Yamamoto Suguru, Narita Ichiei, Kotani Kazuhiko
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; Division of Community and Family Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan.
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan.
Clin Chim Acta. 2016 Jun 1;457:117-22. doi: 10.1016/j.cca.2016.04.012. Epub 2016 Apr 15.
The macrophage and its related cholesterol efflux are considered to be a key player in atherosclerotic formation in relation to the function of high-density lipoprotein (HDL). The HDL function can be evaluated by the reaction between lipid-loaded macrophages and lipid-acceptors in the HDL fraction from the plasma, apolipoprotein B-depleted serum, and/or whole serum/plasma. Recent studies have reported that an impaired cholesterol efflux of HDL is observed in patients with cardiometabolic diseases, such as dyslipidemia, diabetes mellitus, and chronic kidney disease. A population-based cohort study has reported an inverse association between the cholesterol efflux capacity of HDL and the incidence of atherosclerotic disease, regardless of the serum HDL-cholesterol level. Moreover, in this paper, when we summarized several clinical interventional studies of statin treatment that examined cholesterol efflux, a potential increase in the efflux in patients treated with statins was implied. However, the effect was not fully defined in the current situation because of the small sample sizes, lack of a unified protocol for measuring the efflux, and short-term intervention periods without cardiovascular outcomes in available studies. Further investigation is necessary to determine the effect of drugs on cholesterol efflux. With additional advanced studies, cholesterol efflux is a promising laboratory index to understand the HDL function.
就高密度脂蛋白（HDL）的功能而言，巨噬细胞及其相关的胆固醇流出被认为是动脉粥样硬化形成的关键因素。HDL的功能可以通过脂质负载的巨噬细胞与来自血浆、载脂蛋白B缺乏血清和/或全血清/血浆的HDL组分中的脂质受体之间的反应来评估。最近的研究报告称，在患有心脏代谢疾病（如血脂异常、糖尿病和慢性肾病）的患者中，观察到HDL的胆固醇流出受损。一项基于人群的队列研究报告称，HDL的胆固醇流出能力与动脉粥样硬化疾病的发病率呈负相关，无论血清HDL胆固醇水平如何。此外，在本文中，当我们总结了几项研究胆固醇流出的他汀类药物治疗的临床干预研究时，暗示了接受他汀类药物治疗的患者中流出可能增加。然而，由于现有研究样本量小、缺乏测量流出的统一方案以及短期干预且无心血管结局，目前这种效果尚未完全明确。有必要进行进一步研究以确定药物对胆固醇流出的影响。通过更多的深入研究，胆固醇流出有望成为了解HDL功能的实验室指标。
