高密度脂蛋白在糖尿病患者及相关心血管风险中的作用和功能。
The role and function of HDL in patients with diabetes mellitus and the related cardiovascular risk.
机构信息
105 Military Hospital with Outpatient Clinic in Żary, Domańskiego 2, 68-200, Żary, Poland.
Department of Nephrology, Hypertension and Family Medicine, WAM Teaching Hospital of Lodz, Żeromskiego 113, Łódź, 90-549, Poland.
出版信息
Lipids Health Dis. 2017 Oct 30;16(1):207. doi: 10.1186/s12944-017-0594-3.
BACKGROUND
Diabetes mellitus (DM) is a major public health problem which prevalence is constantly raising, particularly in low- and middle-income countries. Both diabetes mellitus types (DMT1 and DMT2) are associated with high risk of developing chronic complications, such as retinopathy, nephropathy, neuropathy, endothelial dysfunction, and atherosclerosis.
METHODS
This is a review of available articles concerning HDL subfractions profile in diabetes mellitus and the related cardiovascular risk. In this review, HDL dysfunction in diabetes, the impact of HDL alterations on the risk diabetes development as well as the association between disturbed HDL particle in DM and cardiovascular risk is discussed.
RESULTS
Changes in the amount of circulation lipids, including triglycerides and LDL cholesterol as well as the HDL are frequent also in the course of DMT1 and DMT2. In normal state HDL exerts various antiatherogenic properties, including reverse cholesterol transport, antioxidative and anti-inflammatory capacities. However, it has been suggested that in pathological state HDL becomes "dysfunctional" which means that relative composition of lipids and proteins in HDL, as well as enzymatic activities associated to HDL, such as paraoxonase 1 (PON1) and lipoprotein-associated phospholipase 11 (Lp-PLA2) are altered. HDL properties are compromised in patients with diabetes mellitus (DM), due to oxidative modification and glycation of the HDL protein as well as the transformation of the HDL proteome into a proinflammatory protein. Numerous studies confirm that the ability of HDL to suppress inflammatory signals is significantly reduced in this group of patients. However, the exact underlying mechanisms remains to be unravelled in vivo.
CONCLUSIONS
The understanding of pathological mechanisms underlying HDL dysfunction may enable the development of therapies targeted at specific subpopulations and focusing at the diminishing of cardiovascular risk.
背景
糖尿病（DM）是一个主要的公共卫生问题，其患病率不断上升，特别是在低收入和中等收入国家。两种糖尿病类型（1 型和 2 型）都与发生慢性并发症的高风险相关，如视网膜病变、肾病、神经病、内皮功能障碍和动脉粥样硬化。
方法
这是一篇关于高密度脂蛋白亚组分谱在糖尿病中的研究综述，以及相关的心血管风险。在这篇综述中，讨论了糖尿病中 HDL 功能障碍、HDL 改变对糖尿病发展风险的影响，以及 DM 中紊乱的 HDL 颗粒与心血管风险之间的关系。
结果
在 1 型和 2 型糖尿病的病程中，循环脂质的数量变化，包括甘油三酯和 LDL 胆固醇以及 HDL 都很常见。在正常状态下，HDL 发挥着多种抗动脉粥样硬化特性，包括逆向胆固醇转运、抗氧化和抗炎能力。然而，有人认为在病理状态下，HDL 变得“功能失调”，这意味着 HDL 中脂质和蛋白质的相对组成，以及与 HDL 相关的酶活性，如对氧磷酶 1（PON1）和脂蛋白相关磷脂酶 A2（Lp-PLA2）发生改变。由于 HDL 蛋白的氧化修饰和糖基化，以及 HDL 蛋白组转化为促炎蛋白，糖尿病患者的 HDL 特性受损。许多研究证实，在这群患者中，HDL 抑制炎症信号的能力显著降低。然而，确切的潜在机制在体内仍有待阐明。
结论
对 HDL 功能障碍的病理机制的理解可能使针对特定亚群的靶向治疗的发展成为可能，并着重于降低心血管风险。
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