Ziegler O, Guerci B, Candiloros H, Drouin P
Service de Médecine G, Hôpital Jeanne d'Arc, Toul, France.
Diabete Metab. 1995 Apr;21(2):127-38.
Lp(a) has atherogenic and thrombotic properties and is considered to be a major risk factor for the development of atherosclerotic disease. The risk of cardiovascular disease is increased in both insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM), and Lp(a) has attracted attention as a potential risk factor in diabetic patients. Lp(a) levels are "probably" elevated in IDDM patients and related to altered metabolic control and increased urinary albumin excretion rate or renal insufficiency, although results are controversial. There appears to be a real difference between the Lp(a) of patients with proliferative diabetic retinopathy and those with or without background retinopathy. The plasma Lp(a) level may therefore be associated with microangiopathy in some IDDM patients. However, data relating Lp(a) to complications of diabetes are limited, and the literature is conflicting. The few available data suggest that Lp(a) is not elevated in NIDDM patients and that there is no strong link between blood glucose control and plasma Lp(a). There is no clear evidence as to whether Lp(a) is related to microalbuminuria in NIDDM patients. There is little evidence for a correlation between increased risk of cardiovascular disease and plasma Lp(a) among diabetic patients. However, some diabetic patients with coronary heart disease have elevated plasma Lp(a), which seems to be correlated with genetic factors (especially the isoforms of apolipoprotein a) rather than to diabetes per se. Lp(a) synthesis and catabolism could be influenced by insulin or by diabetes and its metabolic concomitants. The atherogenic and thrombogenic potential of Lp(a) could also be increased in diabetic patients. Plasma Lp(a) should be measured for both IDDM and NIDDM patients. If the Lp(a) level is elevated, it seems reasonable to check the other major vascular risk factors.
脂蛋白(a)具有致动脉粥样硬化和血栓形成的特性，被认为是动脉粥样硬化性疾病发生的主要危险因素。胰岛素依赖型糖尿病（IDDM）和非胰岛素依赖型糖尿病（NIDDM）患者患心血管疾病的风险均会增加，而脂蛋白(a)作为糖尿病患者的潜在危险因素已受到关注。IDDM患者的脂蛋白(a)水平“可能”升高，且与代谢控制改变、尿白蛋白排泄率增加或肾功能不全有关，尽管结果存在争议。增殖性糖尿病视网膜病变患者与有或无背景性视网膜病变患者的脂蛋白(a)似乎存在实际差异。因此，在一些IDDM患者中，血浆脂蛋白(a)水平可能与微血管病变有关。然而，关于脂蛋白(a)与糖尿病并发症关系的数据有限，且文献报道相互矛盾。现有的少量数据表明，NIDDM患者的脂蛋白(a)水平未升高，血糖控制与血浆脂蛋白(a)之间没有紧密联系。尚无明确证据表明脂蛋白(a)与NIDDM患者的微量白蛋白尿有关。几乎没有证据表明糖尿病患者心血管疾病风险增加与血浆脂蛋白(a)之间存在相关性。然而，一些患有冠心病的糖尿病患者血浆脂蛋白(a)升高，这似乎与遗传因素（尤其是载脂蛋白a的亚型）有关，而非与糖尿病本身相关。脂蛋白(a)的合成和分解代谢可能受胰岛素、糖尿病及其代谢伴随因素的影响。糖尿病患者中脂蛋白(a)的致动脉粥样硬化和血栓形成潜能也可能增加。IDDM和NIDDM患者均应检测血浆脂蛋白(a)。如果脂蛋白(a)水平升高，检查其他主要血管危险因素似乎是合理的。
