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阿托伐他汀和ω-3脂肪酸对混合性高脂血症患者低密度脂蛋白亚组分及餐后高脂血症的影响。

Effects of atorvastatin and omega-3 fatty acids on LDL subfractions and postprandial hyperlipemia in patients with combined hyperlipemia.

作者信息

Nordøy A, Hansen J B, Brox J, Svensson B

机构信息

Department of Medicine, Institute of Clinical Medicine, University of Tromsø, Norway.

出版信息

Nutr Metab Cardiovasc Dis. 2001 Feb;11(1):7-16.

Abstract

BACKGROUND AND AIM

The aim of the present study was to see whether a moderate dose of omega-3 fatty acids (FA) potentiates the beneficial effects of statins on the high risk for coronary heart disease (CHD) in patients with combined hyperlipemia.

METHODS AND RESULTS

In the present double-blind parallel study, 42 patients with combined hyperlipemia with serum triglycerides 2-15 mmol/L-1 and serum total cholesterol > 5.3 mmol/L-1 at the end of a three-month dietary run-in period were treated with 10 mg/d atorvastatin for 10 or more weeks. During the last 5 weeks they were randomized into two groups that received either 1.68 g/d omega-3 FA as ethylesters of eicosapentaenoic (45%) and docosahexaenoic acids (39%), or placebo (corn oil). As expected, atorvastatin significantly reduced serum total LDL-cholesterol (LDL-C), triglycerides and apolipoproteins B, E, CII and CIII, whereas HDL-cholesterol (HDL-C) was increased. Addition of omega-3 FA further increased HDL-C (p < 0.03), and reduced systolic blood pressure (< 0.03), while the small dense LDL-particles (LDL III) (p < 0.05) and postprandial hypertriglyceridemia (p < 0.01) were reduced compared with the baseline, though there were no significant differences to the placebo group. This may be related to the large individual variation in these parameters and the small number of patients. No significant effects on basic or postheparin activities of lipoprotein lipase or hepatic lipase were observed after atorvastatin with or without addition of omega-3 FA.

CONCLUSIONS

This study indicates that addition of a low dose of omega-3 FA may further improve the risk profile for CHD in patients with combined hyperlipemia treated with atorvastatin. The effect is related to reduction of postprandial hyperlipemia and redistribution of LDL subfractions.

摘要

背景与目的

本研究旨在探讨中等剂量的ω-3脂肪酸(FA)是否能增强他汀类药物对合并高脂血症患者冠心病(CHD)高风险的有益作用。

方法与结果

在本双盲平行研究中,42例合并高脂血症患者在为期3个月的饮食导入期结束时,血清甘油三酯为2 - 15 mmol/L - 1且血清总胆固醇>5.3 mmol/L - 1,接受10 mg/d阿托伐他汀治疗10周或更长时间。在最后5周,他们被随机分为两组,一组接受1.68 g/d的ω-3 FA,为二十碳五烯酸(45%)和二十二碳六烯酸(39%)的乙酯,另一组接受安慰剂(玉米油)。正如预期的那样,阿托伐他汀显著降低了血清总低密度脂蛋白胆固醇(LDL - C)、甘油三酯以及载脂蛋白B、E、CII和CIII,而高密度脂蛋白胆固醇(HDL - C)升高。添加ω-3 FA进一步提高了HDL - C(p < 0.03),并降低了收缩压(< 0.03),同时与基线相比,小而密的低密度脂蛋白颗粒(LDL III)(p < 0.05)和餐后高甘油三酯血症(p < 0.01)有所降低,尽管与安慰剂组无显著差异。这可能与这些参数的个体差异大以及患者数量少有关。在使用或未使用ω-3 FA的情况下,阿托伐他汀对脂蛋白脂肪酶或肝脂肪酶的基础活性或肝素后活性均未观察到显著影响。

结论

本研究表明,在接受阿托伐他汀治疗的合并高脂血症患者中,添加低剂量的ω-3 FA可能进一步改善冠心病的风险状况。其作用与降低餐后高脂血症以及低密度脂蛋白亚组分的重新分布有关。

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