基于磁共振波谱技术的直接法餐后低密度脂蛋白胆固醇下降原因探究  

Reason of postprandial low-density lipoprotein cholesterol reduction measured by enzymatic assays:based on nuclear magnetic resonance method

作　　者：付笛 张梓毓 毛玲[2] 胡蝶 唐晓禹 陈瑾 张天铧 刘人可 袁曙光[3] 于碧莲[1] 彭道泉[1] Fu Di;Zhang Ziyu;Mao Ling;Hu Die;Tang Xiaoyu;Chen Jin;Zhang Tianhua;Liu Renke;Yuan Shuguang;Yu Bilian;Peng Daoquan(Department of Cardiovascular Medicine,the Second Xiangya Hospital of Central South University,Changsha 410011,China;Research Institute of Blood Lipid and Atherosclerosis,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院心血管内科,长沙410011 [2]中南大学血脂与动脉粥样硬化研究所,长沙410011 [3]中南大学湘雅二医院肾内科,长沙410011

出　　处：《中华检验医学杂志》2022年第3期260-267,共8页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金(81670426);湖南省自然科学基金(2018JJ2596)。

摘　　要：目的探究直接法测得的血低密度脂蛋白胆固醇(LDL-C)餐后水平低于空腹水平的原因。方法选择中南大学湘雅二医院2017年11月至2019年5月的85名受试者进行前瞻性研究。取受试者空腹和进食后2、4 h的血清样本,分别用直接法和磁共振波谱技术(NMRS)检测样本的血脂水平,并用酶联免疫吸附法检测前蛋白转化酶枯草溶菌素9(PCSK9)的水平。用Friedman双向秩方差分析和韦氏配对符号秩次检验比较不同时间点血脂组分的差异;采用Spearman相关分析分析PCSK9水平与脂蛋白颗粒数之间的相关性。结果经直接法检测,与空腹状态比较,进食后2、4 h的LDL-C均有下降[分别为2.58(2.09,3.12)、2.47(1.92,3.02)、2.37(1.82,2.80)mmol/L,P<0.001]。经NMRS检测,空腹和餐后2、4 h低密度脂蛋白(LDL)颗粒浓度分别为1086(830,1239)、1083(848,1213)、1061(814,1213)nmol/L(P=0.417);LDL颗粒中胆固醇浓度分别为2.13(1.56,2.54)、2.16(1.68,2.50)、2.06(1.58,2.50)mmol/L(P=0.047),但餐后2、4 h与空腹比较,差异均无统计学意义(P均>0.05)。而大颗粒的LDL浓度[空腹、餐后2、4 h分别为185.2(150.6,221.6)、173.0(144.8,220.3)、178.1(144.0,233.6)nmol/L,P=0.001],以及餐后2、4 h大颗粒的LDL中的胆固醇浓度均较空腹时下降[空腹、餐后2、4 h分别为0.49(0.39,0.57)、0.47(0.38,0.57)、0.46(0.37,0.58)mmol/L,P<0.001]。同时,进食后PCSK9水平也明显下降[分别为299(233,397)、257(208,342)、251(215,340)ng/ml,P<0.001],餐后4 h血清PCSK9的下降比例与NMRS所检测的餐后残粒胆固醇增长比例呈正相关(r=0.232,P=0.035)。结论磁共振波谱技术与直接法测得餐后LDL-C水平不一致。直接法测得的餐后LDL-C的下降并非LDL颗粒的清除,而是由于胆固醇在各LDL亚组分中的重新分布。Objective To explore the postprandial plasma low-density lipoprotein cholesterol(LDL-C)changes by various detection methods.Methods A total of 85 subjects admitted to the Second Xiangya Hospital of Central South University from November 2017 to May 2019 were included.Serum samples were collected from fasting and the 2nd hour and the 4th hour after breakfast.Serum lipid levels were measured with enzymatic assays and nuclear magnetic resonance spectroscopy(NMRS),and proprotein invertase subtilisin/kexin type 9(PCSK9)levels were measured with enzyme-linked immunosorbent assays.The differences of blood lipid components at different time points were compared by Friedman two-way rank analysis of variance and Wilcoxon signed rank test,and the correlation between PCSK9 level and lipoprotein particles was analyzed by Spearman correlation.Results Measured by enzymatic assays,compared with the fasting state,LDL-C decreased at the 2nd hour and the 4th hour after the meal(2.58[2.09,3.12],2.47[1.92,3.02],2.37[1.82,2.80]mmol/L,P<0.001).Measured by NMRS,the concentration of LDL particles(1086[830,1239],1083[848,1213],1061[814,1213]nmol/L,P=0.417)did not change significantly,and cholesterol in LDL particles were 2.13(1.56,2.54),2.16(1.68,2.50),2.06(1.58,2.50)mmol/L,respectively(P=0.047),and postprandial cholesterol in LDL particles in the 2nd hour and in the 4th hour did not change significantly compared with fasting(P>0.05).while the concentration of large LDL particles(185.2[150.6,221.6],173.0[144.8,220.3],178.1[144.0,233.6]nmol/L,P=0.001),and the cholesterol level in large LDL particles(0.49[0.39,0.57],0.47[0.38,0.57],0.46[0.37,0.58]mmol/L,P<0.001)decreased after the meal.The PCSK9 level also decreased significantly after the meal(299[233,397],257[208,342],251[215,340]ng/ml,P<0.001).There was an independent positive correlation between the decrease of PCSK9 levels and the increase of remnant cholesterol detected by MNRS after the meal(r=0.232,P=0.035).Conclusions The postprandial LDL-C level measured by NMRS and enzymatic assa

关 键 词：胆固醇 LDL 前蛋白转化酶枯草溶菌素9 磁共振波谱技术 

分 类 号：R541.4[医药卫生—心血管疾病]