Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece.
Int J Clin Pract. 2012 Sep;66(9):843-53. doi: 10.1111/j.1742-1241.2012.02972.x.
Raised triglycerides (TG), decreased high-density lipoprotein cholesterol (HDL-C) levels and a predominance of small dense low density lipoproteins (sdLDL) are characteristics of the metabolic syndrome (MetS).
To compare the effect of high-dose rosuvastatin monotherapy with moderate dosing combined with fenofibrate or ω-3 fatty acids on the lipoprotein subfraction profile in patients with mixed dyslipidaemia and MetS.
We previously randomised patients with low-density lipoprotein cholesterol (LDL-C) > 160 and TG > 200 mg/dl to rosuvastatin monotherapy 40 mg/day (R group, n = 30) or rosuvastatin 10 mg/day combined with fenofibrate 200 mg/day (RF group, n = 30) or ω-3 fatty acids 2 g/day (Rω group, n = 30). In the present study, only patients with MetS were included (24, 23 and 24 in the R, RF and Rω groups respectively). At baseline and after 12 weeks of treatment, the lipoprotein subfraction profile was determined by polyacrylamide 3% gel electrophoresis.
The mean LDL size was significantly increased in all groups. This change was more prominent with RF than with other treatments in parallel with its greater hypotriglyceridemic capacity (p < 0.05 compared with R and Rω). A decrease in insulin resistance by RF was also noted. Only RF significantly raised HDL-C levels (by 7.7%, p < 0.05) by increasing the cholesterol of small HDL particles. The cholesterol of larger HDL subclasses was significantly increased by R and Rω.
All regimens increased mean LDL size; RF was the most effective. A differential effect of treatments was noted on the HDL subfraction profile.
升高的甘油三酯（TG）、降低的高密度脂蛋白胆固醇（HDL-C）水平和小而密的低密度脂蛋白（sdLDL）的优势是代谢综合征（MetS）的特征。
比较高剂量瑞舒伐他汀单药治疗与中等剂量联合非诺贝特或ω-3 脂肪酸对混合性血脂异常和 MetS 患者脂蛋白亚组分谱的影响。
我们之前将 LDL-C > 160 和 TG > 200 mg/dl 的患者随机分为瑞舒伐他汀 40 mg/天单药治疗组（R 组，n = 30）或瑞舒伐他汀 10 mg/天联合非诺贝特 200 mg/天组（RF 组，n = 30）或 ω-3 脂肪酸 2 g/天组（Rω 组，n = 30）。在本研究中，仅纳入 MetS 患者（R、RF 和 Rω 组分别为 24、23 和 24 例）。在基线和治疗 12 周后，通过聚丙烯酰胺 3%凝胶电泳测定脂蛋白亚组分谱。
所有组的 LDL 大小均显著增加。与其他治疗相比，RF 组的这种变化更为明显，同时其降甘油三酯能力更强（与 R 和 Rω 相比，p < 0.05）。还注意到 RF 降低了胰岛素抵抗。只有 RF 通过增加小 HDL 颗粒的胆固醇显著提高了 HDL-C 水平（增加 7.7%，p < 0.05）。R 和 Rω 显著增加了较大 HDL 亚类的胆固醇。
所有方案均增加了平均 LDL 大小；RF 是最有效的。治疗对 HDL 亚组分谱有不同的影响。
