Charlton-Menys V, Durrington P
Division of Cardiovascular and Endocrine Science, Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester, UK.
J Intern Med. 2006 May;259(5):462-72. doi: 10.1111/j.1365-2796.2006.01646.x.
Currently the apolipoprotein B:AI ratio integrates information about the potential for cardiovascular disease (CVD) risk reduction better than any other lipid or lipoprotein index. Certainly it could, with benefit, replace serum cholesterol and HDL cholesterol in the estimation of CVD risk. Defining the therapeutic target of statin therapy in terms of serum apolipoprotein B (apo B) rather than LDL cholesterol could also help to optimize statin treatment. Deciding whether a therapeutic response is adequate also requires knowledge of whether there is persisting hypertriglyceridaemia, because this gives an indication of whether small dense LDL is likely to have been satisfactorily reduced. Raising low levels of HDL, probably best measured as apo AI, may also prove to be an important aim of treatment. This is, however, a more complex issue and also depends on the mechanism by which a particular therapy alters HDL levels and on whether the capacity of HDL to perform its anti-inflammatory and antioxidative functions is restored. A meta-analysis of randomized clinical trials of statins in which apo B and apo AI have been reported could provide valuable information.
目前，载脂蛋白B与载脂蛋白AI的比值比其他任何血脂或脂蛋白指标都能更好地整合有关降低心血管疾病（CVD）风险可能性的信息。当然，在评估CVD风险时，它可以有益地替代血清胆固醇和高密度脂蛋白胆固醇。根据血清载脂蛋白B（apo B）而非低密度脂蛋白胆固醇来定义他汀类药物治疗的靶点，也有助于优化他汀类药物治疗。判断治疗反应是否充分还需要了解是否存在持续的高甘油三酯血症，因为这能表明小而密低密度脂蛋白是否可能已得到满意降低。提高低水平的高密度脂蛋白（可能最好以apo AI来衡量）也可能被证明是一个重要的治疗目标。然而，这是一个更复杂的问题，还取决于特定治疗改变高密度脂蛋白水平的机制，以及高密度脂蛋白执行其抗炎和抗氧化功能的能力是否得以恢复。对已报告apo B和apo AI的他汀类药物随机临床试验进行荟萃分析可能会提供有价值的信息。
