含有载脂蛋白A-I和A-II的高密度脂蛋白（LpA-I:A-II）作为非胰岛素依赖型糖尿病男性冠状动脉疾病的标志物。
HDLs containing apolipoproteins A-I and A-II (LpA-I:A-II) as markers of coronary artery disease in men with non-insulin-dependent diabetes mellitus.
作者信息
Syvänne M, Kahri J, Virtanen K S, Taskinen M R
机构信息
First Department of Medicine, Helsinki University Central Hospital, Finland.
出版信息
Circulation. 1995 Aug 1;92(3):364-70. doi: 10.1161/01.cir.92.3.364.
BACKGROUND
Abnormalities in HDL and an increased risk of coronary artery disease (CAD) coexist in non-insulin-dependent diabetes mellitus (NIDDM). HDLs can be separated by their apolipoprotein (apo) content into particles containing apoA-I but not apoA-II (LpA-I) and those containing both apoA-I and apoA-II (LpA-I:A-II). The LpA-I particles have been suggested to be more effective in conferring protection against CAD than the LpA-I:A-II particles. However, data are sparse, and no studies have defined the role of these two classes of particles in NIDDM.
METHODS AND RESULTS
LpA-I and LpA-I:A-II particles were quantified by a differential electroimmunoassay in four groups of men with similar age and body mass index (BMI) distributions. Group 1 consisted of 50 patients with NIDDM and angiographically verified CAD; group 2, 50 men with CAD but no diabetes; group 3, 50 men with NIDDM but no CAD; and group 4, 31 healthy men. Serum apoA-I and apoA-II concentrations were measured by immunoturbidimetry, and HDL2 and HDL3 were separated by ultracentrifugation. Concentrations of LpA-I:A-II particles in group 1 were 13.8%, 18.3%, and 26.9% lower than in groups 2 through 4, respectively. In a two-by-two factorial ANOVA, adjusted for age and BMI, the differences were significant for both CAD (P < .001) and NIDDM (P < .001), with no interaction between the factors. These results were confirmed by comparable differences in the serum concentrations of apoA-I and apoA-II. LpA-I particles were related to the presence or absence of CAD (P = .013), but the difference was lost in a multivariate analysis. A low HDL3 cholesterol concentration characterized both CAD (P = .002) and NIDDM (P = .024). HDL2 cholesterol differed significantly with regard to the presence of NIDDM (P = .033) but only borderline with respect to CAD (P = .073).
CONCLUSIONS
ApoA-II-containing lipoproteins and HDL3 cholesterol are powerful markers of CAD in men with NIDDM.
背景
非胰岛素依赖型糖尿病（NIDDM）患者中存在高密度脂蛋白（HDL）异常及冠状动脉疾病（CAD）风险增加的情况。HDL可根据其载脂蛋白（apo）成分分为含apoA-I但不含apoA-II的颗粒（LpA-I）和同时含apoA-I和apoA-II的颗粒（LpA-I:A-II）。有人提出LpA-I颗粒在预防CAD方面比LpA-I:A-II颗粒更有效。然而，相关数据稀少，尚无研究明确这两类颗粒在NIDDM中的作用。
方法与结果
采用差异电免疫分析法对四组年龄和体重指数（BMI）分布相似的男性进行LpA-I和LpA-I:A-II颗粒定量分析。第一组由50例经血管造影证实患有CAD的NIDDM患者组成；第二组为50例患有CAD但无糖尿病的男性；第三组为50例患有NIDDM但无CAD的男性；第四组为31名健康男性。采用免疫比浊法测定血清apoA-I和apoA-II浓度，通过超速离心法分离HDL2和HDL3。第一组中LpA-I:A-II颗粒浓度分别比第二组至第四组低13.8%、18.3%和26.9%。在经年龄和BMI校正的二乘二析因方差分析中，CAD（P <.001）和NIDDM（P <.001）的差异均具有统计学意义，且两因素之间无交互作用。血清apoA-I和apoA-II浓度的可比差异证实了这些结果。LpA-I颗粒与CAD的有无相关（P =.013），但在多变量分析中该差异消失。低HDL3胆固醇浓度是CAD（P =.002）和NIDDM（P =.024）的共同特征。HDL2胆固醇在NIDDM患者中差异有统计学意义（P =.033），但在CAD患者中仅接近有统计学意义（P =.073）。
结论
含apoA-II的脂蛋白和HDL3胆固醇是NIDDM男性CAD的有力标志物。
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