Tarnow L, Rossing P, Nielsen F S, Hansen B V, Dyerberg J, Parving H H
Steno Diabetes Center, Gentofte, Denmark.
Diabetes Care. 1996 Dec;19(12):1382-7. doi: 10.2337/diacare.19.12.1382.
The relative mortality from cardiovascular disease (CVD) is increased 40-fold in IDDM patients suffering from diabetic nephropathy as compared with nondiabetic subjects on average. We assessed the potential contribution of dyslipidemia in general and elevated serum apolipoprotein (a) [apo(a)] in particular to CVD in nephropathic patients with IDDM.
We investigated 199 IDDM patients with diabetic nephropathy and 192 normoalbuminuric IDDM patients matched for sex, age, diabetes duration, and BMI.
The prevalence of CVD was 30 and 12% in patients with and without nephropathy, respectively (P < 0.001). The level of apo(a) was significantly higher in patients with nephropathy, 189 (20-2,350) U/l as compared with the normoalbuminuric group, 103 (20-1,940) U/l (P < 0.005). The prevalence of plasma apo(a) > 300 U/l (at-risk level for cardiovascular pathogenicity) was 38% (31-45) vs. 22% (16-28) in patients with and without nephropathy, respectively (P < 0.0005). In nephropathic patients, the prevalence of plasma apo(a) > 300 U/l was raised in patients with CVD (48%, 36-61%) as compared with patients without (34%, 26-42%) (P = 0.05). Furthermore, the serum concentrations of the following apolipoproteins and lipids were higher in patients with nephropathy as compared with normoalbuminuric patients: apoB 1.33 +/- 0.37 vs. 1.06 +/- 0.26 g/l; total cholesterol 5.6 +/- 1.2 vs. 4.8 +/- 0.9 mmol/l; and triglycerides 1.22 (0.31-9.87) vs. 0.77 (0.28-3.05) mmol/l, P < 0.0001. Multiple logistic regression analysis of cardiovascular risk factors revealed that plasma apo(a) concentration > 300 U/l is an independent risk factor for coronary heart disease, odds ratio 1.86 (1.03-3.36) (P < 0.05).
Dyslipidemia and raised plasma concentrations of apo(a), particularly > 300 U/l, may contribute to the enhanced morbidity and mortality from CVD characteristically observed in IDDM patients with diabetic nephropathy.
与非糖尿病患者相比，患有糖尿病肾病的胰岛素依赖型糖尿病（IDDM）患者心血管疾病（CVD）的相对死亡率平均增加40倍。我们评估了一般血脂异常尤其是血清载脂蛋白（a）[apo（a）]升高对IDDM肾病患者CVD的潜在影响。
我们调查了199例患有糖尿病肾病的IDDM患者和192例性别、年龄、糖尿病病程和体重指数相匹配的正常白蛋白尿IDDM患者。
肾病患者和无肾病患者的CVD患病率分别为30%和12%（P<0.001）。肾病患者的apo（a）水平显著高于正常白蛋白尿组，分别为189（20 - 2350）U/l和103（20 - 1940）U/l（P<0.005）。血浆apo（a）>300 U/l（心血管致病风险水平）的患病率在肾病患者和无肾病患者中分别为38%（31 - 45）和22%（16 - 28）（P<0.0005）。在肾病患者中，患有CVD的患者血浆apo（a）>300 U/l的患病率（48%，36 - 61%）高于未患CVD的患者（34%，26 - 42%）（P = 0.05）。此外，与正常白蛋白尿患者相比，肾病患者的以下载脂蛋白和脂质的血清浓度更高：载脂蛋白B 1.33±0.37 vs. 1.06±0.26 g/l；总胆固醇5.6±1.2 vs. 4.8±0.9 mmol/l；甘油三酯1.22（0.31 - 9.87）vs. 0.77（0.28 - 3.05）mmol/l，P<0.0001。心血管危险因素的多因素logistic回归分析显示，血浆apo（a）浓度>300 U/l是冠心病的独立危险因素，比值比为1.86（1.03 - 3.36）（P<0.05）。
血脂异常和血浆apo（a）浓度升高，尤其是>300 U/l，可能导致IDDM糖尿病肾病患者中典型观察到的CVD发病率和死亡率增加。
