载脂蛋白 B/载脂蛋白 A-I 比值比 LDL-C 更能检测心血管风险。
ApoB/apoA-I ratio is better than LDL-C in detecting cardiovascular risk.
机构信息
Internal Medicine, Dipartimento di Scienze Mediche, Università degli Studi del Piemonte Orientale "Amedeo Avogadro" and Azienda Ospedaliero-Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100 Novara, Italy.
出版信息
Nutr Metab Cardiovasc Dis. 2011 Jun;21(6):406-11. doi: 10.1016/j.numecd.2009.11.002. Epub 2010 Feb 19.
BACKGROUND AND AIMS
Cardiovascular (CV) events occur even when LDL-C are <100mg/dL. To improve the detection of CV risk we investigated the apoB/apoA-I ratio versus LDL-C in subjects considered normal glucose tolerant (NGT) by oral glucose tolerance test (OGTT).
METHODS AND RESULTS
We enrolled 616 NGT (273 men and 343 women), and we measured insulin resistance, lipid profile, apoB/apoA-I and the factors compounding the metabolic syndrome (MetS). An unfavourable apoB/apoA-I (≥0.9 for males and ≥0.8 for females) was present in 13.9% of 108 patients with LDL-C <100mg/dL: compared to subjects with lower apoB/apoA-I (<0.9 for males and <0.8 for females), they had more elements of MetS and their lipid profile strongly correlated with high CV risk. Out of 314 patients with lower apoB/apoA-I, 40.12% had LDL-C ≥130mg/dL: these retained a more favourable lipid profile than corresponding subjects with elevated apoB/apoA-I ratio. Finally, we found a significant correlation between LDL-C and apoB/apoA-I ratio (r=0.48, p<0.0001).
CONCLUSIONS
In NGT with LDL-C <100mg/dL, a higher apoB/apoA-I exhibited an atherogenic lipid profile, indicating that LDL-C alone is insufficient to define CV risk. Independent from LDL-level, when apoB/apoA-I is lower, the lipid profile is, in fact, less atherogenic. This study demonstrates that apoB/apoA-I is at least complementary to LDL-C in identifying the "effective" CV risk profile of asymptomatic NGT subjects.
背景与目的
即使 LDL-C<100mg/dL，心血管（CV）事件仍会发生。为了提高 CV 风险的检出率，我们通过口服葡萄糖耐量试验（OGTT）研究了载脂蛋白 B/载脂蛋白 A-I 比值与 LDL-C 在被认为是正常糖耐量（NGT）的受试者中的相关性。
方法和结果
我们纳入了 616 例 NGT（273 名男性和 343 名女性），并测量了胰岛素抵抗、血脂谱、载脂蛋白 B/载脂蛋白 A-I 以及代谢综合征（MetS）的复合因素。在 108 例 LDL-C<100mg/dL 的患者中，有 13.9%存在不良的载脂蛋白 B/载脂蛋白 A-I（男性≥0.9，女性≥0.8）：与载脂蛋白 B/载脂蛋白 A-I 较低的患者相比（男性<0.9，女性<0.8），他们有更多的 MetS 元素，他们的血脂谱与高 CV 风险密切相关。在 314 例载脂蛋白 B/载脂蛋白 A-I 较低的患者中，有 40.12%的 LDL-C≥130mg/dL：这些患者的血脂谱比相应的载脂蛋白 B/载脂蛋白 A-I 比值升高的患者更有利。最后，我们发现 LDL-C 与载脂蛋白 B/载脂蛋白 A-I 比值之间存在显著相关性（r=0.48，p<0.0001）。
结论
在 LDL-C<100mg/dL 的 NGT 中，较高的载脂蛋白 B/载脂蛋白 A-I 表现出致动脉粥样硬化的血脂谱，表明 LDL-C 单独不足以确定 CV 风险。与 LDL 水平无关，当载脂蛋白 B/载脂蛋白 A-I 较低时，血脂谱实际上不那么具有致动脉粥样硬化性。本研究表明，载脂蛋白 B/载脂蛋白 A-I 在确定无症状 NGT 受试者的“有效”CV 风险谱方面至少与 LDL-C 具有互补性。
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