脂餐负荷后血清甘油三酯反应水平与颈动脉内中膜厚度的关系  

Postprandial triglyceridemia and carotid atherosclerosis in male patients with coronary heart disease

作　　者：张原力[1,2] 姜玉新[1,2] 申建民[1,2] 游凯[1,2] 朱文玲[1,2] 方圻[1,2] 

机构地区：[1]中国医学科学院 [2]河北邯郸铁路医院内科

出　　处：《中华内科杂志》1999年第3期164-167,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨餐后血浆富含甘油三酯脂蛋白（ＴＧＲＬ）蓄积与颈动脉粥样硬化的关系。方法４２例经冠状动脉造影证实的男性冠心病患者接受了标准口服脂肪餐负荷试验，分别于餐前及餐后２、４、６、８小时测定血清甘油三酯（ＴＧ）浓度及空腹血清载脂蛋白（Ａｐｏ）Ｂ、高密度脂蛋白胆固醇（ＨＣＬＣ）浓度。对每例受试者进行了高分辨二维颈动脉超声检查，测定了颈动脉内中膜厚度，对餐后脂血症的程度：餐后８小时甘油三酯曲线下面积（ＴＧＡＵＣ）及甘油三酯峰反应（ＴＧＰＲ），与颈动脉内中膜厚度进行了相关分析。结果单因素分析显示餐后脂血症的程度（ＴＧＡＵＣ，ＴＧＰＲ）与平均颈动脉内中膜厚度（左、右颈动脉每侧４个确定的血管阶段测定的均值）呈显著正相关（ｒ值分别为０．４５与０４１，Ｐ值均＜０．０１），当采用多元逐步回归分析消除了年龄、体重指数、空腹血清ＴＧ、ＡｐｏＢ及ＨＤＬＣ等主要相关因素的混杂影响后，这种正相关关系仍独立存在。血清ＨＤＬＣ浓度与颈动脉内中膜厚度呈独立负相关。结论餐后ＴＧＲＬ代谢清除障碍可加速动脉粥样硬化的进展。Objective To test the effect of postprandial accumulation of triglyceride rich lipoprotein(TGRL) on carotid artery atherosclerosis. Methods In 42 male cases with coronary heart disease(CHD) as verified by angiography, high density lipoprotein cholesterol and apolipoprotein B(ApoB) levels in fasting serum , serum triglyceride concentrations before and 2,4,6,8 hours after a standard fat test meal were measured. Each patient underwent a carotid artery high resolution B mode ultrasound examination. The extent of alimentary lipemia [area under the triglyceride curve over 8 hours, TG AUC and peak triglyceride response (TGPR)] correlated with the carotid artery intima media thickness. Results Univariate analyses indicated both TG AUC and TGPR had direct correlation with mean intima media thickness measured from four well defined vessel wall segments in the left and right carotid arteries ( r =0.45 and 0.41, both P <0.01). After controlling for age, body mass index(BMI), triglyceride, HDL C, and apolipoprotein B concentrations in fasting serum with multivariate stepwise regression analysis, the above correlation remained. There was an independent inverse correlation between HDL C and carotid artery intima media thickness. Conclusion It is suggested that abnormal metabolism and clearence of postprandial TGRL can promote the progression of atherosclerosis.

关 键 词：动脉粥样硬化 甘油三酯类 TGRL 超声波诊断 

分 类 号：R543.502[医药卫生—心血管疾病]