Hitsumoto Takashi, Yoshinaga Kunio, Sakurai Takeshi, Aoyagi Kaneyuki, Matsumoto Jun, Iizuka Takuo, Kaku Michihisa, Sugiyama Yuko, Kanai Masahito, Uchi Takashi, Noike Hirofumi, Ohsawa Hidefumi, Watanabe Hitoshi, Shirai Kohji
Department of Cardiovascular Center, Sakura Hospital, Toho University School of Medicine, Shimoshizu 564-1, Sakura, Chiba 285-0841.
J Cardiol. 2002 Jul;40(1):1-9.
Some normocholesterolemic patients have coronary artery disease (CAD) in Japan. This study evaluated the clinical significance of preheparin lipoprotein lipase mass as a risk factor for normocholesterolemic patients with CAD.
This study included 89 normocholesterolemic male patients with CAD (CAD group, 40 with stable organic angina pectoris, 19 with vasospastic angina pectoris, and 30 with acute myocardial infarction), and 13 normocholesterolemic males with normal coronary arteries (control group) with no stenotic lesion and negative reaction to intracoronary administration of acetylcholine. Preheparin lipoprotein lipase mass was measured by enzyme-linked immunosorbent assay. Coronary risk factors including preheparin lipoprotein lipase mass were compared between the two groups. Low-density lipoprotein (LDL) particle size and presence of midband were estimated by polyacrylamide gel disc electrophoresis.
Mild hypertriglyceridemia and low high-density lipoprotein (HDL) cholesterolemia were observed in the CAD group, and small particle size LDL and presence of midband were also common in the CAD group. Preheparin lipoprotein lipase mass level was significantly lower in the CAD group than the control group (52 +/- 18 vs 40 +/- 13 ng/ml, p = 0.005) as well as in each type of patient in the CAD group. Multiple regression analysis showed that small particle size LDL, low preheparin lipoprotein lipase mass and smoking were independent risk factors for CAD (p < 0.001, p = 0.007, p = 0.037). Low preheparin lipoprotein lipase mass concentration was observed in the small particle size LDL group and/or the midband positive group.
These results indicate that low preheparin lipoprotein lipase mass reflects insulin resistance and may be deeply involved in the progression of coronary arteriosclerosis.
在日本，一些血脂正常的患者患有冠状动脉疾病（CAD）。本研究评估了肝素前脂蛋白脂肪酶质量作为血脂正常的CAD患者危险因素的临床意义。
本研究纳入了89例血脂正常的男性CAD患者（CAD组，40例稳定型劳力性心绞痛患者，19例变异型心绞痛患者，30例急性心肌梗死患者），以及13例冠状动脉正常的血脂正常男性（对照组），这些患者无狭窄病变，冠状动脉内注射乙酰胆碱后反应阴性。采用酶联免疫吸附测定法测量肝素前脂蛋白脂肪酶质量。比较两组包括肝素前脂蛋白脂肪酶质量在内的冠状动脉危险因素。通过聚丙烯酰胺凝胶圆盘电泳估计低密度脂蛋白（LDL）颗粒大小和中带的存在情况。
CAD组观察到轻度高甘油三酯血症和低高密度脂蛋白（HDL）胆固醇血症，CAD组中小颗粒大小LDL和中带的存在也很常见。CAD组的肝素前脂蛋白脂肪酶质量水平显著低于对照组（52±18 vs 40±13 ng/ml，p = 0.005），CAD组各类型患者也是如此。多元回归分析显示，小颗粒大小LDL、低肝素前脂蛋白脂肪酶质量和吸烟是CAD的独立危险因素（p < 0.001，p = 0.007，p = 0.037）。在小颗粒大小LDL组和/或中带阳性组中观察到低肝素前脂蛋白脂肪酶质量浓度。
这些结果表明，低肝素前脂蛋白脂肪酶质量反映胰岛素抵抗，可能与冠状动脉粥样硬化的进展密切相关。
