Sabesin S M, Bertram P D, Freeman M R
Adv Intern Med. 1980;25:117-46.
In this review we have endeavored to emphasize the central role of the liver in normal lipoprotein metabolism and to demonstrate how derangements in these metabolic processes can lead to abnormalities characteristic of liver disease. Since changes in the concentration and composition of plasma lipids and lipoproteins occur frequently in liver disease, these findings may be useful in following the clinical course of patients with liver disease of various causes. It should be emphasized that elevated plasma triglycerides and cholesterol are due to underlying defects in lipoprotein metabolism and should not be confused with primary hyperlipidemia. Impaired cholesterol esterification, abnormal lipoprotein electrophoretic patterns and lipoprotein compositional changes, all reflect abnormalities of lipoprotein metabolism that are secondary to hepatocellular injury or cholestasis. These abnormalities are very sensitive indicators of fundamental metabolic defects that are related in part to LCAT and apoprotein activator deficiencies, impaired H-TGL and LPL activity and, perhaps, defective remnant lipoprotein clearance by the liver. Since these abnormalities tend to improve with clinical recovery they have proved to be reliable and sensitive indicators of hepatic function and thus, are useful in the assessment of liver disease.
在本综述中，我们力图强调肝脏在正常脂蛋白代谢中的核心作用，并阐述这些代谢过程的紊乱如何导致肝脏疾病的特征性异常。由于血浆脂质和脂蛋白的浓度及组成变化在肝脏疾病中经常出现，这些发现可能有助于追踪各种病因所致肝脏疾病患者的临床病程。应当强调的是，血浆甘油三酯和胆固醇升高是由于脂蛋白代谢的潜在缺陷，不应与原发性高脂血症相混淆。胆固醇酯化受损、异常的脂蛋白电泳图谱和脂蛋白组成变化，均反映了继发于肝细胞损伤或胆汁淤积的脂蛋白代谢异常。这些异常是基本代谢缺陷的非常敏感的指标，部分与卵磷脂胆固醇酰基转移酶（LCAT）和载脂蛋白激活剂缺乏、肝甘油三酯脂肪酶（H-TGL）和脂蛋白脂肪酶（LPL）活性受损以及肝脏对残余脂蛋白清除可能存在缺陷有关。由于这些异常往往随着临床恢复而改善，它们已被证明是肝功能可靠且敏感的指标，因此，在肝脏疾病的评估中很有用处。
