Nakamura Takamitsu, Takano Hajime, Umetani Ken, Kawabata Ken-ichi, Obata Jyun-ei, Kitta Yoshinobu, Kodama Yasushi, Mende Akira, Ichigi Yoshihide, Fujioka Daisuke, Saito Yukio, Kugiyama Kiyotaka
Department of Internal Medicine II, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Nakakoma-gun, Yamanashi 409-3898, Japan.
Atherosclerosis. 2005 Aug;181(2):321-7. doi: 10.1016/j.atherosclerosis.2005.01.012. Epub 2005 Feb 16.
This study aimed to determine whether elevated levels of remnant lipoprotein, an atherogenic triglyceride-rich lipoprotein, might be associated with coronary artery disease (CAD) and endothelial vasomotor dysfunction in metabolic syndrome. The fasting serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) were measured by an immunoseparation method in 210 patients with metabolic syndrome meeting ATP III criteria. Flow-mediated endothelium-dependent dilatation (FMD) in the brachial artery during reactive hyperemia was examined by high-resolution ultrasound technique. This study found that elevated RLP-C levels were a significant and independent risk factor for impaired FMD and angiographically proven coronary artery disease (CAD). Treatment with bezafibrate (n = 20) or atorvastatin (n = 20) for 4 weeks significantly reduced RLP-C levels, with a concomitant improvement in FMD. The % reduction in RLP-C levels from baseline after the treatment was independently correlated with the magnitude of improvement in FMD after adjustment for the % changes in levels of triglyceride, hsCRP, and IL-6, and HOMA index. Thus, elevated levels of RLP-C are a risk factor for CAD and endothelial vasomotor dysfunction, a predictor of coronary events, in metabolic syndrome. Measurement of RLP-C is useful for assessment of CAD risk and therapeutic effects in metabolic syndrome.
本研究旨在确定残余脂蛋白（一种富含致动脉粥样硬化甘油三酯的脂蛋白）水平升高是否可能与代谢综合征中的冠状动脉疾病（CAD）及内皮血管舒缩功能障碍相关。采用免疫分离法测定了210例符合ATP III标准的代谢综合征患者空腹血清中的残余脂蛋白水平（类残余脂蛋白颗粒胆固醇；RLP-C）。通过高分辨率超声技术检测反应性充血期间肱动脉的血流介导的内皮依赖性舒张功能（FMD）。本研究发现，RLP-C水平升高是FMD受损及血管造影证实的冠状动脉疾病（CAD）的一个显著且独立的危险因素。用苯扎贝特（n = 20）或阿托伐他汀（n = 20）治疗4周可显著降低RLP-C水平，并伴随FMD的改善。治疗后RLP-C水平较基线的降低百分比在调整甘油三酯、hsCRP、IL-6水平及HOMA指数的变化百分比后与FMD改善幅度独立相关。因此，在代谢综合征中，RLP-C水平升高是CAD及内皮血管舒缩功能障碍（冠状动脉事件的一个预测指标）的危险因素。测定RLP-C有助于评估代谢综合征中CAD风险及治疗效果。
