Montanari G, Vaccarino V, Franceschini G, Sirtori M, Bondioli A, Sirtori C R
Center E. Grossi Paoletti, University of Milan, Italy.
Int Angiol. 1987 Oct-Dec;6(4):339-49.
Metabolic and clinical peculiarities of patients with peripheral vascular disease (PVD) were evaluated in two studies. In the first study lipid and lipoprotein composition of 20 patients with PVD were examined. Twelve of these patients were normolipidemic, the other 8 hypertriglyceridemic. Ten normolipidemic and ten hyperlipidemic age-matched subjects served as controls. High density lipoprotein cholesterol (HDL-C) levels were markedly reduced in the hypertriglyceridemic, both with (35.1 +/- 5.0 mg/dl) and without (36.2 +/- 11.7 mg/dl) PVD as compared to the normolipidemic patients (47.0 +/- 6.3 mg/dl) and controls (48.1 +/- 10 mg/dl). All the PVD patients showed an increased apolipoprotein B content in the very low density lipoproteins (VLDL) as compared to controls (p less than 0.001). A significant correlation between VLDL-cholesterol and apo B levels was detected in both groups; however, two distinct populations could be clearly separated (slopes of the regression lines: PVD patients = 0.350; controls = 0.215, p less than 0.0001). These data suggest a possible discriminatory power of VLDL-apo B levels in PVD patients independent of other metabolic parameters. In the second study, the clinical activity of metformin (N, N-dimethylbiguanide) a widely used antidiabetic agent, on arterial blood flow was evaluated in 15 patients with PVD. Flow was determined by quantitative strain-gauge plethysmography during a cross-over trial, comparing 6 months of drug and placebo administration. Metformin (850 mg tid) significantly increased arterial flow after a standardized ischemia in both sequences. In spite of the minimal changes of plasma lipid levels during metformin, a highly significant increase of HDL-C levels (+8.3% during the whole treatment) was demonstrated. Plasma levels of isoprotein AI-1 were also raised during the metformin period. Although the mechanism/s of the beneficial effects of metformin on flow cannot, at present be defined, the reported results underline the significant therapeutic potential of this metabolic drug treatment in PVD.
两项研究评估了外周血管疾病（PVD）患者的代谢和临床特点。在第一项研究中，检测了20例PVD患者的脂质和脂蛋白组成。其中12例患者血脂正常，另外8例高甘油三酯血症。选取10例年龄匹配的血脂正常受试者和10例高脂血症受试者作为对照。与血脂正常患者（47.0±6.3mg/dl）和对照组（48.1±10mg/dl）相比，高甘油三酯血症患者无论是否患有PVD，其高密度脂蛋白胆固醇（HDL-C）水平均显著降低（分别为35.1±5.0mg/dl和36.2±11.7mg/dl）。与对照组相比，所有PVD患者极低密度脂蛋白（VLDL）中的载脂蛋白B含量均增加（p<0.001）。两组均检测到VLDL胆固醇与载脂蛋白B水平之间存在显著相关性；然而，两个不同的群体可以明显区分（回归线斜率：PVD患者=0.350；对照组=0.215，p<0.0001）。这些数据表明，VLDL-apo B水平在PVD患者中可能具有独立于其他代谢参数的鉴别能力。在第二项研究中，对15例PVD患者评估了广泛使用的抗糖尿病药物二甲双胍（N，N-二甲基双胍）对动脉血流的临床活性。在交叉试验期间，通过定量应变仪体积描记法测定血流，比较6个月的药物给药和安慰剂给药。二甲双胍（850mg，每日三次）在两个给药序列中均显著增加了标准化缺血后的动脉血流。尽管二甲双胍治疗期间血浆脂质水平变化极小，但HDL-C水平显著升高（整个治疗期间升高8.3%）。在二甲双胍治疗期间，血浆异蛋白AI-1水平也有所升高。尽管目前尚无法确定二甲双胍对血流有益作用的机制，但报告结果强调了这种代谢药物治疗在PVD中的显著治疗潜力。
