脂餐后血清甘油三酯代谢异常作为冠心病独立危险因素的探讨  

Postprandial abnormal metabolism of serum triglyceride as an independent risk factor of CHD

作　　者：张原力[1] 游凯[1] 方圻[1] 陈保生 刘存英[1] 陈伟[1] 

机构地区：[1]中国医学科学院协和医科大学北京协和医院内科

出　　处：《中华心血管病杂志》1998年第2期89-93,共5页Chinese Journal of Cardiology

摘　　要：目的为探讨血清富含甘油三酯脂蛋白（ＴＧＲＬ）代谢异常与ＣＨＤ的关系，本研究以脂肪餐负荷后血清甘油三酯（ＴＧ）的反应水平作为反映血清ＴＧＲＬ代谢状况的敏感指标，进行独立危险因素的探讨。方法４６例冠状动脉造影确诊的冠心病患者（ＣＨＤ组）及３４例健康人（对照组）禁食１２～１４小时后，均接受标准脂肪餐负荷试验。分别于餐前（０小时）及餐后２、４、６、８小时采血测定血清ＴＧ浓度及空腹血清总胆固醇（ＴＣ）、高密度脂蛋白胆固醇（ＨＤＬＣ）、低密度脂蛋白胆固醇（ＬＤＬＣ）、ＡｐｏＡｌ及ＡｐｏＢ的浓度。结果ＣＨＤ组与对照组相比，空腹血清ＴＧ、ＴＣ、ＬＤＬＣ、ＡｐｏＢ浓度显著增高，ＨＤＬＣ浓度显著降低；餐后２、４、６、８小时血清ＴＧ浓度及综合反映餐后血清ＴＧ水平的ＴＧ峰反应（ＴＧＰＲ）及ＴＧ曲线下面积（ＴＧＡＵＣ），在ＣＨＤ组均显著大于对照组（Ｐ＜０．００１～０．０１）；ＣＨＤ患者餐后血清ＴＧ峰浓度延迟出现；以ＴＧＰＲ及ＴＧＡＵＣ作为反映餐后脂血症水平的指标，同时将年龄、性别、体质指数（ＢＭＩ）、吸烟、及空腹ＴＧ、ＴＣ、ＨＤＬＣ、ＬＤＬＣ、ＡｐｏＢ血清浓度等因素考虑在内，对ＣＨＤ的发病进行多元Ｌｏｇｉｓｔｉｃ?Objective To explore whether postprandial lipemia is a sensitive index to characterize abnormal metabolism of triglyceride rich lipoprotein in CHD.Methods In 46 cases with CHD verified by angiography and 34 healthy control subjects; total cholesterol, HDL cholesterol, LDL cholesterol, and apolipoproteins A1, B in fasting serum and serum triglyceride before and 2, 4, 6, and 8 hours after a standardized test meal were measured (or calculated).Results The concentrations of triglyceride 2,4,6,8 hours after test meal and the triglyceride peak response(TGPR), the area under triglyceride curve over 8 hours after the meal (TG AUC) were higher in CHD than in the controls. After correction for fasting triglyceride level, significant differences between the cases and controls were also present. To define the independent association between postprandial lipemia (TGPR or TG AUC) and case control status, multiple stepwise logistic regrssion analyses were used with age, sex, body mass index, smoking and the fasting serum lipid parameters included. Postprandial but not fasting triglyceride related independently and significantly with CHD, so did apoB and age. The time elapsed between ingestion of the test meal and the serum triglyceride peak was longer in the cases than in the controls. Conclusion abnormal metabolism of triglyceride is an independent risk factor of CHD by multivariate analyses when a challenge test of triglyceride metabolism such as postprandial lipemia is used. The study suggests that the negative correlation between HDL C and CHD actually originates in part from a positive relation between CHD and serum triglyceride, as ascertained in the postprandial state.

关 键 词：冠心病 甘油三酯脂蛋白 代谢异常 脂餐 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]