Yamaguchi H, Homma Y, Handa S
Department of Internal Medicine, Tokai University School of Medicine, Boseidai, Isehara, Japan.
Nutr Metab Cardiovasc Dis. 2003 Dec;13(6):365-71. doi: 10.1016/s0939-4753(03)80005-4.
The risk factors for vasospastic angina pectoris (VSA) have not yet been well defined. We compared the plasma levels of lipids, apo(lipo)proteins, remnants of triglyceride (TG)-rich lipoproteins, oxidized low density lipoprotein (Ox-LDL), cholesteryl ester transfer protein (CETP) [which transfers esterified cholesterol (EC) from HDL to TG-rich lipoproteins and reduces plasma HDL levels], high-sensitivity C-reactive protein (hs-CRP), homocysteine and plasminogen-activator inhibitor (PAI)-1 in background-matched groups of controls, and patients with VSA or coronary atherosclerotic disease (CAD) (n=50 subjects each).
The cholesterol levels of remnant-like particles (RLP), which are equivalent to the remnants of TG-rich lipoproteins, were measured using a precipitation method. Ox-LDL, CETP and PAI-1 were measured by means of sandwich ELISA; hs-CRP by means of nephelometry; and homocysteine by means of HPLC. Plasma LDL-C levels were high only in the CAD group, and plasma apo E and PAI-1 levels were high only in the VSA group. The plasma levels of TG, apo CII and RLP-C were highest in the VSA group, followed by the CAD group. The plasma levels of apoB, apo CIII, Ox-LDL, CETP, hs-CRP and homocysteine were equally increased in both the VSA and CAD groups. The increases in plasma RLP-C, CETP, hs-CRP and homocysteine were not significantly different between stable and unstable states of angina pectoris in either the VSA or CAD group.
The increases in plasma TG-rich lipoproteins and their remnants were more significant markers of VSA than of CAD. The increases in plasma CETP, Ox-LDL, hs-CRP and homocysteine were equally important markers of VAS and CAD.
血管痉挛性心绞痛（VSA）的危险因素尚未明确界定。我们比较了背景匹配的对照组、VSA患者或冠状动脉粥样硬化性心脏病（CAD）患者（每组n = 50例受试者）血浆中的脂质、载脂蛋白、富含甘油三酯（TG）的脂蛋白残粒、氧化型低密度脂蛋白（Ox-LDL）、胆固醇酯转运蛋白（CETP）[其将酯化胆固醇（EC）从高密度脂蛋白（HDL）转运至富含TG的脂蛋白并降低血浆HDL水平]、高敏C反应蛋白（hs-CRP）、同型半胱氨酸和纤溶酶原激活物抑制剂（PAI）-1水平。
采用沉淀法测量相当于富含TG的脂蛋白残粒的类残粒颗粒（RLP）的胆固醇水平。通过夹心酶联免疫吸附测定法（ELISA）测量Ox-LDL、CETP和PAI-1；通过散射比浊法测量hs-CRP；通过高效液相色谱法（HPLC）测量同型半胱氨酸。仅CAD组的血浆低密度脂蛋白胆固醇（LDL-C）水平较高，仅VSA组的血浆载脂蛋白E和PAI-1水平较高。VSA组的血浆TG、载脂蛋白CII和RLP-C水平最高，其次是CAD组。VSA组和CAD组的血浆载脂蛋白B、载脂蛋白CIII、Ox-LDL、CETP、hs-CRP和同型半胱氨酸水平均升高。在VSA组或CAD组中，心绞痛的稳定和不稳定状态下，血浆RLP-C、CETP、hs-CRP和同型半胱氨酸的升高无显著差异。
血浆中富含TG的脂蛋白及其残粒的升高是VSA比CAD更显著的标志物。血浆CETP、Ox-LDL、hs-CRP和同型半胱氨酸的升高是VSA和CAD同等重要的标志物。
