Navab Mohamad, Ananthramaiah G M, Reddy Srinivasa T, Van Lenten Brian J, Ansell Benjamin J, Hama Susan, Hough Greg, Bachini Eugene, Grijalva Victor R, Wagner Alan C, Shaposhnik Zory, Fogelman Alan M
Atherosclerosis Research Unit, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1679, USA.
Ann Med. 2005;37(3):173-8. doi: 10.1080/07853890510007322.
The ability of high-density lipoprotein (HDL) to promote cholesterol efflux is thought to be important in its protection against cardiovascular disease. Anti-inflammatory properties of HDL have emerged as additional properties that may also be important. HDL appears to have evolved as part of the innate immune system functioning to inhibit inflammation in the absence of an acute phase response (APR) but functioning to increase inflammation in the presence of an APR. Inbred strains of mice that are genetically susceptible to atherosclerosis have pro-inflammatory HDL, while inbred strains that are resistant to atherosclerosis have anti-inflammatory HDL. In one small study, humans with coronary heart disease (CHD) or CHD equivalents had pro-inflammatory HDL prior to statin therapy and about half continued to have pro-inflammatory HDL after statin therapy despite a profound decrease in plasma lipids. Pro-inflammatory HDL was relatively weak in its ability to promote cholesterol efflux while anti-inflammatory HDL was better in promoting cholesterol efflux. In other studies, oxidative alterations of the major protein of HDL, apolipoprotein A-I (apoA-I), impaired the ability of the apoA-I to promote cholesterol efflux. Thus, HDL structure and function may be more important than HDL-cholesterol levels in predicting risk for cardiovascular disease.
高密度脂蛋白（HDL）促进胆固醇流出的能力被认为在其预防心血管疾病中起着重要作用。HDL的抗炎特性已成为可能同样重要的其他特性。HDL似乎已进化成为先天免疫系统的一部分，在没有急性期反应（APR）时发挥抑制炎症的作用，但在有APR时发挥增加炎症的作用。对动脉粥样硬化遗传易感的近交系小鼠具有促炎的HDL，而对动脉粥样硬化有抗性的近交系小鼠具有抗炎的HDL。在一项小型研究中，患有冠心病（CHD）或CHD等效疾病的人类在他汀类药物治疗前具有促炎的HDL，并且尽管血浆脂质大幅下降，但约一半患者在他汀类药物治疗后仍继续具有促炎的HDL。促炎的HDL促进胆固醇流出的能力相对较弱，而抗炎的HDL在促进胆固醇流出方面表现更好。在其他研究中，HDL的主要蛋白质载脂蛋白A-I（apoA-I）的氧化改变损害了apoA-I促进胆固醇流出的能力。因此，在预测心血管疾病风险方面，HDL的结构和功能可能比HDL胆固醇水平更重要。
