Lucas Charles P, Boldrin Mark N, Reaven Gerald M
Medical Center, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
Am J Cardiol. 2003 Apr 15;91(8):961-4. doi: 10.1016/s0002-9149(03)00112-7.
The objective of this study was to quantify the effectiveness of orlistat plus a reduced calorie diet on decreasing cardiovascular disease risk in obese individuals with elevated low-density lipoprotein (LDL) cholesterol concentrations, and to compare the beneficial effects in patients with hypercholesterolemia only (type IIA) with those in subjects with combined dyslipidemia (type IIB). Hypercholesterolemic patients treated with orlistat lost more weight (mean +/- SEM 9.9 +/- 0.4 vs 6.1 +/- 0.5 kg, p = 0.0001) and had greater decreases in plasma cholesterol (p = 0.0001), LDL cholesterol (p = 0.0001), triglycerides (p = 0.06), glucose (p = 0.07), and insulin (p = 0.02) concentrations compared with the diet-only treated patients. The greater degree of weight loss in orlistat-treated subjects was similar irrespective of the form of dyslipidemia, and plasma total and LDL cholesterol and insulin levels decreased to a significantly greater degree (p <0.05) in those patients who received orlistat and who had either type IIA and IIB dyslipidemia. However, triglyceride and insulin concentrations decreased and high-density lipoprotein (HDL) cholesterol increased to a significantly greater degree following orlistat-assisted weight loss in patients with type IIB compared with type IIA subjects, which was associated with a significantly greater decrease in the ratio of LDL/HDL cholesterol. Thus, weight loss in response to a reduced calorie diet in obese hypercholesterolemic patients was associated with a significant decrease in plasma LDL cholesterol levels. The beneficial metabolic effects of weight loss were accentuated in response to orlistat administration, and the improvement was greatest in patients with combined dyslipidemia (type IIB).
本研究的目的是量化奥利司他联合低热量饮食对降低低密度脂蛋白（LDL）胆固醇浓度升高的肥胖个体心血管疾病风险的有效性，并比较仅患有高胆固醇血症（IIA型）的患者与合并血脂异常（IIB型）的患者的有益效果。与仅接受饮食治疗的患者相比，接受奥利司他治疗的高胆固醇血症患者体重减轻更多（平均±标准误 9.9±0.4 与 6.1±0.5 kg，p = 0.0001），血浆胆固醇（p = 0.0001）、LDL胆固醇（p = 0.0001）、甘油三酯（p = 0.06）、葡萄糖（p = 0.07）和胰岛素（p = 0.02）浓度下降幅度更大。无论血脂异常的形式如何，接受奥利司他治疗的受试者体重减轻程度更大，并且接受奥利司他治疗的IIA型和IIB型血脂异常患者的血浆总胆固醇、LDL胆固醇和胰岛素水平下降幅度明显更大（p <0.05）。然而，与IIA型受试者相比，IIB型患者在奥利司他辅助减肥后甘油三酯和胰岛素浓度下降，高密度脂蛋白（HDL）胆固醇升高幅度明显更大，这与LDL/HDL胆固醇比值显著降低有关。因此，肥胖高胆固醇血症患者对低热量饮食的体重减轻与血浆LDL胆固醇水平显著降低有关。奥利司他给药可增强体重减轻的有益代谢作用，在合并血脂异常（IIB型）的患者中改善最为明显。
