cholesterol levels were low in all patient groups, as compared with controls (P < 0.0001), in particular, HDL cholesterol. ApoA1 and apoB concentrations were low only in the more severely affected patients. CONCLUSIONS: During sepsis and SIRS, the plasma concentrations of apoM decrease dramatically, the degree of decrease reflecting the severity of the disease. As a carrier for barrier-protective S1P in HDL, the decrease in apoM could contribute to the increased vascular leakage observed in sepsis and SIRS.     

Dietary fats do not contribute to hyperlipidemia in children and adolescents with type 1 diabetes

OBJECTIVE: To determine the relative influence of diet, metabolic control, and familial factors on lipids in children with type 1 diabetes and control subjects. RESEARCH DESIGN AND METHODS: We assessed fasting serum cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, lipoprotein(a), apolipoprotein (apo)-A1, and apoB in 79 children and adolescents with type 1 diabetes and 61 age- and sex-matched control subjects, together with dietary intakes using a quantitative food frequency questionnaire. RESULTS: Total cholesterol, LDL cholesterol, apoB, HDL cholesterol, and apoA1 were significantly higher in children with diabetes. Children with diabetes had higher percentage energy intake from complex carbohydrates (P = 0.001) and fiber intake (P = 0.02), and they had lower intake of refined sugar (P < 0.001) and percentage energy from saturated fat (P = 0.045) than control subjects. Total cholesterol (beta = 0.43, P < 0.001), LDL cholesterol (beta = 0.4, P < 0.001), and apoB (beta = 0.32, P = 0.006) correlated independently with HbA(1c) but not dietary intake. HDL cholesterol (beta = 0.24, P = 0.05) and apoA1 (beta = 0.32, P = 0.004) correlated independently with HbA(1c), and HDL cholesterol (beta = -0.34, P = 0.009) correlated with percentage energy intake from complex carbohydrates. Triglycerides correlated independently with percentage energy intake from complex carbohydrates (beta = 0.33, P = 0.01) and insulin dose (beta = 0.26, P = 0.04). Subjects with diabetes and elevated LDL (>3.35 mmol/l, >130 mg/dl), for whom dietary therapy would be recommended, had significantly higher HbA(1c) (P = 0.007), but they had higher intake of complex carbohydrates than subjects with LDL cholesterol <3.35 mmol/l. CONCLUSIONS: Lipid abnormalities remain common in children and adolescents with type 1 diabetes who adhere to current dietary recommendations, and they relate to metabolic control but not dietary intake.     

人血清载脂蛋白M与血脂的相关性研究

目的 探讨血浆中载脂蛋白M(ApoM)水平与总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平的相关关系.方法 用ELISA法检测200例随机人群血清(男101例,女99例)中ApoM水平,酶法检测其TC、TG、HDL-C 和LDL-C水平,分析ApoM与各项目之间的相关性.结果 男女混合分析显示ApoM与TC水平呈正相关(r=0.418,P<0.01),与TG水平呈负相关(r=-0.407,P<0.01)同时与HDL-C呈正相关(r=0.786,P<0.01),与HDL-C/TC呈正相关(r=0.671,P<0.01).结论 血浆中ApoM水平与TC、HDL-C水平呈正相关,与TG水平呈负相关,提示ApoM在血脂代谢中有一定的生理功能.