Nasstrom Birgit, Stegmayr Bernd G, Olivecrona Gunilla, Olivecrona Thomas
Division of Nephrology, Department of Internal Medicine, Umeå University, Umeå, Sweden.
J Lab Clin Med. 2003 Aug;142(2):90-9. doi: 10.1016/S0022-2143(03)00059-3.
The functional pool of lipoprotein lipase (LPL) is anchored to heparan sulfate at the vascular endothelium. Injection of heparin releases the enzyme into the circulating blood. Animal experiments have shown that the enzyme is then extracted and degraded by the liver. Low molecular weight (LMW) heparin preparations are widely used in the clinic and are supposed to release less LPL. In this study, we infused a LMW heparin into healthy volunteers for 8 hours. The peak of LPL activity was only about 30% and the subsequent plateau of LPL activity only about 40% compared with those seen with conventional heparin. When a bolus of heparin was given after 4 hours' infusion of LMW or conventional heparin, only relatively small, and similar, amounts of LPL entered plasma. This suggests that the difference between LMW and conventional heparin lay in the ability to retain LPL in the circulating blood, not in the ability to release the lipase. Triglycerides (TGs) decreased when the heparin infusion was started, as expected from the high circulating LPL activities. After 1 to 2 hours, TG levels increased again, and after 8 hours they were about twice as high as before the heparin infusion. This indicates that the amount of LPL available for lipoprotein metabolism had become critically low in relation to TG transport rates. This study indicates that LMW heparin compared with conventional heparin causes as much or more depletion of LPL and subsequent impairment of TG clearing.
脂蛋白脂肪酶(LPL)的功能池锚定在血管内皮的硫酸乙酰肝素上。注射肝素会将该酶释放到循环血液中。动物实验表明,该酶随后会被肝脏摄取并降解。低分子量(LMW)肝素制剂在临床上广泛使用,且据推测其释放的LPL较少。在本研究中,我们对健康志愿者输注低分子量肝素8小时。与使用传统肝素相比,LPL活性峰值仅约为30%,随后的LPL活性平台期仅约为40%。当在输注低分子量或传统肝素4小时后给予一剂肝素时,只有相对少量且相似量的LPL进入血浆。这表明低分子量肝素与传统肝素之间的差异在于其在循环血液中保留LPL的能力,而非释放脂肪酶的能力。正如高循环LPL活性所预期的那样,开始输注肝素时甘油三酯(TGs)下降。1至2小时后,TG水平再次升高,8小时后约为肝素输注前的两倍。这表明相对于TG转运速率,可用于脂蛋白代谢的LPL量已变得极低。本研究表明,与传统肝素相比,低分子量肝素导致LPL的消耗程度相同或更高,进而损害TG清除。