Groop P H, Viberti G C, Elliott T G, Friedman R, Mackie A, Ehnholm C, Jauhiainen M, Taskinen M R
Unit for Metabolic Medicine, United Medical School, Guy's Hospital, London, England.
Diabet Med. 1994 Dec;11(10):961-7. doi: 10.1111/j.1464-5491.1994.tb00254.x.
Lp(a) was measured in 64 normoalbuminuric, 52 microalbuminuric, and 37 proteinuric Type 1 diabetic patients and 54 healthy subjects. Microalbuminuric and proteinuric Type 1 diabetic patients had higher median Lp(a) values (133 (16-1932) and 169 (17-1149) mg l-1) than patients with normal AER (73 (15-1078) mg l-1; p = 0.048 and p = 0.027). Lp(a) in healthy subjects (110 (15-1630)mg l-1) did not differ from the diabetic subgroups. The frequency of Lp(a) values in the upper quarter of the normal distribution was similar in the diabetic groups and did not differ between diabetic and control subjects. The cumulative distribution of Lp(a) was similar in all groups. Lp(a) concentrations were not related to AER, age, gender, duration of diabetes, body mass index, glycaemic control, serum creatinine, free insulin or systolic blood pressure. Cholesterol, LDL-cholesterol, triglycerides, and apo B were higher in microalbuminuric and proteinuric than in normoalbuminuric Type 1 diabetic patients. Lp(a) was independently related to diastolic blood pressure, fibrinogen, and macroangiopathy. In conclusion, median Lp(a) concentrations tend to be higher in Type 1 diabetic patients with early and established renal disease, although the differences are small and the overlap between groups large. Lp(a) is related to diastolic blood pressure and fibrinogen, and this association of powerful risk factors suggests that Lp(a) may play a role in the pathogenesis of cardiovascular disease in Type 1 diabetic patients with proteinuria. Whether Lp(a) is an independent determinant of increased cardiovascular risk in these patients needs to be elucidated by prospective studies.
对64例正常白蛋白尿、52例微量白蛋白尿和37例蛋白尿的1型糖尿病患者以及54名健康受试者测定了脂蛋白(a)[Lp(a)]。微量白蛋白尿和蛋白尿的1型糖尿病患者的Lp(a)中位数[分别为133(16 - 1932)和169(17 - 1149)mg/L]高于尿白蛋白排泄率(AER)正常的患者[73(15 - 1078)mg/L；p = 0.048和p = 0.027]。健康受试者的Lp(a)[110(15 - 1630)mg/L]与糖尿病亚组无差异。糖尿病组中Lp(a)值处于正态分布上四分位数的频率相似，糖尿病组与对照组之间也无差异。所有组中Lp(a)的累积分布相似。Lp(a)浓度与AER、年龄、性别、糖尿病病程、体重指数、血糖控制、血清肌酐、游离胰岛素或收缩压无关。微量白蛋白尿和蛋白尿患者的胆固醇、低密度脂蛋白胆固醇、甘油三酯和载脂蛋白B高于正常白蛋白尿的1型糖尿病患者。Lp(a)与舒张压、纤维蛋白原和大血管病变独立相关。总之，1型糖尿病早期和已确诊肾病患者的Lp(a)中位数浓度往往较高，尽管差异较小且组间重叠较大。Lp(a)与舒张压和纤维蛋白原相关，这种强大危险因素的关联表明Lp(a)可能在1型糖尿病蛋白尿患者的心血管疾病发病机制中起作用。Lp(a)是否是这些患者心血管风险增加的独立决定因素需要前瞻性研究来阐明。
