Elisaf M S, Bairaktari E T, Tzallas C S, Siamopoulos K C
Department of Internal Medicine, Medical School, University of Ioannina, Greece.
Ann Med. 1997 Aug;29(4):305-9. doi: 10.3109/07853899708999352.
Although the genetic background is the most important determinant of lipoprotein (a) (Lp(a)) concentration other factors, such as coexistent dyslipidaemia, could modify its levels. We undertook the present study to examine the serum Lp(a) concentration in various dyslipidaemias and to reveal any correlation of serum Lp(a) concentration with the other lipid parameters in a large group of dyslipidaemic Greek patients. A total of 242 patients followed as outpatients in our lipid clinic were studied. The patients were stratified into four main groups. Patients with cholesterol levels greater than 5.17 mmol/L but normal triglycerides were regarded as hypercholesterolaemic (n=85), patients with triglycerides greater than 2.25 mmol/L but normal cholesterol levels as hypertriglyceridaemic (n=51), patients with both increased cholesterol and triglyceride levels as having mixed hyperlipidaemia (n=62), and finally patients with decreased (<0.90 mmol/L) high-density lipoprotein (HDL) cholesterol but normal cholesterol and triglyceride levels as having primary hypoalphalipoproteinaemia (n=44). Hypercholesterolaemic patients exhibited the highest serum Lp(a) levels, while hypertriglyceridaemic patients exhibited the lowest. Patients with mixed hyperlipidaemia had intermediate serum Lp(a) concentration, which was significantly higher than that of hypertriglyceridaemic patients but significantly lower than that of hypercholesterolaemic patients. Interestingly, patients with low serum HDL-cholesterol levels presented with low serum Lp(a) concentration similar to that of hypertriglyceridaemic patients. In hypercholesterolaemic patients no correlation was found between serum total and low-density lipoprotein (LDL) cholesterol nor apolipoprotein B (apoB) levels and Lp(a) concentration. On the contrary, in hypertriglyceridaemic patients an inverse correlation was observed between serum triglycerides and Lp(a) concentration. After dividing the hypertriglyceridaemic patients into one group with elevated (>1.3 g/L) serum apoB levels (n=32) and another group with normal apoB levels (n=19), we found that the median serum Lp(a) concentration was three times higher in hyperapoB patients compared to patients with normal apoB levels. We conclude that serum Lp(a) levels are different in various types of primary hyperlipidaemia and are modulated according to the type of lipid elevation.
尽管遗传背景是脂蛋白(a)[Lp(a)]浓度的最重要决定因素，但其他因素，如并存的血脂异常，也可能改变其水平。我们开展本研究以检测各类血脂异常患者的血清Lp(a)浓度，并揭示一大组血脂异常的希腊患者血清Lp(a)浓度与其他血脂参数之间的相关性。共研究了在我们血脂门诊随访的242例门诊患者。患者被分为四个主要组。胆固醇水平高于5.17 mmol/L但甘油三酯正常的患者被视为高胆固醇血症患者(n = 85)，甘油三酯高于2.25 mmol/L但胆固醇水平正常的患者被视为高甘油三酯血症患者(n = 51)，胆固醇和甘油三酯水平均升高的患者被视为混合性高脂血症患者(n = 62)，最后，高密度脂蛋白(HDL)胆固醇降低(<0.90 mmol/L)但胆固醇和甘油三酯水平正常的患者被视为原发性低α脂蛋白血症患者(n = 44)。高胆固醇血症患者的血清Lp(a)水平最高，而高甘油三酯血症患者的血清Lp(a)水平最低。混合性高脂血症患者的血清Lp(a)浓度处于中等水平，显著高于高甘油三酯血症患者，但显著低于高胆固醇血症患者。有趣的是，血清HDL胆固醇水平低的患者血清Lp(a)浓度低，与高甘油三酯血症患者相似。在高胆固醇血症患者中，未发现血清总胆固醇、低密度脂蛋白(LDL)胆固醇及载脂蛋白B(apoB)水平与Lp(a)浓度之间存在相关性。相反，在高甘油三酯血症患者中，观察到血清甘油三酯与Lp(a)浓度呈负相关。将高甘油三酯血症患者分为血清apoB水平升高(>1.3 g/L)的一组(n = 32)和apoB水平正常的另一组(n = 19)后，我们发现apoB升高的患者血清Lp(a)浓度中位数是apoB水平正常患者的三倍。我们得出结论，血清Lp(a)水平在各类原发性高脂血症中有所不同，并根据血脂升高的类型受到调节。
