Moulin P, Appel G B, Ginsberg H N, Tall A R
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032.
J Lipid Res. 1992 Dec;33(12):1817-22.
Hyperlipidemia is a prominent feature of the nephrotic syndrome. Lipoprotein abnormalities include increased very low and low density lipoprotein (VLDL and LDL) cholesterol and variable reductions in high density lipoprotein (HDL) cholesterol. We hypothesized that plasma cholesteryl ester transfer protein (CETP), which influences the distribution of cholesteryl esters among the lipoproteins, might contribute to lipoprotein abnormalities in nephrotic syndrome. Plasma CETP, apolipoprotein and lipoprotein concentrations were measured in 14 consecutive untreated and 7 treated nephrotic patients, 5 patients with primary hypertriglyceridemia, and 18 normolipidemic controls. Patients with nephrotic syndrome displayed increased plasma concentrations of apoB, VLDL, and LDL cholesterol. The VLDL was enriched with cholesteryl ester (CE), shown by a CE/triglyceride (TG) ratio approximately twice that in normolipidemic or hypertriglyceridemic controls (P < 0.001). Plasma CETP concentration was increased in patients with untreated nephrotic syndrome compared to controls (3.6 vs. 2.3 mg/l, P < 0.001), and was positively correlated with the CE concentration in VLDL (r = 0.69, P = 0.004) and with plasma apoB concentration (r = 0.68, P = 0.007). Treatment with corticosteroids resulted in normalization of plasma CETP and of the CE/TG ratio in VLDL. An inverse correlation between plasma CETP and HDL cholesterol was observed in hypertriglyceridemic nephrotic syndrome patients (r = -0.67, P = 0.03). The dyslipidemia of nephrotic syndrome includes increased levels of apoB-lipoproteins and VLDL that are unusually enriched in CE and likely to be atherogenic. Increased plasma CETP probably plays a significant role in the enrichment of VLDL with CE, and may also contribute to increased concentrations of apoB-lipoproteins and decreased HDL cholesterol in some patients.
高脂血症是肾病综合征的一个显著特征。脂蛋白异常包括极低密度脂蛋白（VLDL）和低密度脂蛋白（LDL）胆固醇增加，以及高密度脂蛋白（HDL）胆固醇不同程度降低。我们推测，影响胆固醇酯在脂蛋白间分布的血浆胆固醇酯转运蛋白（CETP）可能与肾病综合征的脂蛋白异常有关。对14例未经治疗的肾病患者、7例接受治疗的肾病患者、5例原发性高甘油三酯血症患者和18例血脂正常的对照者测定了血浆CETP、载脂蛋白和脂蛋白浓度。肾病综合征患者的血浆载脂蛋白B、VLDL和LDL胆固醇浓度升高。VLDL富含胆固醇酯（CE），其CE/甘油三酯（TG）比值约为血脂正常或高甘油三酯血症对照者的两倍（P<0.001）。与对照者相比，未经治疗的肾病综合征患者血浆CETP浓度升高（3.6 vs. 2.3 mg/l，P<0.001），且与VLDL中的CE浓度呈正相关（r = 0.69，P = 0.004），与血浆载脂蛋白B浓度呈正相关（r = 0.68，P = 0.007）。皮质类固醇治疗使血浆CETP及VLDL中的CE/TG比值恢复正常。在高甘油三酯血症肾病综合征患者中观察到血浆CETP与HDL胆固醇呈负相关（r = -0.67，P = 0.03）。肾病综合征的血脂异常包括载脂蛋白B-脂蛋白和VLDL水平升高，这些脂蛋白异常富含CE且可能具有致动脉粥样硬化作用。血浆CETP升高可能在VLDL富含CE过程中起重要作用，并且在一些患者中可能也导致了载脂蛋白B-脂蛋白浓度升高和HDL胆固醇降低。
