Bakogianni M C, Kalofoutis C A, Skenderi K I, Kalofoutis A T
Department of Biological Chemistry, University of Athens, School of Medicine, Goudi, 115 27 Athens, Greece.
J Diabetes Complications. 2001 Sep-Oct;15(5):265-9. doi: 10.1016/s1056-8727(01)00159-3.
Low levels of high-density lipoprotein cholesterol (HDL-C) have a strong association with coronary artery disease (CAD) in patients with non-insulin-dependent diabetes mellitus (NIDDM). In this study, we tried to evaluate whether one or both of the major HDL subclasses (HDL2, HDL3) is strongly associated with the risk of CAD in NIDDM subjects.
The separation of HDL subclasses was carried out by ultracentrifugation in a Beckman Airfuge. HDL2 subclass was isolated from the supernatant and its cholesterol content was measured enzymatically. Plasma HDL3 cholesterol was calculated as the difference between results for total HDL cholesterol and HDL2 cholesterol.
NIDDM patients with CAD had significantly higher triglyceride levels compared to either control (217.09+/-55.04 versus 89.62+/-31.29 mg/dl, P=.001) or CAD patients without NIDDM (217.09+/-55.04 versus 156.28+/-46.39 mg/dl, P<.05). However, in the diabetic patients with CAD, there was a statistically significant decrease in HDL cholesterol (39.63+/-8.59 versus 55.86+/-13.49 mg/dl, P<.01), HDL2 cholesterol (8.74+/-3.28 versus 16.95+/-5.73 mg/dl, P<.001), and HDL3 cholesterol (31.23+/-7.41 versus 38.91+/-8.93 mg/dl, P<.05) in comparison to nondiabetic controls. Moreover, in the comparison between non-insulin-dependent diabetics with CAD and CAD subjects without NIDDM, HDL cholesterol (39.63+/-8.59 versus 46.13+/-6.33 mg/dl, P<.05) and HDL2 cholesterol (8.74+/-3.28 versus 11.84+/-4.01 mg/dl, P<.02) were significantly reduced, while HDL3 cholesterol levels were (31.23+/-7.41 versus 34.29+/-7.94 mg/dl, P=.92) unaltered. Additionally, the percentage reduction of cholesterol in HDL2 fraction was proportionately greater than the decrease in HDL3 subclass in both comparisons. Moreover, in NIDDM with CAD, HDL cholesterol was reduced by 29% and 14%, HDL2 cholesterol by 48% and 26%, and HDL3 cholesterol by 20% and 9%, compared relatively to controls and CAD subjects without NIDDM.
In conclusion, HDL2 is the more variable subclass and reflects changes in HDL. This suggests that the protective role of total HDL against CAD is mainly mediated through HDL2 fraction. Therefore, HDL2 might be a better predictor of coronary heart disease than total HDL, in non-insulin-dependent diabetes mellitus.
在非胰岛素依赖型糖尿病（NIDDM）患者中，高密度脂蛋白胆固醇（HDL-C）水平低与冠状动脉疾病（CAD）密切相关。在本研究中，我们试图评估主要的HDL亚类（HDL2、HDL3）中的一个或两个是否与NIDDM患者的CAD风险密切相关。
通过在贝克曼空气离心机中进行超速离心来分离HDL亚类。从上层清液中分离出HDL2亚类，并通过酶法测量其胆固醇含量。血浆HDL3胆固醇通过总HDL胆固醇和HDL2胆固醇结果之间的差值计算得出。
与对照组（217.09±55.04对89.62±31.29mg/dl，P = 0.001）或无NIDDM的CAD患者（217.09±55.04对156.28±46.39mg/dl，P<0.05）相比，患有CAD的NIDDM患者甘油三酯水平显著更高。然而，与非糖尿病对照组相比，患有CAD的糖尿病患者的HDL胆固醇（39.63±8.59对55.86±13.49mg/dl，P<0.01）、HDL2胆固醇（8.74±3.28对16.95±5.73mg/dl，P<0.001）和HDL3胆固醇（31.23±7.41对38.91±8.93mg/dl，P<0.05）在统计学上有显著降低。此外，在患有CAD的非胰岛素依赖型糖尿病患者与无NIDDM的CAD患者的比较中，HDL胆固醇（39.63±8.59对46.13±6.33mg/dl，P<0.05）和HDL2胆固醇（8.74±3.28对11.84±4.01mg/dl，P<0.02）显著降低，而HDL3胆固醇水平（31.23±7.41对34.29±7.94mg/dl，P = 0.92）未改变。此外，在两项比较中，HDL2组分中胆固醇降低的百分比均比HDL3亚类的降低成比例地更大。而且，与对照组和无NIDDM的CAD患者相比，患有CAD的NIDDM患者的HDL胆固醇降低了29%和14%，HDL2胆固醇降低了48%和26%，HDL3胆固醇降低了20%和9%。
总之，HDL2是更具变异性的亚类，反映了HDL的变化。这表明总HDL对CAD的保护作用主要通过HDL2组分介导。因此，在非胰岛素依赖型糖尿病中，HDL2可能比总HDL是更好的冠心病预测指标。
