Rosoklija Ankica, Georgievska-Ismail Ljubica, Dzekova-Stojkova Sloboda
Prilozi. 2004;25(1-2):67-82.
Low HDL cholesterol level in the blood increases the risk of unwanted coronary events in patients with verified CAD, which can be considerably decreased by appropriate and on-time application of pharmacologic and non-pharmacologic therapeutical measures. Numerous studies have shown that the level of the serum lipids, measured in the first 24 hours of the acute myocardial infarction, in fact is the basal lipid level, which is liable to changes immediately after the event, and gets back to its initial (basal) value within the next 6-12 weeks. In order to confirm if there are changes in the lipid profile and what they look like, particularly the HDL cholesterol in the blood, in 230 middle aged patients (59.87 +/- 13 years old), mostly males (66.5%) with ST-elevation acute myocardial infarction (STEMI), a follow-up of the HDL cholesterol level was performed, taken from the vein blood and determined by standard enzymatic methods at different time intervals after the actual event (24 hours, 3-7 days, 10-14 days, 30-60 days, 60-90-days) was performed. The results acquired showed that the patients with STEMI had a lower initial HDL cholesterol level, which showed a tendency to decrease three days after the actual event, and to be gradually "normalized" after 60-90 days, i.e. not only turning back the HDL cholesterol values to the initial level, but their overcoming too. It is interesting to mention, that the average value of HDL cholesterol level in the blood, checked after 60-90 days after the actual event, is overcoming that basal value in a positive sense, but it was further on higher than the desired aim of 40 mg/dl (1.03 mmol/l). From the results of our follow-ups, we can conclude that the optimal time for determining the HDL cholesterol level in the blood in patients with STEMI, are the first 24 hours of the actual event, since in the first 24 hours there is a relevant decrease of the HDL cholesterol level in the blood. The values of the lipid profile acquired at that period, should be considered as basal.
血液中高密度脂蛋白胆固醇（HDL-C）水平较低会增加确诊冠心病患者发生不良心血管事件的风险，而通过适当且及时地应用药物和非药物治疗措施，这种风险可大幅降低。大量研究表明，急性心肌梗死最初24小时测得的血脂水平实际上是基础血脂水平，该水平在事件发生后会立即改变，并在接下来的6 - 12周内恢复到初始（基础）值。为了确定血脂谱是否发生变化以及变化情况如何，特别是血液中的HDL-C，对230例中年患者（59.87±13岁）进行了随访，这些患者大多为男性（66.5%），患有ST段抬高型急性心肌梗死（STEMI）。在实际事件发生后的不同时间间隔（24小时、3 - 7天、10 - 14天、30 - 60天、60 - 90天），采集静脉血并采用标准酶法测定HDL-C水平。结果显示，STEMI患者的初始HDL-C水平较低，在实际事件发生三天后呈下降趋势，并在60 - 90天后逐渐“正常化”，即不仅HDL-C值恢复到初始水平，甚至还超过了初始水平。有趣的是，在实际事件发生60 - 90天后检测的血液中HDL-C平均水平在正向意义上超过了基础值，但仍高于40mg/dl（1.03mmol/l）的理想目标。从我们的随访结果可以得出结论，对于STEMI患者，测定血液中HDL-C水平的最佳时间是实际事件发生后的最初24小时，因为在此期间血液中HDL-C水平会有显著下降。该时期获得的血脂谱值应被视为基础值。
