正常(或低)胆固醇冠心病患者的脂蛋白谱特点

目的研究血清总胆固醇（ＴＣ）正常或低于平均水平的冠心病（ＣＨＤ）患者的脂蛋白谱特点。方法观察诊断明确的男性ＣＨＤ２２５例，以年龄配对、生活水平相似的健康男子２２５例为对照。两组中均排除与脂代谢有关的疾病及用药。对血脂作多指标［１４项，包括载脂蛋白（ａｐｏ）８项］综合分析。结果ＣＨＤ患者中ＴＣ高于５．１７ｍｍｏｌ／Ｌ者１０８例（４８％），低于此水平者１１７例（５２％）。高ＴＣ组的血脂特点以低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）和ａｐｏＢ增高为主，低ＴＣ组（ＴＣ平均４．４１ｍｍｏｌ／Ｌ，相应的对照组为４．８１ｍｍｏｌ／Ｌ）的特点是高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）及其亚类明显偏低，尤以ａｐｏＡＩ低下最明显。多数ＨＤＬ－Ｃ低的病例并无甘油三酯增高，部分病例以低ＨＤＬ（包括ＨＤＬ－Ｃ，ａｐｏＡＩ、ＡＩ）为单一的血脂异常。逐步回归分析优选判断ＣＨＤ的指标，在低ＴＣ组首选是ａｐｏＡＩ，其次为脂蛋白（ａ）；但高ＴＣ组以ａｐｏＢ为首选。结论低ＴＣ组在ＬＤＬ致动脉硬化作用明显减弱的情况下，低ＨＤＬ成为主要的（独立的）脂类危险因素

Serum lipoprotein pattern of coronary heart disease patients with normal or low cholesterol levels

Objective To study the characteristics of lipoprotein pattern of coronary heart disease (CHD) patients with average or below average total serum cholesterol (TC) levels. Methods The subjects studied were 225 males with CHD (diagnosed by coronary angiography or with definite history of myocardial infarction), and age matched 225 healthy men as controls. Those with relevant diseases and taking lipid lowering drugs were excluded in both groups. Various lipids and lipoproteins (14 analytes including 8 kinds of apolipoproteins) of each fasting serum were analyzed simultaneously. Results CHD patients were divided into two groups with TC levels above or below 5.17 mmol/L (200 mg/dl). The group with higher TC levels (108 patients) had an average TC of 5.96 mmol/L (4.92 mmol/L for corresponding controls). The main lipoprotein abnormalities of this group were increased in LDL C and apoB, while the low TC group (117 patients) had an average TC of 4.41 mmol/L (4.81 mmol/L for corresponding controls). Decreased HDL (apoAI, apoAII, HDL C and its subgroups) was the most significant change. The low HDL C in most patients was not accompanied by high triglyceride level. Certain patients showed no any other lipid abnormality except low HDL in the absence of other known CHD risk factor. Progressive regression analysis selected apoAI and Lp(a) as the best discriminators for CHD in the low TC group, while apoB was the first selected discriminator in the high TC group. Conclusion While atherogenic action of LDL is weakened because of low LDL C and aopB level, decrease of HDL is the most important lipid risk factor of CHD. It is supposed that low HDL level may directly accelerate the development of coronary atherosclerosis.