Does measurement of apolipoprotein B have a place in cholesterol management?
Does measurement of apolipoprotein B have a place in cholesterol management?
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载脂蛋白 B 的测量在胆固醇管理中占有一席之地吗？
DOI：
--
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发表时间：
1990
期刊：
影响因子：
--
通讯作者：
Scott M. Grundy
中科院分区：
文献类型：
--
作者：
G. L. Vega;Scott M. Grundy
在随后的社论中，Sniderman和西尔伯贝格提出了一个问题，“是时候测量载脂蛋白B了吗？”如果这个问题意味着现在是时候在临床上测量载脂蛋白B-100（apo B）来估计冠心病（CHD）的风险或指导降脂治疗，我们的回答是不合格的“不”。载脂蛋白B的测量在未来是否有价值是另一个问题;答案是“也许。“Sniderman及其同事认识到有些患者在血清胆固醇水平“正常”的情况下具有高浓度的载脂蛋白B，从而做出了重要贡献。毫无疑问，低密度脂蛋白（LDL）载脂蛋白B水平可以不成比例地高胆固醇水平相比。LDL载脂蛋白B升高而LDL胆固醇正常的情况称为“高载脂蛋白血症”。在他们最初的定义中，apo B升高仅限于LDL组分。最近，他们的定义似乎已经扩大到包括血清总载脂蛋白B，高总载脂蛋白B的一个简单术语是“高载脂蛋白B”。总载脂蛋白B包括LDL、中密度脂蛋白（IDL）和极低密度脂蛋白（VLDL）中的载脂蛋白B。对于这些类别中的每一种，每个脂蛋白颗粒都有一个载脂蛋白B分子;因此，测量总载脂蛋白B浓度可得出一定体积血浆中含载脂蛋白B的脂蛋白总数。Sniderman等人的研究提出的关键问题。3是总载脂蛋白B水平是否比总胆固醇水平或其他胆固醇参数更好地预测CHD。与此问题相关的数据是什么？证据是基于小型的回顾性研究，而不是大型的前瞻性研究。在认为载脂蛋白B测定上级胆固醇测定之前，需要后者。回顾性调查因提供未经大型前瞻性研究证实的暗示性证据而臭名昭著。因此，在这个时候，我们不能假设总载脂蛋白B比总胆固醇更好地检测高风险个体。此外，总胆固醇测量的预测能力通过添加甘油三酯、LDL胆固醇、HDL胆固醇、非HDL胆固醇和胆固醇比率而增强。为了证明引入复杂和昂贵的载脂蛋白新方法的合理性，必须证明总载脂蛋白B水平在预测CHD风险或监测治疗方面肯定上级总脂质和脂蛋白胆固醇。在推荐总载脂蛋白B测定时，Sniderman和西尔伯贝格似乎假定所有含载脂蛋白B的脂蛋白具有相似的致动脉粥样硬化性。因此，一个VLDL颗粒将具有与一个LDL颗粒相同的致动脉粥样硬化性，或者在LDL密度类别内，小LDL颗粒将具有与大LDL颗粒相似的致动脉粥样硬化性。虽然这是一个有趣的假设，但它并没有被普遍接受。含载脂蛋白B的脂蛋白在大小、载脂蛋白的类型以及载脂蛋白、甘油三酯和胆固醇的含量方面不同。因此，如果所有的脂蛋白种类都具有同样的致动脉粥样硬化性，这将是令人惊讶的。这个概念上的障碍可能阻碍了人们普遍接受总载脂蛋白B水平作为冠心病风险的预测因子。
In the accompanying editorial, Sniderman and Silberberg raise the question, "Is It Time To Measure Apolipoprotein B"? If this question means whether it is time to measure apolipoprotein B-100 (apo B) clinically to estimate the risk for coronary heart disease (CHD) or to guide in lipid-lowering therapy, our answer is an unqualified "No." Whether measurement of apo B will prove valuable in the future is another question; the answer is "Maybe." Sniderman and associates made an important contribution with the recognition that some patients have high concentrations of apo B in the presence of "normal" serum cholesterol levels. Without question, low density lipoprotein (LDL) apo B levels can be disproportionately high compared to cholesterol levels. The condition of elevated LDL apo B and normal LDL cholesterol they called "hyperapobetalipoproteinemia." In their initial definition, "elevated" apo B was confined to the LDL fraction. More recently, their definition seemingly has been expanded to include serum total apo B, and a simple term for high total apo B is "hyperapo B." Total apo B includes apo B in LDL, intermediate density lipoprotein (IDL), and very low density lipoprotein (VLDL). For each of these classes, there is one molecule of apo B per lipoprotein particle; hence, measurement of total apo B concentration yields the total number of apo B-containing lipoproteins in a volume of plasma. The critical question raised by the research of Sniderman et al . 3 is whether total apo B levels better predict CHD than does the total cholesterol level or another cholesterol parameter. What are the data related to this question? The evidence is based on small, retrospective studies and not on large, prospective studies. The latter are required before apo B determination can be considered superior to cholesterol measurement. Retrospective surveys are notorious for giving suggestive evidence that is not confirmed by large prospective studies. At this time, therefore, we cannot assume that total apo B is better than total cholesterol for detection of high-risk individuals. Moreover, the predictive power of total cholesterol measurement is enhanced by adding triglycerides, LDL cholesterol, HDL cholesterol, non-HDL cholesterol, and cholesterol ratios. To justify introducing complex and expensive new methodology for apolipoproteins, it must be demonstrated that the total apo B level is definitely superior to total lipids and lipoprotein cholesterols for predicting CHD risk or for monitoring therapy. In recommending total apo B measurements, Sniderman and Silberberg seemingly postulate that all apo Bcontaining lipoproteins are similarly atherogenic. Accordingly, one VLDL particle would have the same atherogenecity as one LDL particle, or within the LDL density class, small LDL particles would have similar atherogenecity as large LDL particles. Although this is an intriguing hypothesis, it is not universally accepted. Apo B-containing lipoproteins vary in size, types of apolipoproteins, and contents of apolipoproteins, triglycerides, and cholesterol. It, therefore, would be surprising if all lipoprotein species are equally atherogenic. This conceptual stumbling block probably stands in the way of universal acceptance of total apo B level as a predictor of CHD risk.
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多不饱和脂肪对血浆脂蛋白和载脂蛋白组成的影响。
影响因子：
6.5
作者：
Vega,GL;Groszek,E;Wolf,R;Grundy,SM
通讯作者：
Grundy,SM
DOI：
10.1001/jama.1988.03410130125037
发表时间：
1988-10
期刊：
JAMA
影响因子：
--
作者：
M. Austin;J. Breslow;C. Hennekens;Julie E. Buring;W. Willett;R. Krauss
通讯作者：
M. Austin;J. Breslow;C. Hennekens;Julie E. Buring;W. Willett;R. Krauss
影响因子：
4.8
作者：
KRAUSS, RM
通讯作者：
KRAUSS, RM
冠心病患者低密度脂蛋白中载脂蛋白B与胆固醇的比较
影响因子：
6.5
作者：
Vega,GL;Grundy,SM
通讯作者：
Grundy,SM