Duriez P, Dallongeville J, Fruchart J C
Département de Recherches, Institut Pasteur, INSERM U.325, Lille, France.
Br J Clin Pract Suppl. 1996 Jan;77A:54-61.
Lipoprotein(a) (Lp(a)) resembles a low-density lipoprotein (LDL) particle, but with the addition of apolipoprotein(a). Apolipoprotein(a) (apo(a)) is homologous to plasminogen, and its similarity to plasminogen indicates a prothrombogenic role for Lp(a), whereas the similarity of Lp(a) to LDL suggests a proatherogenic role. Thus, Lp(a) is a link between atherosclerosis and thrombosis. The apo(a) gene is highly polymorphic, and a relationship exists between the different apo(a) alleles and plasma Lp(a) levels. There is also evidence to suggest an association between serum Lp(a) concentration and the frequency of cardiovascular atherosclerosis, particularly myocardial infarction in men, although some of the recently published epidemiological studies have been controversial. The heightened awareness of increased Lp(a) levels being a risk factor for coronary artery disease has led to the evaluation of the effects of lipid-lowering agents on Lp(a) levels. The data that have emerged, however, are conflicting, and are derived mostly from short-term studies involving the use of statins. Our group has studied the short- and long-term effect of fluvastatin on Lp(a) in hypercholesterolaemic patients; fluvastatin was found to have no effect in such patients as observed in the short-term studies, but significant reductions in Lp(a) levels were noted during long-term treatment. Although our findings are in agreement with those of a previously published report, there is still a great need to confirm the data that have been reported in separate studies.
脂蛋白(a)（Lp(a)）类似于低密度脂蛋白（LDL）颗粒，但添加了载脂蛋白(a)。载脂蛋白(a)（apo(a)）与纤溶酶原同源，其与纤溶酶原的相似性表明Lp(a)具有促血栓形成作用，而Lp(a)与LDL的相似性提示其具有促动脉粥样硬化作用。因此，Lp(a)是动脉粥样硬化与血栓形成之间的一个联系环节。apo(a)基因具有高度多态性，不同的apo(a)等位基因与血浆Lp(a)水平之间存在关联。也有证据表明血清Lp(a)浓度与心血管动脉粥样硬化的发生频率有关，尤其是男性心肌梗死，尽管最近发表的一些流行病学研究存在争议。对Lp(a)水平升高作为冠状动脉疾病危险因素的认识不断提高，促使人们评估降脂药物对Lp(a)水平的影响。然而，现有的数据相互矛盾，且大多来自涉及使用他汀类药物的短期研究。我们小组研究了氟伐他汀对高胆固醇血症患者Lp(a)的短期和长期影响；在短期研究中发现氟伐他汀对此类患者无作用，但在长期治疗期间观察到Lp(a)水平显著降低。尽管我们的研究结果与之前发表的一份报告一致，但仍非常需要证实各独立研究中所报告的数据。
