Department of Medicine, Sunnybrook Health Sciences Centre, Division of Nephrology, Toronto, Ontario.
Department of Medicine, Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, McGill University Health Centre, Montreal, Quebec, Canada.
Curr Opin Endocrinol Diabetes Obes. 2021 Apr 1;28(2):90-96. doi: 10.1097/MED.0000000000000596.
This review summarizes the evidence that apolipoprotein B (apoB) integrates the conventional lipid markers - total cholesterol, triglycerides, LDL-cholesterol, and non-HDL-cholesterol - into a single index that accurately and simply quantitates the atherogenic risk due to the apoB lipoprotein particles.
Marked hypertriglyceridemia remains the essential signal for hyperchylomicronemia and potential pancreatitis. However, with the exception of Lp(a) and the abnormal cholesterol-enriched remnant particles that are the hallmark of type III hyperlipoproteinemia, recent evidence from discordance analyses and Mendelian randomization indicate that apoB integrates the risk due to the atherogenic lipoprotein particles because all LDL particles are, within the limits of our ability to measure any differences, equally atherogenic and all, except the largest VLDL particles are, within the limits of our ability to measure any differences, equally atherogenic.
Measuring apoB as well as the conventional lipids is essential for accurate diagnosis. For almost all follow-up, however, apoB is all that need be measured. ApoB is the Rosetta Stone of lipidology because dyslipoproteinemia cannot be understood unless apoB is measured.
本综述总结了载脂蛋白 B（apoB）将传统脂质标志物——总胆固醇、甘油三酯、LDL-胆固醇和非 HDL-胆固醇——整合为一个单一指数的证据，该指数能够准确、简单地定量由于 apoB 脂蛋白颗粒导致的动脉粥样硬化风险。
明显的高甘油三酯血症仍然是高乳糜微粒血症和潜在胰腺炎的重要信号。然而，除了 Lp(a)和作为 III 型高脂蛋白血症特征的异常富含胆固醇的残粒外，来自不一致性分析和孟德尔随机化的新证据表明，apoB 整合了由于动脉粥样硬化脂蛋白颗粒导致的风险，因为所有 LDL 颗粒在我们能够测量任何差异的范围内，都是同等的动脉粥样硬化，而且除了最大的 VLDL 颗粒外，在我们能够测量任何差异的范围内，都是同等的动脉粥样硬化。
测量 apoB 以及传统脂质对于准确诊断至关重要。然而，对于几乎所有的随访，apoB 是唯一需要测量的。apoB 是脂质学的罗塞塔石碑，因为如果不测量 apoB，就无法理解脂蛋白异常。
