根据血浆总胆固醇、甘油三酯和载脂蛋白 B 诊断 III 型高脂蛋白血症。

Diagnosis of type III hyperlipoproteinemia from plasma total cholesterol, triglyceride, and apolipoprotein B.

机构信息

Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, H7.22, Royal Victoria Hospital, MUHC, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1.

出版信息

J Clin Lipidol. 2007 Aug;1(4):256-63. doi: 10.1016/j.jacl.2007.07.006. Epub 2007 Jul 27.

DOI:10.1016/j.jacl.2007.07.006

PMID:21291689

Abstract

OBJECTIVE

Our objective was to develop a simple algorithm that could be applied in routine clinical practice to diagnose type III hyperlipoproteinemia based on plasma total cholesterol, triglyceride and apolipoprotein (Apo) B.

METHODS

Analysis of plasma lipid, lipoprotein lipid, and apolipoprotein data from 1771 patients in a tertiary care lipid clinic, from whom all data had been collected prospectively by standardized methods. Of the 1771, based on the Fredrickson classification, 16 had type I hyperlipoproteinemia, 736 type IIa hyperlipoproteinemia, 371 type IIb hyperlipoproteinemia, 38 type III hyperlipoproteinemia, 509 type IV hyperlipoproteinemia, and 101 type V hyperlipoproteinemia.

RESULTS

Mean plasma ApoB was highest in type IIb (1.53 ± 0.36 g/L), borderline high (1.1 ± 0.23 g/L) in type IV, normal in type III and type V (1.04 ± 0.21 g/L and 0.96 ± 0.40 g/L, respectively) and low in type I (0.48 ± 0.16 g/L). In type III hyperlipoproteinemia, very low-density lipoprotein ApoB (ie, d<1.006 g/mL) accounted for 42.3% of total ApoB, a value that was substantially higher than in any of the other dyslipoproteinemias. The total cholesterol (TC)/ApoB ratio was similar in the uncommon dyslipoproteinemias-type I, III, and V hyperlipoproteinemia (10.5 ± 4.8, 8.7 ± 1.8, 10.3 ± 7.7, respectively)-and much higher than in the common dyslipoproteinemias-type IIa, IIb, and type IV hyperlipoproteinemia (5.0 ± 0.4, 4.6 ± 0.4, 4.9 ± 1.1, respectively). Notwithstanding that the TC/ApoB area under the curve-receiver operating characteristic (AUC-ROC) was very high (0.93), it did not discriminate among the uncommon dyslipoproteinemias. However, the triglyceride (TG)/ApoB ratio was much higher in type I (42.4 ± 28.8) and type V (25.6 ± 30.2) than in type III (5.8 ± 3.2). All cases of type III had a TC/ApoB ratio >6.2 and a TG/ApoB ratio of <10.0. Using these cutpoints, there were also no false positives. Based on the TC/ApoB ratio and the TG/ApoB ratio, the AUC-ROC was 0.99.

CONCLUSIONS

These data indicate that type III hyperlipoproteinemia can be reliably diagnosed based on plasma cholesterol, TG, and ApoB.

摘要

目的

我们的目的是开发一种简单的算法，以便能够根据血浆总胆固醇、甘油三酯和载脂蛋白（Apo）B 在常规临床实践中诊断出 III 型高脂蛋白血症。

方法

对来自一家三级护理脂质诊所的 1771 名患者的血浆脂质、脂蛋白脂质和载脂蛋白数据进行分析，所有数据均通过标准化方法前瞻性收集。在这 1771 名患者中，根据弗雷德里克森分类，16 名患有 I 型高脂蛋白血症，736 名患有 IIa 型高脂蛋白血症，371 名患有 IIb 型高脂蛋白血症，38 名患有 III 型高脂蛋白血症，509 名患有 IV 型高脂蛋白血症，101 名患有 V 型高脂蛋白血症。

结果

在 IIb 型（1.53 ± 0.36 g/L）中，平均血浆 ApoB 最高，在 IV 型中（1.1 ± 0.23 g/L）边缘升高，在 III 型和 V 型中正常（分别为 1.04 ± 0.21 g/L 和 0.96 ± 0.40 g/L），在 I 型中最低（0.48 ± 0.16 g/L）。在 III 型高脂蛋白血症中，极低密度脂蛋白 ApoB（即 d<1.006 g/mL）占总 ApoB 的 42.3%，这一数值明显高于其他任何一种脂蛋白血症。总胆固醇（TC）/ApoB 比值在罕见的脂蛋白血症（I 型、III 型和 V 型高脂蛋白血症）中相似（分别为 10.5 ± 4.8、8.7 ± 1.8、10.3 ± 7.7），且明显高于常见的脂蛋白血症（IIa、IIb 和 IV 型高脂蛋白血症）（分别为 5.0 ± 0.4、4.6 ± 0.4、4.9 ± 1.1）。尽管 TC/ApoB 曲线下面积-受试者工作特征（AUC-ROC）非常高（0.93），但它并不能区分罕见的脂蛋白血症。然而，I 型（42.4 ± 28.8）和 V 型（25.6 ± 30.2）的甘油三酯（TG）/ApoB 比值明显高于 III 型（5.8 ± 3.2）。所有 III 型病例的 TC/ApoB 比值均>6.2，TG/ApoB 比值均<10.0。使用这些切点，也没有假阳性。基于 TC/ApoB 比值和 TG/ApoB 比值，AUC-ROC 为 0.99。