Tomkin G H, Owens D
Department of Diabetes and Endocrinology, Trinity College Dublin and Adelaide and Meath Hospital, Dublin, Ireland.
Diabetes Metab Res Rev. 2001 Jan-Feb;17(1):27-43. doi: 10.1002/dmrr.179.
Atherosclerosis is the major cause of death in patients with diabetes. Low-density lipoprotein (LDL) being the most important cholesterol-carrying lipoprotein has been studied extensively in both diabetes and non-diabetes. This paper reviews the literature but also focuses on the precursors of LDL and in particular the postprandial apo B-containing lipoproteins. Abnormalities in the postprandial lipoproteins and alteration in chylomicron assembly and clearance are discussed and the evidence presented suggesting the importance of dysregulation of these lipoproteins in atherosclerotic progression. The relationship between chylomicron production in the intestine and hepatic release of very low-density lipoproteins (VLDL) is explored, as is the interrelationship between clearance rates of these lipoproteins. The size of LDL influences its atherogenicity. VLDL composition and size in relation to its influence on LDL is discussed. The effect of diet on the composition of lipoproteins and the relationship between fatty acid composition and clearance is reviewed. Evidence that diabetic control beneficially alters lipoprotein composition is presented suggesting how improved diabetic control may reduce atherosclerosis. The review concludes with a discussion on the effect of the apo B-containing lipoproteins and their modification through glycation and oxidation on macrophage and endothelial function.
动脉粥样硬化是糖尿病患者的主要死因。低密度脂蛋白（LDL）作为最重要的载脂蛋白，在糖尿病和非糖尿病患者中都得到了广泛研究。本文回顾了相关文献，同时关注LDL的前体，特别是餐后含载脂蛋白B的脂蛋白。文中讨论了餐后脂蛋白异常以及乳糜微粒组装和清除的改变，并提供了证据表明这些脂蛋白的失调在动脉粥样硬化进展中的重要性。探讨了肠道中乳糜微粒的产生与肝脏极低密度脂蛋白（VLDL）释放之间的关系，以及这些脂蛋白清除率之间的相互关系。LDL的大小会影响其致动脉粥样硬化性。讨论了VLDL组成和大小对LDL的影响。综述了饮食对脂蛋白组成的影响以及脂肪酸组成与清除之间的关系。文中提供了证据表明糖尿病控制可有益地改变脂蛋白组成，提示改善糖尿病控制可能如何降低动脉粥样硬化。综述最后讨论了含载脂蛋白B的脂蛋白及其通过糖基化和氧化修饰对巨噬细胞和内皮功能的影响。
