Kobayashi Junji, Tateishi Sumiko, Maruyama Tokiko, Kudoh Akito, Murano Shunichi
Department of Internal Medicine, Shimotsuga General Hospital, 5-32 Fujimicho, Tochigi City, Tochigi 328-8505, Japan.
Clin Chim Acta. 2003 Sep;335(1-2):33-8. doi: 10.1016/s0009-8981(03)00244-4.
C-reactive protein (CRP) is a well-established, sensitive marker of systemic inflammation and the risk of cardiovascular disease. High-density lipoprotein (HDL) is an anti-atherogenic lipoprotein known to be regulated by genetic and acquired factors.
The patient was a 77-year-old Japanese woman, who was diagnosed with type 2 diabetes mellitus (DM), with a body height of 152 cm and a weight of 65 kg (body mass index 28.1 kg/m2). She suffered from diabetic foot gangrene in her right foot with high-grade fever when she visited our hospital. Her plasma glucose (PG) concentration and serum CRP were markedly elevated being 21.6 mmol/l and 370 mg/l, respectively, while her serum HDL-C concentrations were markedly low being 0.13 mmol/l. She was immediately admitted to our hospital and received intensive insulin treatment, along with intravenous-administration of antibiotics. Her general conditions were gradually improved and the high-grade fever disappeared, with concentrations of plasma PG and serum CRP being reduced, and concurrent reciprocal increase in her serum HDL-C concentrations.
To determine the potential causative factors responsible for the drastic change in serum HDL-C concentrations, we investigated the relationship of serum HDL-C to serum CRP, serum total protein (TP) and PG. Serum CRP and PG showed inverse relationships with serum HDL-C, while serum TP concentrations showed a positive association with HDL-C. After multivariate analyses with CRP, TP and PG as independent variables and serum HDL-C as dependent variable, CRP maintained its independent association with serum HDL-C. CRP also showed inverse correlations with lipoprotein lipase (LPL) mass and cholesteryl ester transfer protein mass.
In acute inflammation and poorly controlled diabetes, CRP is suggested to be inversely associated with serum HDL-C, independent of PG and TP.
C反应蛋白（CRP）是一种公认的全身性炎症和心血管疾病风险的敏感标志物。高密度脂蛋白（HDL）是一种抗动脉粥样硬化脂蛋白，已知受遗传和后天因素调节。
患者为一名77岁的日本女性，被诊断为2型糖尿病（DM），身高152cm，体重65kg（体重指数28.1kg/m²）。她因右足糖尿病足坏疽伴高热前来我院就诊。她的血浆葡萄糖（PG）浓度和血清CRP显著升高，分别为21.6mmol/l和370mg/l，而血清HDL-C浓度显著降低，为0.13mmol/l。她立即被收入我院，接受强化胰岛素治疗，并静脉注射抗生素。她的一般情况逐渐改善，高热消退，血浆PG和血清CRP浓度降低，同时血清HDL-C浓度相应升高。
为确定导致血清HDL-C浓度急剧变化的潜在病因，我们研究了血清HDL-C与血清CRP、血清总蛋白（TP）和PG的关系。血清CRP和PG与血清HDL-C呈负相关，而血清TP浓度与HDL-C呈正相关。以CRP、TP和PG为自变量，血清HDL-C为因变量进行多变量分析后，CRP与血清HDL-C保持独立相关性。CRP还与脂蛋白脂肪酶（LPL）质量和胆固醇酯转运蛋白质量呈负相关。
在急性炎症和糖尿病控制不佳的情况下，CRP与血清HDL-C呈负相关，独立于PG和TP。
