Koivisto P V, Leinonen H
Second Department of Medicine, University of Helsinki, Finland.
Atherosclerosis. 1988 Mar;70(1-2):21-7. doi: 10.1016/0021-9150(88)90096-2.
We evaluated lower limb arterial circulation in 37 patients with heterozygous familial hypercholesterolemia using strain-gauge plethysmography. Nineteen patients were initially allocated to surgical therapy (ileal bypass operation), and 18 control patients were treated conservatively. After a follow-up period of 3-12 years (mean 10 yrs) the surgically treated patients had significantly lower serum total (9.4 vs. 11.9 mmol/l, P less than 0.001) and LDL (6.2 vs. 8.1 mmol/l, P less than 0.01) cholesterol and apoprotein B levels and higher HDL cholesterol (1.2 vs. 1.0 mmol/l, P less than 0.05) and apoprotein A-I levels compared with controls. There was no significant difference in the prevalence of intermittent claudication (16 vs. 6%) or coronary heart disease (68 vs. 61%) between the operated and control groups. The ankle-arm systolic blood pressure ratio was pathologically low in 53% of the operated and 72% of the control patients, and the toe-arm pressure ratio in 50% and 44%, respectively. These differences or the differences in the mean ankle-arm and toe-arm pressure ratios between the groups were not significant. The toe-ankle pressure gradient was normal in all but 2 patients indicating that atherosclerotic changes predominantly affect the more proximal arteries in familial hypercholesterolemia. Patients with peripheral arterial disease could not be differentiated by serum lipoprotein levels, blood pressure or the presence of coronary heart disease. However, smoking was more prevalent (38% vs. 0%, P less than 0.05) in patients with impaired peripheral circulation. We conclude that asymptomatic peripheral arterial disease is quite common in familial hypercholesterolemia, and that smoking increases its risk.(ABSTRACT TRUNCATED AT 250 WORDS)
我们采用应变计体积描记法评估了37例杂合子家族性高胆固醇血症患者的下肢动脉循环情况。19例患者最初被分配接受手术治疗（回肠旁路手术），18例对照患者接受保守治疗。经过3至12年（平均10年）的随访期后，接受手术治疗的患者血清总胆固醇（9.4 vs. 11.9 mmol/l，P<0.001）、低密度脂蛋白胆固醇（6.2 vs. 8.1 mmol/l，P<0.01）及载脂蛋白B水平显著降低，高密度脂蛋白胆固醇（1.2 vs. 1.0 mmol/l，P<0.05）及载脂蛋白A-I水平升高，与对照组相比差异有统计学意义。手术组与对照组之间间歇性跛行（16% vs. 6%）或冠心病（68% vs. 61%）的患病率无显著差异。手术组53%的患者及对照组72%的患者踝臂收缩压比值病理性降低，趾臂压比值分别为50%和44%。两组间这些差异或平均踝臂和趾臂压比值的差异均无统计学意义。除2例患者外，所有患者的趾-踝压力梯度均正常，表明在家族性高胆固醇血症中动脉粥样硬化改变主要影响更近端的动脉。外周动脉疾病患者无法通过血清脂蛋白水平、血压或冠心病的存在进行区分。然而，外周循环受损患者中吸烟更为普遍（38% vs. 0%，P<0.05）。我们得出结论，无症状外周动脉疾病在家族性高胆固醇血症中相当常见，且吸烟会增加其风险。（摘要截选至250字）
