Winocour P H, Durrington P N, Bhatnagar D, Ishola M, Mackness M, Arrol S
University of Manchester, Department of Medicine, U.K.
Atherosclerosis. 1991 Jul;89(1):49-57. doi: 10.1016/0021-9150(91)90006-o.
The procedure of discontinuous gradient ultracentrifugation (DGU) was used to characterize the influence of early diabetic nephropathy on the composition of very low density lipoprotein (VLDL, flotation density 60-400 Svedberg (Sf) units), low density lipoprotein (LDL, flotation density 0-12 Sf) and subfractions of intermediate density lipoprotein (IDL1 and IDL2, 20-60 and 12-20 Sf, respectively). Forty-six subjects with type 1 (insulin-dependent) diabetes and serum creatinine, less than 140 mumol/l were studied, of whom 23 consistently had normal rates of albumin excretion (AER less than 15 micrograms/min), and 23 had persistent albuminuria (AER 20.0-960.6 micrograms/min). The two groups were similar with respect to total serum lipids, glycaemic control, age and body mass. The composition (lipid, protein and phospholipid) and mass of VLDL, LDL and IDL2 was not appreciably altered by early nephropathy, but free and total cholesterol concentration in IDL1 (Sf 20-60) was increased (total cholesterol 0.68 (0.09) (mean (SE)) vs. 0.47 (0.07) mmol/l, and free cholesterol 0.27 (0.04) vs. 0.17 (0.03) mmol/l, both P less than 0.05). The explanation of these findings was probably an accumulation in the circulation of the remnants of chylomicron metabolism and/or intermediates in the conversion from VLDL to IDL1. In addition, there was a decrease in serum high density lipoprotein (HDL) cholesterol in early nephropathy (1.27 (0.06) vs. 1.38 (0.10) mmol/l, P less than 0.05), due to a decrease in the HDL2 cholesterol subfraction (P less than 0.05). These findings may in part explain the increased risk of premature atherosclerosis associated with the development of albuminuria.
采用不连续梯度超速离心法（DGU）来研究早期糖尿病肾病对极低密度脂蛋白（VLDL，漂浮密度60 - 400斯维德伯格（Sf）单位）、低密度脂蛋白（LDL，漂浮密度0 - 12 Sf）以及中间密度脂蛋白亚组分（IDL1和IDL2，分别为20 - 60 Sf和12 - 20 Sf）组成的影响。对46例1型（胰岛素依赖型）糖尿病且血清肌酐低于140 μmol/l的患者进行了研究，其中23例尿白蛋白排泄率持续正常（AER低于15 μg/min），23例存在持续性蛋白尿（AER为20.0 - 960.6 μg/min）。两组在总血脂、血糖控制、年龄和体重方面相似。早期肾病并未明显改变VLDL、LDL和IDL2的组成（脂质、蛋白质和磷脂）及质量，但IDL1（Sf 20 - 60）中的游离胆固醇和总胆固醇浓度升高（总胆固醇分别为0.68（0.09）（均值（标准误））与0.47（0.07）mmol/l，游离胆固醇分别为0.27（0.04）与0.17（0.03）mmol/l，P均小于0.05）。这些发现的原因可能是乳糜微粒代谢残余物和/或从VLDL转化为IDL1过程中的中间产物在循环中蓄积。此外，早期肾病患者血清高密度脂蛋白（HDL）胆固醇降低（1.27（0.06）与1.38（0.10）mmol/l，P小于0.05），这是由于HDL2胆固醇亚组分降低所致（P小于0.05）。这些发现可能部分解释了与蛋白尿发生相关的动脉粥样硬化过早发生风险增加的原因。
