脑梗塞患者载脂蛋白B基因3′端小卫星区的多态性研究

采用聚合酶链反应（ＰＣＲ）对８４ 例动脉粥样硬化性脑梗塞（ＡＣＩ）患者（ＡＣＩ组）的载脂蛋白Ｂ（ａｐｏＢ）基因３′端小卫星区（ＭＳＲ）的ＤＮＡ多态性进行研究,并与１０７ 例正常人（对照组）进行比较。结果两组ａｐｏＢ基因３′端等位基因分布频率均以ＭＳＲ３７ 和ＭＳＲ３９ 最高,ＡＣＩ组分别为０．４８、０．１９,对照组分别为０．５０、０．１７,且ＡＣＩ组的大拷贝等位基因（ＭＳＲＢ）分布频率增高。组内及组间分析显示,ＭＳＲＢ与血清ａｐｏＢ以及ＬＤＬ－ｃｈ 增高有关;３′端ＭＳＲ等位基因是已知ａｐｏＢ基因的有用标记;大片段ＭＳＲ等位基因与ＡＣＩ有相关性,支持不同拷贝数目的基因多态性可影响血脂水平代谢;位于ａｐｏＢ３′端的ＭＳＲ等位基因的多态性,可能是动脉粥样硬化多源性病因的一部分,其可能涉及病理过程中胶原暴露及内皮损伤,并共同参与ＡＣＩ的发病。     

冠心病患者血浆氧化修饰低密度脂蛋白水平的变化

对８６例冠心病（ＣＨＤ）患者及６０例正常对照组血浆氧化修饰低密度脂蛋白（ＯＸ－ＬＤＬ）及血脂、脂蛋白和载脂蛋白（ａｐｏ）水平进行了测定。结果显示ＣＨＤ患者血浆ＯＸ－ＬＤＬ、血清甘油三酯（ＴＧ）、低密度脂蛋白（ＬＤＬ）及ａｐｏＢ１００均显著高于正常对照组，而血清高密度脂蛋白（ＨＤＬ）、ａｐｏＡＩ及ａｐｏＡＩ／ａｐｏＢ１００均显著低于正常对照组；相关分析表明，血浆ＯＸ－ＬＤＬ水平与ＴＧ、ＬＤＬ、ａｐｏＢ１００水平均呈显著正相关，而与ＨＤＬ、ａｐｏＡＩ及ａｐｏＡＩ／ａｐｏＢ１００水平均呈显著负相关；多元逐步回归分析表明ＯＸ－ＬＤＬ对ＣＨＤ的预测价值优于目前临床常用的血脂、脂蛋白及ａｐｏ。认为，ＯＸ－ＬＤＬ与ＣＨＤ的发生发展密切相关，ＣＨＤ患者体内ＬＤＬ氧化修饰增加，在治疗过程中应加强抗氧化治疗以抑制ＬＤＬ在体内的氧化修饰。     

高血压患者血脂,脂蛋白,载脂蛋白及胰岛素分析

本文就４９例高血压患者血脂、脂蛋白、载脂蛋白及血胰岛素（Ｉｎ）水平与４０例正常人比较分析发现：高血压患者体重指数（ＢＭＩ）、总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬＣ）、低密度脂蛋白胆固醇／高密度脂蛋白胆固醇（ＬＤＬ－ｃ／ＨＤＬ－Ｃ）、载脂蛋白Ｂ（ａｐｏＢ）、血糠（Ｇ）及Ｉｎ均较对照组显著升高、ＨＤＬ－Ｃ、ＨＤＬ２－Ｃ、ａｐｏＡＩ、ａｐｏＡＩ／ａｐｏＢ及Ｇ／Ｉｎ较对照组显著降低。Ｉｎ水平随ＢＭＩ增加而升高。相关分析发现：ＨＢＰ患者Ｉｎ与ＢＭＩ和ａｐｏＢ呈正相关，与ＨＤＬ－Ｃ、ａｐｏＡＩ／ａｐｏＢ呈负相关。Ｇ／Ｉｎ与ＨＤＬ－Ｃ呈正相关。血浆ＴＧ与ＨＤＬ－Ｃ呈负相关。     

冠心病家族史少年儿童血清脂蛋白（a）的研究

对５４例有冠心病（ＣＨＤ）家族史和１０７例无ＣＨＤ家族史（作对照组）少年儿童检测血清脂蛋白（ａ）［Ｌｐ（ａ）］、载脂蛋白Ａ－Ｉ（ａｐｏＡ－Ｉ）、载脂蛋白Ｂ（ａｐｏＢ）水平及身高、体重五项指标。结果显示：（１）有ＣＨＤ家族史组Ｌｐ（ａ）平均值为１９８．６ｍｇ／Ｌ，对照组则为１３６．０３ｍｇ／Ｌ，两组有差异显著性（Ｐ＜０．０１）；（２）有ＣＨＤ家族史组Ｌｐ（ａ）增高的频率也明显高于对照组；（３）Ｌｐ（ａ）水平与体重无显著相关，与ａｐｏＡ－Ｉ、ａｐｏＢ、年龄和身高也均无相关性。     

急性白血病患者血浆脂蛋白及载脂蛋白的临床研究

目的：探讨急性白血病患者血脂及载脂蛋白改变的临床意义。方法：用全自动生化分析仪检测９４例急性白血病患者血浆中血脂及载脂蛋白的含量。结果;急性白血病组较正常对照组ＴＧ、ａｐｏＢ显著升高,而 ＬＤＬ－Ｃ、 ＨＤＬ－Ｃ、ａｐｏＡ　Ｉ、ａｐｏＡＩ／ａｐｏＢ显著下降; ＡＬ患者缓解后较治疗前ＴＧ、ａｐｏＢ显著下降,而ＬＤＬ－Ｃ、ＨＤＬ－Ｃ、ａｐｏＡ　Ｉ、ａｐｏＡ　Ｉ／ａｐｏＢ显著升高。结论：急性白血病患者血脂及载脂蛋白监测是一项对患者疗效判断、病情监测均有重要意义均敏感指标。     

高脂蛋白血症与冠心病患者血清载脂蛋白CⅡ含量的变化

目的观察血清载脂蛋白ＣⅡ（ａｐｏＣⅡ）在高脂蛋白血症及冠心病中的变化特点。方法应用酶联免疫法（ＥＬＩＳＡ）测定新生儿至老年人群及１１８例高脂蛋白血症患者、４６例冠心病（ＣＨＤ）、５４例急性心肌梗死（ＡＭＩ）与２５例陈旧性心肌梗死（ＯＭＩ）患者血清ａｐｏＣⅡ含量，并分析与甘油三酯（ＴＧ）、高密度脂蛋白（ＨＤＬ）的关系。结果脐带血ａｐｏＣⅡ含量最低，随着年龄增长，ａｐｏＣⅡ含量逐渐增加。高脂蛋白血症组ａｐｏＣⅡ显著高于老年健康组（Ｐ＜０．００１），ａｐｏＣⅡ与ＴＧ含量呈正相关（ｒ＝０．５２，Ｐ＜０．００１），但有１０例患者ＴＧ很高，而ａｐｏＣⅡ较低。ＣＨＤ、ＡＭＩ和ＯＭＩ组的ａｐｏＣⅡ水平随着ＨＤＬ－Ｃ下降而显著低于老年健康组。结论血清ａｐｏＣⅡ的测定有助于阐明高脂蛋白血症的发病机理及ＣＨＤ、ＡＭＩ和ＯＭＩ患者的血脂紊乱、ａｐｏＣⅡ水平下降可能是某些病例ＴＧ升高的原因之一。     

铁等微量元素和自由基对冠心病发病的影响

本文对３８例冠心病患者（ＣＨＤ组，其中心肌梗塞１８例，心绞痛２０例）和３２例健康人（对照组）的血清铁（Ｆｅ）、铜（Ｃｕ）、锌（Ｚｎ）、硒（Ｓｅ）、脂质过氧化物（ＬＰＯ）、超氧化物歧化酶（ＳＯＤ）、血清载脂蛋白Ａ１、３（ａｐｏ－Ａ１、ａｐｏ－Ｂ）和血压的水平进行了对比观察。结果发现：ＣＨＤ组的血清Ｆｅ、ａｐｏ－Ｂ、甘油三酯（ＴＧ）及血压明显高于对照组；而Ｚｎ、Ｓｅ、ａｐｏ－Ａ１／ａｐｏ－Ｂ和ＳＯＤ则明显低于对照组。多元相关分析表明，Ｆｅ和舒张压与ＣＨＤ的发生呈正相关；Ｚｎ和ＳＯＤ与其呈负相关。提示体内Ｆｅ储存增加可能是ＣＨＤ发病的危险因素之一。     

老年人红细胞膜唾液酸含量与红细胞免疫功能的相关性

目的探讨老年人红细胞膜唾液酸（ＲＢＣｍ－ＳＡ）与红细胞免疫功能的相关性。方法采用Ｂｉａｌｓｃｈｅ试剂法检测ＲＢＣｍ－ＳＡ，Ｆ－８８３６化学比色法检测血浆唾液酸（Ｐ－ＳＡ），红细胞免疫粘附试验观察红细胞Ｃ３ｂ受体花环率（ＲＲＣＦ）。结果老年急性心肌梗死（ＡＭＩ）组和脑梗塞（ＡＣＩ）组的ＲＢＣｍ－ＳＡ分别为３０．８±４．３和３１．３±４．４μｇＮＡＮＡ／ｍｇ膜蛋白，ＲＲＣＦ分别为１６．７％±３．５％和１６．０％±３．６％，均低于老年对照组（Ｐ＜０．０１或０．０５），老年对照组均低于非老年对照组（均为Ｐ＜０．０５）；ＡＭＩ和ＡＣＩ患者的Ｐ－ＳＡ分别为２．４±０．４和２．４±０．３ｍｍｏｌ／Ｌ，均高于老年对照组（均为Ｐ＜０．０５），老年对照组则高于非老年对照组（Ｐ＜０．０５）。老年患者和老年对照组的ＲＢＣｍ－ＳＡ与ＲＲＣＦ均呈正相关，而ＲＢＣｍ－ＳＡ与Ｐ－ＳＡ均呈负相关。结论老年人红细胞Ｃ３ｂ受体花环率降低与ＲＢＣｍ－ＳＡ代谢障碍有关。     

高血压病患者血清脂蛋白、载脂蛋白异常与胰岛素抵抗的关系

目的：探讨高血压病患者血脂／载脂蛋白异常与胰岛素抵抗的关系。方法：以空腹胰岛素／空腹葡萄糖比值和口服葡萄糖负荷后胰岛素曲线下面积／葡萄糖曲线下面积比值作为胰岛素抵抗指标，与空腹血脂／载脂蛋白进行直线相关分析。结果：与正常对照组（ｎ＝２１）比较，高血压病组（ｎ＝３２）血清甘油三酯（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）、载脂蛋白（Ａｐｏ）Ｂ、空腹胰岛素、空腹胰岛素／空腹葡萄糖比值以及胰岛素曲线下面积、葡萄糖曲线下面积和胰岛素曲线下面积／葡萄糖曲线下面积比值均显著增加（Ｐ＜０．０５～０．００１），高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、ＨＤＬ２－Ｃ、ＡｐｏＡＩ及ＡｐｏＡＩ／ＡｐｏＢ比值均显著降低（Ｐ＜０．０５～０．００１）。高血压病组空腹胰岛素／空腹葡萄糖比值和胰岛素曲线下面积／葡萄糖曲线下面积比值均分别与甘油三酯、低密度脂蛋白胆固醇和ＡｐｏＢ呈正相关（Ｐ＜０．０５～０．０１），与ＨＤＬ２－Ｃ、ＡｐｏＡＩ和ＡｐｏＡＩ／ＡｐｏＢ比值呈负相关（Ｐ＜０．０５～０．００１）。正常对照组上述指标间则无相关（Ｐ＞０．０５）。结论：高血压病患者血脂／载脂蛋白异常与胰岛素抵抗密切相关。     

老年男性冠心病患者血清硫酸脱氢表雄酮含量变化的临床意义

目的观察老年男性冠心病患者血清硫酸脱氢表雄酮（ＤＨＥＡ－Ｓ）含量变化，探讨其与睾酮（Ｔ）、胰岛素（ＩＮＳ）、血糖（Ｇｌｕ）、甘油三酯（ＴＧ）、总胆固醇（ＴＣ）、载脂蛋白Ｂ（ａｐｏＢ）及年龄的相关性。方法用放免法测定６９例老年男性冠心病患者血清ＤＨＥＡ－Ｓ含量，并与３５例年龄匹配的男性健康人对照。结果冠心病组ＤＨＥＡ－Ｓ含量（２．９６±１．８０μｍｏｌ／Ｌ）显著低于对照组（４．０６±１．７６μｍｏｌ／Ｌ，Ｐ＜０．０１），病情重组（２．４４±１．３６μｍｏｌ／Ｌ）又明显低于病情轻组（３．３２±２．１２μｍｏｌ／Ｌ，Ｐ＜０．０５）；冠心病组ＤＨＥＡ－Ｓ含量与年龄呈负相关（ｒ＝－０．３０５４，Ｐ＜０．０１），对照组两者也呈负相关（ｒ＝－０．３６１５，Ｐ＜０．０５）；冠心病患者ＤＨＥＡ－Ｓ降低与空腹血清ＩＮＳ、ＴＧ及ａｐｏＢ增高均呈负相关（分别为ｒ＝－０．３２９７、－０．２５１９及－０．２４１３，Ｐ＜０．０１或０．０５）。结论老年男性冠心病患者血清ＤＨＥＡ－Ｓ含量降低，并与冠心病某些危险因素如老年、高胰岛素血症、高甘油三酯血症、血清ａｐｏＢ高值相关，但其确切的发病机理有待深入研究。     

apoB基因EcoRI、XbaI位点和apoAI基因-75bp、＋83bp位点多态性的联合作用与哈萨克族人群血脂异常的关系

目的分析载脂蛋白B（apoB）基因EcoRI、XbaI位点和载脂蛋白AI（apoAI）基因一75bp、＋83bp位点多态性与哈萨克族人群血脂异常的关系。方法采用聚合酶链式反应-限制性片段长度多态性分析法检测225例哈萨克族血脂异常患者和187例哈萨克族正常对照者各个位点多态性,并分析其多种联合与血脂异常之间的关系。结果（1）两组各基因型联合的总体分布不同（P〈0．05）,基因型联合7频率在两组之间比较（19．1％vs11．2％）差异有统计学意义（P〈0．05）。（2）血脂异常组中基因型联合7的患者apoB、甘油三酯、总胆固醇水平显著高于其余基因型联合（联合1～6）的平均水平,apoAI、apoAI／apoB水平显著低于其余基因型联合的平均水平;同时此类患者的LDL—C显著低于基因型联合4,apoAI／apoB显著高于基因型联合4;而且其apoAI／apoB、HDL-C显著低于基因型联合1。（3）对照组基因型联合7的HDL-C、apoAI／apoB显著低于基因型联合1—6的平均水平,LDL—C显著高于基因型联合1～6平均水平;其HDL．C、apoAI／apoB显著高于基因型联合4;apoAI／apoB显著低于基因型联合1。结论基因型联合7与新疆石河子地区哈萨克族人群血脂异常相关,其机制可能与基因变异引起apoB、apoAI／apoB的变化等有关,且血脂紊乱可能始于基因变异引起的apoAI／apoB的变化。基因型联合4可能与哈萨克族人群血脂异常相关,基因型联合1可能预防血脂异常的发生。     

心肌梗死患者载脂蛋白B基因多态性

为研究载脂蛋白Ｂ基因多态性与动脉粥样硬化的关联,选择健康体检者８４人和确诊为心肌梗死患者８４人为对象,进行载脂蛋白Ｂ基因多态性的研究。用聚合酶链反应检测心肌梗死患者和正常人的载脂蛋白Ｂ基因上３个位点的遗传多态性标记,结果显示,心肌梗死患者组载脂蛋白Ｂ基因上的ＸｂａＩ酶切位点上Ｘ＋等位基因相对频率明显高于正常组（Ｐ〈０．０５）。而ＥｃｏＲＩ和ＭｓｐＩ酶切位点的Ｅ＋和Ｍ＋等位基因相对频率与正常人组无明     

冠心病患者胰岛素抵抗与血脂、载脂蛋白异常的关系

目的探讨冠心病(CHD)患者胰岛素抵抗(IR)与血脂、载脂蛋白异常的关系。方法以空腹胰岛素(FIns)／空腹葡萄糖(FBG)比值和口服葡萄糖负荷之后胰岛素曲线下面积(RIAUC)／葡萄糖曲线下面积(GAUC)比值作为IR指标，与空腹血脂、载脂蛋白进行直线相关分析。结果与正常对照组比较，冠心病组血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(apoB)；FIns／FBG比值以及RIAUC、GAUC和RIAUC／GAUC比值均显著增加(P<0．05～0．001)，高密度脂蛋白胆固醇(HDL-C)，HDL2-C，apoAI及apoAI／apoB比值均显著降低(P<0．05～0．001)；冠心病组FIns/FBG比值和RIAUC／FBG比值均分别与TG、LDL-C和apoB呈正相关(P<0．05～0．01)，与HDL2-C、apoAI和apoAI／apoB比值呈负相关(P<0．05～0．001)，正常对照组与上述指标间则无相关(P>0．05)。结论CHD患者IR与血脂、载脂蛋白异常密切相关。     

Glucose tolerance, function of pancreatic B-cells and blood lipids in "healthy" offspring of parents with conjugal type 2 diabetes

In 56 adult normoglycemic nondiabetic (WHO criteria) subjects, whose both parents had type 2 diabetes, and in 68 control probants, matched for age, sex and body mass without family history of diabetes, the OGTT (75 g) was carried out, including measurement of serum insulin (IRI) and C-peptide (CP). In fasting state also the blood lipid profile was determined: serum triglycerides, total cholesterol, LDL-cholesterol, HDL-cholesterol, apolipoprotein AI (apoAI) and apolipoprotein B (apoB). In comparison with the control group, the offspring had significantly lower mean glycaemia on fasting, and non significantly elevated from the 60 min of the test, the significantly higher values of serum IRI and CP in fasting state and at the end of the test (120-180 min), and significantly lower serum CP:IRI molar ratio, expressing the reduced hepatic clearance of insulin. The offspring had significantly higher mean values of serum LDL-cholesterol, and significantly lower of serum HDL-cholesterol and apoAI, not disclosing significant differences in the serum levels of triglycerides, total cholesterol and apoB with the control group. Only serum HDL-cholesterol was significantly (negatively) correlated wit serum IRI and CP-values. The covariance analysis, eliminating the influence of age, body mass and the secretory activity of pancreatic B-cells, revealed the significant correlation of the presence of parental diabetes with serum levels of LDL-cholesterol (increase), and HDL-cholesterol and apoAI (decrease) in the offspring. These results prove indirectly, that in subjects genetically predisposed to type 2 diabetes, before the manifestation of glucose intolerance are present other effects of insulin resistance, expressed in increased activity of pancreatic B-cells, increased transfer of insulin to extrahepatic tissues, and in changes of concentration/composition of some lipoproteins dues to reduced influence of insulin on the enzymes which control their metabolism.     

Associations between apolipoprotein B, apolipoprotein AI, the apolipoprotein B/AI ratio and coronary heart disease: a literature-based meta-analysis of prospective studies

OBJECTIVES: To assess associations of circulating levels of apolipoprotein (apo) AI, apoB and the apoB/AI ratio (apoB/A) with risk of incident coronary heart disease (CHD). DESIGN: Literature-based meta-analysis of prospective studies. DATA SOURCES: Prospective studies in essentially general populations that reported on associations between apoAI, apoB or apoB/A and first incident CHD outcomes. Studies were identified by computer-based searches and by manual searches of the relevant literature. RESULTS: Data from 23 relevant studies were identified. For apoAI, with 6333 CHD cases in 21 studies, comparison of individuals in the bottom third with those in the top third of baseline values yielded a combined relative risk of 1.62 (95% confidence interval: 1.43-1.83), i.e. an inverse association. For apoB, a combined analysis of 6320 CHD cases from 19 studies gave a relative risk of 1.99 (1.65-2.39) for a comparison of individuals in the top third versus those in the bottom third of baseline values. For apoB/A, with 3730 CHD cases from seven studies, a comparison of individuals in the top third versus the bottom third of baseline values gave a combined relative risk of 1.86 (1.55-2.22). These associations were somewhat stronger following correction for within-person variations in apolipoprotein levels. There was evidence of heterogeneity amongst the published studies, but it was only partly explained by available study-level characteristics. CONCLUSIONS: The present quantitative review suggests the existence of moderately strong associations between baseline levels of each of apoAI, apoB, and apoB/A and risk of CHD. More detailed analysis, perhaps based on individual participant data from prospective studies, could help to overcome several limitations in the present review and to clarify any relevance of these apolipoproteins to disease prediction and aetiology.     

Plasma lipoproteins and apolipoproteins in insulin-dependent and young non-insulin-dependent Arab women

Summary Plasma lipids, lipoproteins and apolipoproteins (apo) were analysed in 30 young Arab IDDM and 50 young insulin-requiring NIDDM women. The mean age of IDDM and NIDDM groups was 20.2 and 34.5 years, and mean duration of diabetes was 5.7 and 4.6 years, respectively. Two groups of 40 and 60 healthy women (matched for age and BMI) provided corresponding control groups. In comparison with control subjects, diabetics showed marked increases in the following parameters: total cholesterol (TC), low density lipoprotein (LDL) cholesterol, total triglycerides (TG), very low density lipoprotein (VLDL) triglycerides, phospholipids, apoB, LDL apoB, glucose and glycosylated hemoglobin (HbA_1c) as well as the ratios of total cholesterol/high density lipoprotein (HDL) cholesterol, LDL-cholesterol/HDL-cholesterol, LDL cholesterol/high density lipoprotein 2 (HDL₂) cholesterol and apoB/apoAI. Plasma LCAT activity, concentrations of HDL₃ apoAI and apoAII in plasma and lipoprotein fractions were normal in both the diabetic groups. Levels of C-peptide, HDL, HDL₂ and HDL₃ cholesterol, plasma apoAI, HDL apoAI and HDL₂ apoAI were markedly decreased in the diabetic groups as compared to their corresponding controls. There was no significant correlation between fasting glucose or HbA_1c and any of the above parameters. Despite insulin therapy in both the diabetic groups studied, abnormalities in lipids, apoB and apoAI still persisted. Our data suggest a possible higher risk of atherosclerosis in these patients.     

国人健康男女及冠心病患者血浆脂蛋白(a)水平

为了了解国人人群脂蛋白(a)的分布及水平,探讨脂蛋白(a)与冠心病及其它血脂与载脂蛋白的关系,本文应用单价抗载脂蛋白(a)及抗载脂蛋白B抗体夹心酶联法测定668名健康人血浆脂蛋白(a),测得(?);122.34±141.97mg/L,M为81.07mg/L(0～1 250mg/L),呈典型的正偏态分布,无性别年龄差异,与其它脂类及载脂蛋白不相关。48例冠心病患者血浆脂蛋白(a)水平及>200mg/L的频率分布均明显高于同年龄对照组,提示高脂蛋白(a)水平是致动脉粥样硬化的一个独立危险因素。     

脂蛋白(a)与其他脂蛋白和载脂蛋白相关性研究

目的探讨冠心病患者血浆脂蛋白(a)与HDL-C、LDL-C、载脂蛋白(apo)A-Ⅰ、apoB的相关性,评价血脂异常与冠心病的相关性。方法选择因胸痛入院的患者1011例,经冠状动脉造影确诊为冠心病患者613例作为冠心病组,非冠心病患者398例作为对照组。测定脂蛋白(a)、apoA-Ⅰ、apoB、HDL-C和LDL-C,进行相关性分析,并计算apoB/apoA-Ⅰ比值。结果冠心病组的脂蛋白(a)、LDL-C及apoB水平较对照组明显升高(P=0.000);冠心病组脂蛋白(a)水平与LDL-C、apoB呈显著正相关(r=0.135、r=0.168,P0.01),与HDL-C、apoA-Ⅰ无相关性。对照组脂蛋白(a)与LDL-C、apoB呈显著正相关(r=0.201、r=0.236,P0.01),与HDL-C、apoA-Ⅰ无相关性。apoB/apoA-Ⅰ是诊断冠心病最显著的独立危险因素(OR=31.577,95% CI:8.324～11 9.788,P=0.000),其次为脂蛋白(a)(OR=19.446,95% CI:3.831～98.716,P=0.000)。结论脂蛋白(a)与LDL-C、apoB呈正相关,提示三者均为动脉粥样硬化的危险因素;apoB/apoA-Ⅰ和脂蛋白(a)为冠心病的独立危险因素。     

ApoB/apoA-I ratio: an independent predictor of insulin resistance in US non-diabetic subjects.

BACKGROUND: Recently, the apoB/apoAI ratio has been associated with the metabolic syndrome; however, is unclear if its association with insulin resistance is mediated through traditional risk factors or if it adds an independent risk by itself. The aim of this study was to assess the independent association between apoB/apoAI ratio and insulin resistance in the US non-diabetic population. METHODS: We examined the association between high apoB/apoAI ratio and insulin resistance among 2955 adults (mean age 47 years; 1457 women) without diabetes (fasting glucose < or =7 mmol/L and not taking diabetes medication), who participated in the Third National Health and Nutrition Examination Survey. Insulin resistance was estimated using the computer homeostatic model assessment (HOMA2) and defined as the upper quartile. The updated ATP-III definition of the metabolic syndrome was used. First, logistic regression was applied to estimate the cross-sectional association between apoB/apoAI (highest quartile vs. lowest quartile) and insulin resistance adjusting for metabolic syndrome components excluding glucose. Finally, multiple linear regression was used to assess the relationships between apoB/apoAI and insulin sensitivity. RESULTS: Overall, median of apoB/apoAI ratio was significantly higher in subject with insulin resistance than without (0.85, IQR 0.69-0.99 vs. 0.69, IQR 0.56-0.85; P < 0.0001). High apoB/apoAI ratio was independently associated with insulin resistance after adjustment for age and race, and remained significant after further adjustment for metabolic syndrome components, traditional and inflammatory risk factors (in men: OR, 4.12-95% CI, 1.97-8.81; in women: OR, 3.69-95% CI, 1.94-7.27). When apoB/apoAI was considered as a quantitative trait rather than dichotomized, use of the ratio improved the prediction of HOMA2 independently of metabolic syndrome components, traditional and inflammatory risk factors (in men: additional R(2) = 0.09, P < 0.001; in women: additional R(2) = 0.05, P < 0.001). CONCLUSION: In the US population, apoB/apoAI ratio is significantly associated with insulin resistance in non-diabetic subjects, independently of the traditional risk factors, metabolic syndrome components, and inflammatory risk factors. Important clinical risk information provided by apoB/apoAI ratio should be recognized and implemented in future clinical guidelines.     

原发性肾病综合征患者血脂及载脂蛋白的变化

目的 :研究原发性肾病综合征 （NS）患者血清总胆固醇 （TC）、甘油三酯 （TG）、高密度脂蛋白胆固醇 （HDL- c）、低密度脂蛋白胆固醇 （L DL- c）、载脂蛋白 apo A1 ,apo B1 0 0 含量和 apo A1 /apo B1 0 0 及其临床意义。方法 :检测 5 0例原发性 NS患者与 5 0例健康人 （对照组 ）的血脂及脂蛋白 ,并进行比较。结果 :原发性 NS患者血清 TC,TG,L DL- c,apo B1 0 0 较对照组显著升高 （P<0 .0 1） ,而 apo A1 /apo B1 0 0 较对照组显著下降 （P<0 .0 5 ）。结论 :NS患者存在着明显的脂代谢紊乱。