Otto C, Pschierer V, Soennichsen A C, Schwandt P, Richter W O
Department of Medicine II, Klinikum Grosshadern, University of Munich, Germany.
Metabolism. 1997 Nov;46(11):1299-304. doi: 10.1016/s0026-0495(97)90234-1.
Impaired postprandial lipoprotein metabolism has been found to be related to the extent of coronary artery disease. Moreover, since dyslipoproteinemias are associated with impaired hemorrheology, we investigated the effect of postprandial hypertriglyceridemia on hemorrheological parameters before and after triglyceride-lowering therapy. Triglyceride-rich lipoproteins (TRLs) separated by ultracentrifugation (d < 1.006 g/dL) and chylomicrons and chylomicron remnants (quantified by apolipoprotein [apo] B-48 determination) were determined after a fat load in 10 patients with familial hypertriglyceridemia before and after therapy with gemfibrozil (900 mg daily). Lipid and hemorrheological parameters (plasma and whole-blood viscosity [PV and BV], red cell aggregation [RCA], hematocrit, and fibrinogen) were determined at baseline and every hour up to 6 hours postprandially. Fasting total triglycerides and TRL triglycerides significantly decreased with gemfibrozil therapy (P < .01). Total triglycerides postprandially increased from 9.53 +/- 1.72 to 14.47 +/- 2.07 mmol/L (TRL triglycerides by 61%) before therapy (P < .05) and from 4.61 +/- 1.28 to 7.17 +/- 0.99 mmol/L (TRL triglycerides by 57%) after therapy (P < .05). The postprandial TRL apo B increase was reduced with gemfibrozil (from 11.6 +/- 2.8 to 20.7 +/- 5.0 mg/dL with therapy v 19.0 +/- 7.6 to 33.0 +/- 12.5 mg/dL before therapy, P < .05, respectively) with a proportionally greater increase in apo B-48 (119% and 169%, respectively) compared with apo B-100 (64% and 64%, respectively). Fasting RCA was improved with lipid-lowering therapy (P < .05), but PV, BV, RCA, and fibrinogen did not show any statistically significant postprandial changes either before or after lipid-lowering therapy. In summary, we did not find any statistically significant changes in hemorrheological parameters, despite a strong postprandial increase of triglycerides. In particular, these findings were independent of fasting triglyceride levels. We conclude that triglyceride-lowering therapy by gemfibrozil had no substantial beneficial effects with respect to hemorrheology in patients with familial hypertriglyceridemia.
餐后脂蛋白代谢受损已被发现与冠状动脉疾病的程度相关。此外，由于血脂异常与血液流变学受损有关，我们研究了在进行降甘油三酯治疗前后，餐后高甘油三酯血症对血液流变学参数的影响。对10例家族性高甘油三酯血症患者在服用吉非贝齐（每日900毫克）治疗前后，给予脂肪负荷后，通过超速离心法分离出富含甘油三酯的脂蛋白（TRLs，密度<1.006克/分升）以及乳糜微粒和乳糜微粒残粒（通过载脂蛋白[apo]B - 48测定进行定量）。在基线以及餐后每小时直至6小时，测定血脂和血液流变学参数（血浆黏度和全血黏度[PV和BV]、红细胞聚集[RCA]、血细胞比容和纤维蛋白原）。吉非贝齐治疗后空腹总甘油三酯和TRL甘油三酯显著降低（P <.01）。治疗前餐后总甘油三酯从9.53±1.72毫摩尔/升增加至14.47±2.07毫摩尔/升（TRL甘油三酯增加61%）（P <.05），治疗后从4.61±1.28毫摩尔/升增加至7.17±0.99毫摩尔/升（TRL甘油三酯增加57%）（P <.05）。吉非贝齐使餐后TRL apo B的增加减少（治疗后从11.6±2.8毫克/分升增加至20.7±5.0毫克/分升，而治疗前从19.0±7.6毫克/分升增加至33.0±12.5毫克/分升，P分别<.05），与apo B - 100相比，apo B - 48的增加比例更大（分别为119%和169%，而apo B - 100分别为64%和64%）。降脂治疗使空腹RCA得到改善（P <.05），但在降脂治疗前后，PV、BV、RCA和纤维蛋白原在餐后均未显示出任何统计学上的显著变化。总之，尽管餐后甘油三酯显著升高，但我们未发现血液流变学参数有任何统计学上的显著变化。特别是，这些发现与空腹甘油三酯水平无关。我们得出结论，对于家族性高甘油三酯血症患者，吉非贝齐进行的降甘油三酯治疗在血液流变学方面没有实质性的有益作用。
