Berneis Kaspar, Jeanneret Christina, Muser Jürgen, Felix Barbara, Miserez André R
Department of Internal Medicine and Central Laboratories, Basel University Hospital Bruderholz, Switzerland 4101.
Metabolism. 2005 Feb;54(2):227-34. doi: 10.1016/j.metabol.2004.08.017.
The atherogenic lipoprotein phenotype is characterized by an increase in plasma triglycerides, a decrease in high-density lipoprotein (HDL), and the prevalence of small, dense low-density lipoprotein (LDL) particles. The present study investigated the clinical significance of LDL size and subclasses as markers of atherosclerosis in diabetes type 2. Thirty-eight patients with type 2 diabetes, total cholesterol of less than 6.5 mmol/L, and hemoglobin A1c (HbA1c) of less than 9% were studied. Median age was 61 years, mean (+/-SD) body mass index 29 +/- 4.3 kg/m2 , and mean HbA1c 7.1 +/- 0.9 %. Laboratory parameters included plasma lipids and lipoproteins, lipoprotein (a), apolipoprotein (apo) A-I, apo B-100, apo C-III, and high-sensitivity C-reactive protein. Low-density lipoprotein size and subclasses were measured by gradient gel electrophoresis and carotideal intima media thickness (IMT) by duplex ultrasound. By factor analysis, 10 out of 21 risk parameters were selected: age, body mass index, systolic blood pressure, smoking (in pack-years), HbA1c, high-sensitivity C-reactive protein, lipoprotein (a), LDL cholesterol, HDL cholesterol, and LDL particle size. Multivariate analysis of variance of these 10 risk parameters identified LDL particle size as the best risk predictor for the presence of coronary heart disease (P = .002). Smaller LDL particle size was associated with an increase in IMT (P = .03; cut-off >1 mm). Within the different lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, apo B, apo A-I, apo C-III, LDL particle size), LDL particle size was most strongly associated with the presence of coronary heart disease (P = .002) and IMT (P = .03). It is concluded that LDL size is the strongest marker for clinically apparent as well as non-apparent atherosclerosis in diabetes type 2.
动脉粥样硬化性脂蛋白表型的特征是血浆甘油三酯升高、高密度脂蛋白（HDL）降低以及小而密的低密度脂蛋白（LDL）颗粒增多。本研究调查了LDL大小和亚类作为2型糖尿病动脉粥样硬化标志物的临床意义。研究对象为38例2型糖尿病患者，总胆固醇低于6.5 mmol/L，糖化血红蛋白（HbA1c）低于9%。中位年龄为61岁，平均（±标准差）体重指数为29±4.3 kg/m2，平均HbA1c为7.1±0.9%。实验室参数包括血脂和脂蛋白、脂蛋白（a）、载脂蛋白（apo）A-I、apo B-100、apo C-III和高敏C反应蛋白。通过梯度凝胶电泳测量低密度脂蛋白大小和亚类，通过双功超声测量颈动脉内膜中层厚度（IMT）。通过因子分析，从21个风险参数中选择了10个：年龄、体重指数、收缩压、吸烟量（以包年计）、HbA1c、高敏C反应蛋白、脂蛋白（a）、LDL胆固醇、HDL胆固醇和LDL颗粒大小。对这10个风险参数进行多变量方差分析，确定LDL颗粒大小是冠心病存在的最佳风险预测指标（P = 0.002）。较小的LDL颗粒大小与IMT增加相关（P = 0.03；临界值>1 mm）。在不同血脂参数（总胆固醇、LDL胆固醇HDL胆固醇、甘油三酯、apo B、apo A-I、apo C-III、LDL颗粒大小）中，LDL颗粒大小与冠心病存在（P = 0.002）和IMT（P = = 0.03）的相关性最强。结论是，LDL大小是2型糖尿病临床显性和非显性动脉粥样硬化的最强标志物。
