烟酸和 ω-3 脂肪酸对超重伴甘油三酯升高和高密度脂蛋白胆固醇降低患者载脂蛋白的影响。
Effects of niacin and omega-3 fatty acids on the apolipoproteins in overweight patients with elevated triglycerides and reduced HDL cholesterol.
机构信息
Cardiovascular Health Research Center, Sanford Research USD, Sioux Falls, SD, USA.
Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, USA.
出版信息
Atherosclerosis. 2015 Jun;240(2):520-5. doi: 10.1016/j.atherosclerosis.2015.04.793. Epub 2015 Apr 22.
OBJECTIVE
Prescription omega-3 acid ethyl esters (P-OM3) and extended release niacin (ERN) both have beneficial effects on plasma lipids and lipoproteins. The purpose of this study was to describe the effects of mono- and combination (Combo) therapy of these agents in patients with the metabolic syndrome.
METHODS
Very low density (VLDL), intermediate/low density (IDL/LDL, hereafter LDL), and high density lipoproteins (HDL) were isolated from 56 overweight patients with elevated triglyceride/HDL-C ratios at baseline and after 16 weeks of treatment with placebo, ERN (2g/day), P-OM3 (4g/day), or Combo and then analyzed by quantitative electrophoresis for apolipoproteins (apo) A1, A2, B, C2, C3 and E. Total plasma concentrations and the ratios of each apo with apoB (in VLDL and LDL) and with apoA1 (in HDL) were calculated. An apoC3 glycosylation index (a ratio between di- and mono-sialylated isoforms) was also determined in plasma and in each lipoprotein fraction.
RESULTS
ERN reduced plasma apoB (-11%, p < 0.05). Combo increased LDL apoE/apoB ratio (64%, p < 0.01) and LDL apoA1/apoB (91%, p < 0.05). ERN increased the apoC3 glycosylation index only in HDL (37%, p < 0.05), whereas P-OM3 and Combo increased the index in whole plasma (48% and 49%, respectively, p < 0.05 for both) and in every lipoprotein class (VLDL: 26%, p < 0.01 and 26%, p < 0.05; LDL: 55%, p < 0.01 and 61%, p < 0.01; HDL: 43%, p < 0.001 and 44%, p < 0.001, respectively). All findings were significant after adjustment for age, sex, body mass index (BMI), smoking, medications, and baseline apo value.
CONCLUSIONS
ERN produced a beneficial reduction in plasma apoB. The enrichment of LDL with apoE and apoA1 was unique to the Combo group and might be beneficial owing to the atheroprotective properties of apoE and HDL2 (a likely source of apoA1 in LDL fraction). The effect of therapies on the apoC3 glycosylation index is a novel finding, the implications of which will require further study.
目的
处方ω-3 酸乙酯（P-OM3）和烟酸缓释剂（ERN）对血浆脂质和脂蛋白均有有益作用。本研究旨在描述代谢综合征患者中单用和联合（Combo）应用这些药物的治疗效果。
方法
从 56 名超重患者中分离出极低密度脂蛋白（VLDL）、中间/低密度脂蛋白（IDL/LDL，以下简称 LDL）和高密度脂蛋白（HDL），这些患者的甘油三酯/HDL-C 比值升高。在基线和治疗 16 周后，患者分别接受安慰剂、ERN（2g/天）、P-OM3（4g/天）或 Combo 治疗，然后通过定量电泳分析载脂蛋白（apo）A1、A2、B、C2、C3 和 E。计算总血浆浓度以及每种载脂蛋白与载脂蛋白 B（在 VLDL 和 LDL 中）和载脂蛋白 A1（在 HDL 中）的比值。还在血浆和每种脂蛋白中测定 apoC3 糖基化指数（二和单唾液酸化异构体之间的比值）。
结果
ERN 降低了血浆 apoB（-11%，p<0.05）。Combo 增加了 LDL 载脂蛋白 E/载脂蛋白 B 比值（64%，p<0.01）和 LDL 载脂蛋白 A1/载脂蛋白 B（91%，p<0.05）。ERN 仅增加了 HDL 中的 apoC3 糖基化指数（37%，p<0.05），而 P-OM3 和 Combo 则分别增加了全血浆（48%和 49%，均为 p<0.05）和所有脂蛋白的指数（VLDL：26%，p<0.01 和 26%，p<0.05；LDL：55%，p<0.01 和 61%，p<0.01；HDL：43%，p<0.001 和 44%，p<0.001）。所有发现均经过年龄、性别、体重指数（BMI）、吸烟、药物和基线 apo 值的调整。
结论
ERN 降低了血浆 apoB，产生了有益作用。LDL 中载脂蛋白 E 和载脂蛋白 A1 的富集是 Combo 组特有的，可能是有益的，因为载脂蛋白 E 和 HDL2（LDL 中载脂蛋白 A1 的可能来源）具有抗动脉粥样硬化作用。治疗对 apoC3 糖基化指数的影响是一个新发现，其意义需要进一步研究。
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