Oravec Stanislav, Gruber Kristína, Dostal Elisabeth, Mikl Johannes
2nd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
Neuro Endocrinol Lett. 2011;32(3):322-7.
The identification of a non-atherogenic and an atherogenic lipoprotein profile, non-athero phenotype A vs. athero phenotype B, in a group of hypercholesterolemic subjects reveals newly discovered non-atherogenic hypercholesterolemia. Individuals with this type of hypercholesterolemia, or hyper-betalipoproteinemia LDL1,2, are probably not at increased risk to develop a premature atherothrombosis or a sudden cardiovascular event. Examined individuals with hyper-betalipoproteinemia LDL1,2 were divided into two subgroups: individuals under 40 years of age, and older individuals between 46 and 71 years of age. Subjects in the under 40 years of age group did not have any apparent clinical or laboratory-proven impairment of the cardiovascular system. The older subjects with hyper-betalipoproteinemia and a non-atherogenic lipoprotein profile had only mild signs of clinically irrelevant aortic valve sclerosis.
A quantitative analysis of the lipoprotein spectrum in plasma in a group of hypercholesterolemic subjects was performed. An innovative electrophoresis method on polyacrylamide gel (PAG) was used for the analysis of plasma lipoproteins and for the identification of atherogenic vs. non-atherogenic lipoproteins in plasma. With regard to lipids, total cholesterol and triglycerides in plasma were analyzed with an enzymatic CHOD PAP method (Roche Diagnostics, FRG). A new parameter, the score for anti-atherogenic Risk (SAAR), was calculated as the ratio between non-atherogenic to atherogenic plasma lipoproteins in the examined subjects.
There was a high concentration of LDL1, and LDL2 subfractions (p<0.0001), and an extremely low concentration of LDL3-7 (p<0.0001) in the non-atherogenic lipoprotein profile of hyper-betalipoproteinemia LDL1,2 compared to the control group. Higher concentrations (p<0.0001) of lipids and lipoproteins in the non-atherogenic hypercholesterolemia, compared to the control group, were also found. The hyper-betalipoproteinemia LDL1,2 was also characterized by high SAAR values. There was found a higher concentration of HDL large and HDL intermediate subfractions in hypercholesterolemic subjects.
The advantages of this new diagnostic method include: (i) identification of the existence of a non-atherogenic hyper-betalipoproteinemia LDL1,2 in examined hypercholesterolemic subjects with untreated hypercholesterolemia (ii) introduction of a new risk measure, the score for anti-atherogenic risk (SAAR), for the estimation of atherogenic/anti-atherogenic risk. (iii) the presence of small dense LDL in plasma is decisive for the declaration of an atherogenic lipoprotein profile. It is valid for hyperlipidemia and for normolipidemia as well.
在一组高胆固醇血症患者中识别出非动脉粥样硬化性和动脉粥样硬化性脂蛋白谱，即非动脉粥样硬化表型A与动脉粥样硬化表型B，从而发现了新的非动脉粥样硬化性高胆固醇血症。患有这种类型高胆固醇血症或高β脂蛋白血症LDL1,2的个体，发生过早动脉粥样硬化血栓形成或突发性心血管事件的风险可能并未增加。对患有高β脂蛋白血症LDL1,2的个体进行检查并分为两个亚组：40岁以下个体以及46至71岁的老年个体。40岁以下年龄组的受试者没有任何明显的临床或实验室证实的心血管系统损害。患有高β脂蛋白血症且脂蛋白谱为非动脉粥样硬化性的老年受试者仅具有临床上无关紧要的主动脉瓣硬化的轻微体征。
对一组高胆固醇血症患者的血浆脂蛋白谱进行定量分析。采用一种创新的聚丙烯酰胺凝胶（PAG）电泳方法分析血浆脂蛋白，并识别血浆中动脉粥样硬化性与非动脉粥样硬化性脂蛋白。对于脂质，采用酶促CHOD PAP法（德国罗氏诊断公司）分析血浆中的总胆固醇和甘油三酯。计算一个新参数，抗动脉粥样硬化风险评分（SAAR），作为受检受试者中非动脉粥样硬化性血浆脂蛋白与动脉粥样硬化性血浆脂蛋白的比值。
与对照组相比，高β脂蛋白血症LDL1,2的非动脉粥样硬化性脂蛋白谱中LDL1和LDL2亚组分浓度较高（p<0.0001），而LDL3 - 7浓度极低（p<0.0001）。与对照组相比，非动脉粥样硬化性高胆固醇血症中脂质和脂蛋白浓度也较高（p<0.0001）。高β脂蛋白血症LDL1,2的特征还在于SAAR值较高。在高胆固醇血症患者中发现HDL大颗粒和HDL中间亚组分浓度较高。
这种新诊断方法的优点包括：（i）在未经治疗的高胆固醇血症的受检高胆固醇血症患者中识别出非动脉粥样硬化性高β脂蛋白血症LDL1,2的存在；（ii）引入一种新的风险衡量指标，即抗动脉粥样硬化风险评分（SAAR），用于评估动脉粥样硬化性/抗动脉粥样硬化性风险；（iii）血浆中存在小而密的LDL对于判定动脉粥样硬化性脂蛋白谱具有决定性意义。它对高脂血症和正常血脂血症均有效。
