Harano Y, Kageyama A, Nakao Y, Hara Y, Suzuki M, Sato A, Ikebuchi M, Shinozaki K, Tsushima M
Division of Atherosclerosis, Metabolism, and Clinical Nutrition, National Cardiovascular Center, Suita, Osaka, Japan.
Diabetes. 1996 Jul;45 Suppl 3:S31-4. doi: 10.2337/diab.45.3.s31.
Cholesterol, triglyceride (TG), and apolipoprotein (apo) B were determined in plasma and in lipoprotein subfractions (VLDL, intermediate-density lipoproteins [IDL], LDL, and HDL) in nonobese NIDDM subjects, who were classified into well-controlled, fairly controlled, or poorly controlled states with or without macrovascular complications (macroangiopathy [MA]). The same analyses were also performed on subjects who had coronary artery disease (CAD) with stable angina pectoris (SA) or unstable angina pectoris (UA) and acute myocardial infarction, cerebrovascular disease (CVD) with atherothrombotic or lacunar infarction, and arteriosclerosis obliterans (ASO). In nonobese NIDDM subjects, the number of apoB-containing lipoproteins (VLDL, IDL, and LDL) increased. This alteration was more prominent in subjects with poorly or fairly controlled disease as well as in subjects with MA, but not in those with well-controlled NIDDM. Cholesterol/apoB in LDL decreased in subjects with poorly or fairly controlled diabetes or with MA and was correlated with low HDL cholesterol. The disorder is characterized by hyperbetalipoproteinemia with elevated LDL cholesterol and small dense LDL. In obese NIDDM subjects, the similar disorder was more pronounced. Glycemic control had less effect and hyperinsulinemia, if present, aggravated the lipid disorder. In those with CAD, the number of IDLs increased and the LDL fraction had the properties of small dense LDL. HDL cholesterol decreased. In those with UA, the LDL number increased without elevation of LDL cholesterol, indicating typical hyperbetalipoproteinemia. The subjects with atherothrombotic brain infarction, an increased number of small-sized LDLs was noted. In those with ASO, the number of VLDL and IDL increased with small LDL. HDL cholesterol decreased in those with CAD, cerebrovascular disease, and ASO. Since similar quantitative and qualitative alterations of apoB-containing lipoprotein have been observed in NIDDM patients as well as in those with macrovascular diseases, diabetic patients are thought to be more susceptible to the initiation and progression of atheromatous lesions in coronary, brain, and peripheral arteries.
对非肥胖型非胰岛素依赖型糖尿病（NIDDM）患者的血浆及脂蛋白亚组分（极低密度脂蛋白[VLDL]、中间密度脂蛋白[IDL]、低密度脂蛋白[LDL]和高密度脂蛋白[HDL]）中的胆固醇、甘油三酯（TG）和载脂蛋白（apo）B进行了测定。这些患者根据血糖控制情况分为控制良好、控制一般或控制较差状态，且伴有或不伴有大血管并发症（大血管病变[MA]）。同时，对患有稳定型心绞痛（SA）或不稳定型心绞痛（UA）以及急性心肌梗死的冠状动脉疾病（CAD）患者、患有动脉粥样硬化血栓形成或腔隙性梗死的脑血管疾病（CVD）患者以及闭塞性动脉硬化（ASO）患者也进行了相同的分析。在非肥胖型NIDDM患者中，含apoB的脂蛋白（VLDL、IDL和LDL）数量增加。这种改变在病情控制较差或一般的患者以及患有MA的患者中更为显著，但在病情控制良好的NIDDM患者中则不明显。控制较差或一般的糖尿病患者或患有MA的患者，其LDL中的胆固醇/apoB降低，且与低HDL胆固醇相关。该病症的特征为高β脂蛋白血症，伴有LDL胆固醇升高和小而密LDL。在肥胖型NIDDM患者中，类似病症更为明显。血糖控制效果较差，若存在高胰岛素血症，则会加重脂质紊乱。在CAD患者中，IDL数量增加，LDL组分具有小而密LDL的特性。HDL胆固醇降低。在UA患者中，LDL数量增加，但LDL胆固醇未升高，表明为典型的高β脂蛋白血症。在患有动脉粥样硬化血栓形成性脑梗死的患者中，观察到小尺寸LDL数量增加。在ASO患者中，VLDL和IDL数量增加，伴有小LDL。CAD、脑血管疾病和ASO患者的HDL胆固醇均降低。由于在NIDDM患者以及大血管疾病患者中均观察到了含apoB脂蛋白类似的定量和定性改变，因此认为糖尿病患者更容易发生冠状动脉、脑动脉和外周动脉粥样硬化病变的起始和进展。
