Fujiwara R, Kutsumi Y, Hayashi T, Kim S S, Misawa T, Tada H, Nishio H, Toyota K, Tamai T, Nakai T
Third Department of Internal Medicine, Fukui Medical School, Japan.
Jpn Circ J. 1990 May;54(5):493-500. doi: 10.1253/jcj.54.493.
The relationship of plasma lipid and apolipoprotein (apo) concentrations and plasma insulin response to oral glucose load to angiographically determined coronary artery disease (CAD) was investigated in 65 normolipidemic (plasma cholesterol less than 230 mg/dl and plasma triglyceride less than 150 mg/dl) males. According to the results of coronary angiography, the patients were divided into 2 groups: patients with normal coronary artery, NCA group (n = 21); and patients with coronary artery disease, CAD group (n = 44). No significant differences in concentrations of plasma cholesterol and triglyceride were observed between the CAD and NCA groups. In the CAD group cumulative lifetime tobacco consumption was higher and high density lipoprotein (HDL) cholesterol concentration was lower than those in the NCA group. The variables that correlated with the severity of CAD, defined by the number of lesions and percent stenosis, were levels of plasma apo A-I and apo B. Prevalence of subjects with reduced oral glucose tolerance did not differ between 2 groups. However, hyperinsulinemic response to oral glucose load was present in the CAD group. HDL-cholesterol concentration, the sum of plasma insulin levels and the magnitude of the early insulin response during oral glucose challenge were accurate predictors of the presence of but not the severity of CAD. Multivariate analysis of the data confirmed the independent effect of plasma levels of apo A-I and apo B on the severity of CAD. The present data indicated that plasma levels of apo A-I and apo B were powerful discriminators in the normolipidemic CAD patients and that a high insulin response might be an indicator of enhanced susceptibility to the distinct coronary atherosclerosis.
在65名血脂正常（血浆胆固醇低于230mg/dl且血浆甘油三酯低于150mg/dl）的男性中，研究了血浆脂质和载脂蛋白（apo）浓度以及口服葡萄糖负荷后的血浆胰岛素反应与经血管造影确定的冠状动脉疾病（CAD）之间的关系。根据冠状动脉造影结果，将患者分为两组：冠状动脉正常患者，即NCA组（n = 21）；冠状动脉疾病患者，即CAD组（n = 44）。CAD组和NCA组之间血浆胆固醇和甘油三酯浓度未观察到显著差异。CAD组的累积终生烟草消费量较高，高密度脂蛋白（HDL）胆固醇浓度低于NCA组。与由病变数量和狭窄百分比定义的CAD严重程度相关的变量是血浆apo A-I和apo B水平。两组之间口服葡萄糖耐量降低的受试者患病率无差异。然而，CAD组存在对口服葡萄糖负荷的高胰岛素血症反应。HDL胆固醇浓度、口服葡萄糖激发期间血浆胰岛素水平总和以及早期胰岛素反应的幅度是CAD存在的准确预测指标，但不是CAD严重程度的预测指标。对数据的多变量分析证实了血浆apo A-I和apo B水平对CAD严重程度的独立影响。目前的数据表明，在血脂正常的CAD患者中，血浆apo A-I和apo B水平是有力的鉴别指标，并且高胰岛素反应可能是对明显冠状动脉粥样硬化易感性增强的一个指标。
