Ritter M M, Loscar M, Richter W O, Schwandt P
Medical Department II, Klinikum Grosshadern, Munich, FRG.
Clin Chim Acta. 1993 Jan 31;214(1):45-54. doi: 10.1016/0009-8981(93)90301-j.
Epidemiologic studies have identified lipoprotein(a) (Lp(a)) as an independent risk factor for atherosclerosis, mainly for coronary heart disease. Atherosclerosis is the most common cause of death in diabetic patients, but there is little information available concerning the importance of Lp(a) in these patients. We compared the presence or absence of late diabetic complications with Lp(a) serum concentrations in 224 patients (82 IDDM, 142 NIDDM). Lp(a) distribution was skewed as described for non-diabetic patients. Despite highly significant differences for total cholesterol, total triglycerides, HDL-cholesterol, VLDL-cholesterol and VLDL-triglycerides (P < 0.001) and for LDL-cholesterol (P < 0.01) Lp(a) concentrations were similar in NIDDM and IDDM (mean: 27 vs. 30, median: 12 vs. 21 mg/dl, P = 0.10). Diabetic polyneuropathy, autonomic neuropathy, nephropathy, peripheral occlusive disease, diabetic gangrene and coronary heart disease were not associated with raised Lp(a) values. Non-insulin-dependent patients with retinopathy exhibited higher Lp(a) concentrations in serum than those without this complication. This significant association was lost when duration of diabetes was taken into account by logistic regression. We conclude, that other risk factors surpass the significance of Lp(a) in diabetic patients.
流行病学研究已将脂蛋白(a) [Lp(a)]确定为动脉粥样硬化的独立危险因素，主要与冠心病有关。动脉粥样硬化是糖尿病患者最常见的死亡原因，但关于Lp(a)在这些患者中的重要性，目前几乎没有相关信息。我们比较了224例患者（82例胰岛素依赖型糖尿病，142例非胰岛素依赖型糖尿病）的糖尿病晚期并发症情况与血清Lp(a)浓度。Lp(a)的分布与非糖尿病患者一样呈偏态分布。尽管总胆固醇、总甘油三酯、高密度脂蛋白胆固醇、极低密度脂蛋白胆固醇和极低密度脂蛋白甘油三酯存在高度显著差异（P<0.001），低密度脂蛋白胆固醇也有显著差异（P<0.01），但非胰岛素依赖型糖尿病和胰岛素依赖型糖尿病患者的Lp(a)浓度相似（均值：27对30，中位数：12对21mg/dl，P=0.10）。糖尿病多发性神经病变、自主神经病变、肾病、周围血管闭塞性疾病、糖尿病坏疽和冠心病与Lp(a)值升高无关。有视网膜病变的非胰岛素依赖型患者血清Lp(a)浓度高于无此并发症的患者。当通过逻辑回归考虑糖尿病病程时，这种显著关联消失。我们得出结论，在糖尿病患者中，其他危险因素比Lp(a)更具重要性。
