皮质类固醇疗法可提高活动性结节病和低α脂蛋白血症患者的高密度脂蛋白胆固醇浓度。

Corticosteroid therapy increases HDL-cholesterol concentrations in patients with active sarcoidosis and hypoalphalipoproteinemia.

作者信息

Salazar Albert, Mañá Juan, Pintó Xavier, Argimón Josep Ma, Hurtado Isabel, Pujol Ramon

机构信息

Internal Medicine Service, University of Barcelona, Ciutat Sanitària i Universitària de Bellvitge, C/ Consell de Cent, 218, 3o 1a, 08011 Barcelona, Spain.

出版信息

Clin Chim Acta. 2002 Jun;320(1-2):59-64. doi: 10.1016/s0009-8981(02)00046-3.

DOI:10.1016/s0009-8981(02)00046-3

PMID:11983201

Abstract

BACKGROUND

We have previously reported that the decrease in high-density lipoprotein (HDL)-cholesterol that is observed in patients with untreated sarcoidosis is limited to those with active disease.

AIM

To determine the effect of corticosteroids, used in the treatment of active sarcoidosis, on the reported lipoprotein metabolism abnormalities.

METHODS

We studied 62 patients with biopsy-proven sarcoidosis, all of them with active disease. Sarcoidosis activity was evaluated by means of clinical, chest X-ray, gallium-67 scan, serum angiotensin-converting enzyme (peptidyl-dipeptidase A) values, and pulmonary function tests. A total of 40 patients were not treated with prednisone and 22 patients were treated with prednisone. The mean daily prednisone dosage in the treated patients with sarcoidosis was 20 mg and the mean duration of prednisone therapy was 6 months. Analysis of lipoprotein metabolism included: serum cholesterol, low-density lipoprotein (LDL)-cholesterol, HDL-cholesterol, HDL(2)-cholesterol, HDL(3)-cholesterol, apolipoprotein (apo) A-I, apo B, and triglyceride concentrations.

RESULTS

When patients with active sarcoidosis not treated with prednisone were compared to those treated with prednisone, the former had significantly lower HDL-cholesterol (1.17+/-0.36 vs. 1.42+/-0.42 mmol/l; P=0.01) and HDL(2)-cholesterol (0.37+/-0.18 vs. 0.53+/-0.25 mmol/l; P=0.009) levels. Multiple regression analysis demonstrated that the HDL-cholesterol (P=0.004), HDL(2)-cholesterol (P=0.002), HDL(3)-cholesterol (P=0.02), and apo A-I (P=0.02) levels were the variables independently and significantly associated with steroid therapy.

CONCLUSIONS

Corticosteroid therapy, used in the treatment of active sarcoidosis, increased HDL-cholesterol levels to those seen in inactive disease. These changes are manifestations of reducing disease activity.

摘要

背景

我们之前报道过，在未经治疗的结节病患者中观察到的高密度脂蛋白（HDL）胆固醇降低仅限于患有活动性疾病的患者。

目的

确定用于治疗活动性结节病的皮质类固醇对所报道的脂蛋白代谢异常的影响。

方法

我们研究了62例经活检证实为结节病的患者，所有患者均患有活动性疾病。通过临床、胸部X线、镓-67扫描、血清血管紧张素转换酶（肽基二肽酶A）值和肺功能测试来评估结节病的活动性。40例患者未接受泼尼松治疗，22例患者接受泼尼松治疗。接受治疗的结节病患者泼尼松的平均日剂量为20mg，泼尼松治疗的平均持续时间为6个月。脂蛋白代谢分析包括：血清胆固醇、低密度脂蛋白（LDL）胆固醇、HDL胆固醇、HDL（2）胆固醇、HDL（3）胆固醇、载脂蛋白（apo）A-I、apo B和甘油三酯浓度。

结果

将未接受泼尼松治疗的活动性结节病患者与接受泼尼松治疗的患者进行比较时，前者的HDL胆固醇（1.17±0.36 vs. 1.42±0.42 mmol/L；P=0.01）和HDL（2）胆固醇（0.37±0.18 vs. 0.53±0.25 mmol/L；P=0.009）水平显著更低。多元回归分析表明，HDL胆固醇（P=0.004）、HDL（2）胆固醇（P=0.002）、HDL（3）胆固醇（P=0.02）和apo A-I（P=0.02）水平是与类固醇治疗独立且显著相关的变量。