Luister Alexandra, Schött Hans Frieder, Husche Constanze, Schäfers Hans-Joachim, Böhm Michael, Plat Jogchum, Gräber Stefan, Lütjohann Dieter, Laufs Ulrich, Weingärtner Oliver
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, D-66421 Homburg, Germany.
Institut für klinische Chemie und klinische Pharmakologie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany.
Steroids. 2015 Jul;99(Pt B):272-80. doi: 10.1016/j.steroids.2015.03.011. Epub 2015 Mar 23.
The aim of the study was to evaluate the relationship between phytosterols, oxyphytosterols, and other markers of cholesterol metabolism and concomitant coronary artery disease (CAD) in patients with severe aortic stenosis who were scheduled for elective aortic valve replacement. Markers of cholesterol metabolism (plant sterols and cholestanol as markers of cholesterol absorption and lathosterol as an indicator of cholesterol synthesis) and oxyphytosterols were determined in plasma and aortic valve tissue from 104 consecutive patients with severe aortic stenosis (n=68 statin treatment; n=36 no statin treatment) using gas chromatography-flame ionization and mass spectrometry. The extent of CAD was determined by coronary angiography prior to aortic valve replacement. Patients treated with statins were characterized by lower plasma cholesterol, cholestanol, and lathosterol concentrations. However, statin treatment did not affect the sterol concentrations in cardiovascular tissue. The ratio of campesterol-to-cholesterol was increased by 0.46±0.34μg/mg (26.0%) in plasma of patients with CAD. The absolute values for the cholesterol absorption markers sitosterol and campesterol were increased by 18.18±11.59ng/mg (38.8%) and 11.40±8.69ng/mg (30.4%) in the tissues from patients with documented CAD compared to those without concomitant CAD. Campesterol oxides were increased by 0.06±0.02ng/mg (17.1%) in the aortic valve cusps and oxidized sitosterol-to-cholesterol ratios were up-regulated by 0.35±0.2ng/mg (22.7%) in the plasma of patients with CAD. Of note, neither cholestanol nor the ratio of cholestanol-to-cholesterol was associated with CAD. Patients with concomitant CAD are characterized by increased deposition of plant sterols, but not cholestanol in aortic valve tissue. Moreover, patients with concomitant CAD were characterized by increased oxyphytosterol concentrations in plasma and aortic valve cusps.
本研究的目的是评估计划接受择期主动脉瓣置换术的重度主动脉瓣狭窄患者中植物甾醇、氧化植物甾醇及其他胆固醇代谢标志物与并发冠状动脉疾病（CAD）之间的关系。采用气相色谱-火焰离子化和质谱法，对104例连续的重度主动脉瓣狭窄患者（n = 68接受他汀类药物治疗；n = 36未接受他汀类药物治疗）的血浆和主动脉瓣组织中的胆固醇代谢标志物（植物甾醇和胆甾烷醇作为胆固醇吸收的标志物，羊毛甾醇作为胆固醇合成的指标）及氧化植物甾醇进行了测定。在主动脉瓣置换术前，通过冠状动脉造影确定CAD的程度。接受他汀类药物治疗的患者血浆胆固醇、胆甾烷醇和羊毛甾醇浓度较低。然而，他汀类药物治疗并未影响心血管组织中的甾醇浓度。CAD患者血浆中菜油甾醇与胆固醇的比值增加了0.46±0.34μg/mg（26.0%）。与无并发CAD的患者相比，有记录的CAD患者组织中胆固醇吸收标志物谷甾醇和菜油甾醇的绝对值分别增加了18.18±11.59ng/mg（38.8%）和11.40±8.69ng/mg（30.4%）。CAD患者主动脉瓣尖中菜油甾醇氧化物增加了0.06±0.02ng/mg（17.1%），血浆中氧化谷甾醇与胆固醇的比值上调了0.35±0.2ng/mg（22.7%）。值得注意的是，胆甾烷醇及胆甾烷醇与胆固醇的比值均与CAD无关。并发CAD的患者主动脉瓣组织中植物甾醇沉积增加，但胆甾烷醇未增加。此外，并发CAD的患者血浆和主动脉瓣尖中氧化植物甾醇浓度增加。
