Weis S, Kudchodkar B J, Clearfield M B, Lacko A G
Department of Medicine, Texas College of Osteopathic Medicine/University of North Texas, Fort Worth.
Artery. 1992;19(6):353-66.
Thirty subjects, 5 normotriglyceridemic (NTG) with low HDL cholesterol (HDL-C < 35 mg/dl) and 25 hypertriglyceridemic (HTG) with low and high HDL-C (HDL-C > 35 mg/dl) were selected fo this study. They were treated with gemfibrozil (600 mg BID) for 12 weeks. In both groups, gemfibrozil significantly reduced serum TG levels (p < 0.005), yet HDL-C increased significantly only in HTG patients (p < 0.005). The changes in HDL-C levels were highly variable (-40 to 50%) and appeared to be dependent on the levels of serum TG achieved during treatment. Based on post-treatment serum TG, the HTG patients were divided into 2 groups. Group 1 with serum TG of < 100 mg/dL and Group 2 with serum TG levels > 100 mg/dl. Significant post treatment increases in HDL-C were seen only in Group 1 (p < 0.005). The two groups had similar pretreatment serum TG and HDL-C levels but the LDL-C was significantly higher in Group 1 (p < 0.025). Pretreatment serum LDL-C also correlated positively with the increases in HDL-C during treatment (r = 0.51, p < 0.01, n = 25). Consequently, the patients were divided into three groups based on their initial serum LDL-C levels (Group 1: LDL-C < 130 mg/dl. Group 2: LDL-C, 130-159 mg/dl and Group 3: LDL-C > 160 mg/dl). The HDL-C levels increased significantly upon treatment only in Group 3. Pretreatment levels of serum TG and HDL-C were not significantly different among the three groups. Initial body weight (r = -0.43 p < 0.025, n = 30) and percent change in body weight during treatment (r = -0.47, p < 0.025, n = 30) correlated negatively with the percent reduction in serum TG. The change in body weight also showed significant negative correlation with the changes in HDL cholesterol (r = -0.48, p < 0.25, n = 30). We conclude that gemfibrozil is most effective in reducing serum triglycerides, LDL-C and increasing serum HDL-cholesterol in HTG patients who also have comparatively high initial LDL cholesterol levels (Fredrickson's type IIb phenotype). For effective improvement of HDL-cholesterol in most HTG patients, serum TG levels need to be lowered below 100 mg/dl. Furthermore, the benefit of gemfibrozil therapy may be significantly enhanced by weight loss during treatment.
本研究选取了30名受试者，其中5名正常甘油三酯血症（NTG）患者伴有低高密度脂蛋白胆固醇（HDL-C<35mg/dl），25名高甘油三酯血症（HTG）患者伴有低或高HDL-C（HDL-C>35mg/dl）。他们接受吉非贝齐（600mg，每日两次）治疗12周。在两组中，吉非贝齐均显著降低了血清甘油三酯水平（p<0.005），但仅在HTG患者中HDL-C显著升高（p<0.005）。HDL-C水平的变化高度可变（-40%至50%），且似乎取决于治疗期间达到的血清甘油三酯水平。根据治疗后的血清甘油三酯水平，HTG患者被分为两组。第1组血清甘油三酯<100mg/dL，第2组血清甘油三酯水平>100mg/dl。仅在第1组中观察到治疗后HDL-C显著升高（p<0.005）。两组治疗前的血清甘油三酯和HDL-C水平相似，但第1组的低密度脂蛋白胆固醇（LDL-C）显著更高（p<0.025）。治疗前血清LDL-C也与治疗期间HDL-C的升高呈正相关（r=0.51，p<0.01，n=25）。因此，根据患者初始血清LDL-C水平将其分为三组（第1组：LDL-C<130mg/dl。第2组：LDL-C，130-159mg/dl；第3组：LDL-C>160mg/dl）。仅在第3组中治疗后HDL-C水平显著升高。三组之间治疗前的血清甘油三酯和HDL-C水平无显著差异。初始体重（r=-0.43，p<0.025，n=30）和治疗期间体重变化百分比（r=-0.47，p<0.025，n=30）与血清甘油三酯降低百分比呈负相关。体重变化也与HDL胆固醇变化呈显著负相关（r=-0.48，p<0.25，n=30）。我们得出结论，对于初始LDL胆固醇水平相对较高（弗雷德里克森IIb型表型）的HTG患者，吉非贝齐在降低血清甘油三酯、LDL-C和升高血清HDL胆固醇方面最有效。为了有效改善大多数HTG患者的HDL胆固醇，血清甘油三酯水平需要降至100mg/dl以下。此外，治疗期间体重减轻可能会显著增强吉非贝齐治疗的益处。
