Kostner Karam M, Kostner Gert M
Department of Medicine, Princess Alexandra Hospital, Woolloongabba, Australia.
Semin Vasc Med. 2004 May;4(2):211-4. doi: 10.1055/s-2004-835380.
Lp(a) appears to be one of the most atherogenic lipoproteins. It consists of an low-density lipoprotein core in addition to a covalently bound glycoprotein, apo(a). Apo(a) exists in numerous polymorphic forms. The size of the polymorphism is mediated by the variable number of kringle-4 Type 2 repeats found in apo(a). Plasma Lp(a) levels are determined to more than 90% by genetic factors. Plasma Lp(a) levels in healthy individuals correlate significantly highly with apo(a) biosynthesis, and not with its catabolism. There are several hormones that are known to have a strong effect on Lp(a) metabolism. In certain diseases, such as kidney disease, the Lp(a) catabolism is impaired, leading to elevations that are up to a fivefold increase. Lp(a) levels rise with age but are otherwise only little influenced by diet and lifestyle. There is no safe and efficient way of treating individuals with elevated plasma Lp(a) concentrations. Most of the lipid-lowering drugs have either no significant influence on Lp(a) or exhibit a variable effect in patients with different forms of primary and secondary hyperlipoproteinemia.
脂蛋白(a)[Lp(a)]似乎是最具致动脉粥样硬化性的脂蛋白之一。它除了含有一个共价结合的糖蛋白载脂蛋白(a)[apo(a)]外，还包含一个低密度脂蛋白核心。apo(a)存在多种多态性形式。这种多态性的大小由apo(a)中kringle-4 2型重复序列的可变数量介导。血浆Lp(a)水平90%以上由遗传因素决定。健康个体的血浆Lp(a)水平与apo(a)的生物合成显著高度相关，而与其分解代谢无关。已知有几种激素对Lp(a)代谢有强烈影响。在某些疾病中，如肾脏疾病，Lp(a)的分解代谢受损，导致其水平升高可达五倍。Lp(a)水平随年龄增长而升高，但在其他方面仅受饮食和生活方式的影响很小。目前没有安全有效的方法来治疗血浆Lp(a)浓度升高的个体。大多数降脂药物对Lp(a)要么没有显著影响，要么在不同类型的原发性和继发性高脂蛋白血症患者中表现出不同的效果。
