不同类型冠心病与脂蛋白及载脂蛋白异常

对三种不同类型冠心病患者作血清脂蛋白、载脂蛋白的测定，以了解不同类型冠心病患者脂质异常情况及异常类型。急性心肌梗死组21例；不稳定型心绞痛组27例；稳定型心绞痛组35例；正常对照组50例。总胆固醇和甘油三酯测定采用酶法；高密度脂蛋白胆固醇及其亚组分以聚乙二醇沉淀后用酶法测定；载脂蛋白A1、载脂蛋白B100以免疫火箭电泳法测定：脂蛋白（a）、载脂蛋白E采用酶联免疫法测定；低密度脂蛋白胆固醇含量由Friedwald公式推算。结果发现三组的脂蛋白（a）、载脂蛋白B100和载脂蛋白E含量均高于正常对照组；高密度脂蛋白胆固醇及其亚组分和载脂蛋白A1含量均低于正常对照组。低密度脂蛋白／高密度脂蛋白胆固醇的比值在急性心肌梗死组高于稳定型心绞痛组。三组冠心病患者的血清脂质异常检出率，以载脂蛋白B100、载脂蛋白E含量增高者最多见，次之为高密度脂蛋白胆固醇含量降低者；在三组的脂质异常类型方面，以脂蛋白（a）含量增高者为最多见。以上结果提示：应重视血清脂蛋白（a）、载脂蛋白B100、载脂蛋白E含量的增高以及高密度脂蛋白胆固醇含量的下降在冠心病患者血清脂质异常中的重要性；低密度脂蛋白胆固醇／高密度脂蛋白胆固醇比值增高是冠心病的一个预告指标。

Abnormalities of Lipoprotein and Apolipoprotein in Various Types of Coronary Heart Disease

Aim To study the abnormalities of lipoprotein and apoliprotein in patients with acute myocardial infarc-tion(AMI),unstable angina pectoris(UAP)and stable angina pectoris(SAP).Methods The subjects studied were 21 cases with AMI,27 cases with UAP,35 cases with SAP and 50cases as controls.The serum lipids and lipoprotein and apolipoprotein of each fasting serum were exam-ined simultaneously.Results 1.In AMI.UAP and SAP groups the serum levels of Lp(a)(360±364mg/L,297±301mg/L and 232±200mg/L respectively),Apo B100(0.89±0.28g/L,0.90±0.24g/L and 0.84±0.25g/L re-spectively)and Apo E(43.4±8.3mg/L,42.8±10.6mg/L and 42.6±8.1mg/L respectively)were signifi-cantly higher than that in healthy control group(Lp (a)124±110mg/L,Apo B1000.62±0.16g/L and Apo E 34.5±8.0mg/L);while in AMI,UAP and SAP groups.serum levels of HDLC(1.12±0.29mmol/L,1.18±0.25mmol/L and 1.25±0.28mmol/L respectively).HDL2C(0.35±0.14mmol/L,0.37±0.12mmol/L and 0.37±0.11 mmol/L respectively)and Apo AI(1.09±0.23g/L,1.09±0.24g/L and 1.13±0.23g/L respectively)were signifi-cantly lower than that in healthy control group(HDLC 1.405±0.26mmol/L,HDL2C 0.49±0.26mmol/L and ApoAI 1.25±0.21g/L).2.The ratio of LDLC/HDLC was higher in AMI group than that in SAP group.3.In serum lipid abnormality detectable rat in AMI,UAP and SAP groups,the increased serum Apo B100(53.13% to 57.89%),Apo E(43.48% to 63.64%)were the highest;and the next was the decreased HDLC(39.39% to 62.96%).In serum lipid abnormality pattern in AMI,UAP and SAP groups the increased LP(a)(37.97%)was the most frequent one.Conclusion Increased Lp(a).ApoB100.ApoE and decreased HDLC play an important role in coronary heart disease(CHD)and increased ratio of LDLC/HDLC is a predictor of CHD.