Effects of hyperlipoproteinemias and their treatment on the peripheral circulation.
Effects of hyperlipoproteinemias and their treatment on the peripheral circulation.
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高脂蛋白血症及其治疗对外周循环的影响。
DOI：
10.1172/jci106300
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发表时间：
1970
期刊：
影响因子：
--
通讯作者：
R. Levy
中科院分区：
文献类型：
--
作者：
R. Zelis;D. Mason;E. Braunwald;R. Levy
本研究的目的是确定家族性高脂蛋白血症（HLP）对周围血管疾病（PVD）的影响，以及血管疾病（PVD）的程度，以及脂蛋白疾病治疗对血管疾病的改善程度。PVD通过观察缺血后反应性充血峰（PRHBF）的减少来检测。32名正常受试者（年龄19-50岁）的肢体PRHBF值最低，为39.6+/-1.5 SEM, ml/min / 100 g。未经治疗的HLP患者。PRHBF低于正常下限的2 / 11为II型，9 / 12为III型，1 / 10为IV型。作为一个组，III型HLP患者PRHBF降低（26.6 +/-3.0 ml/min / 100 g, P <0.01）。鉴于III型HLP患者在治疗后PVD发生率高，血脂显著降低，黄瘤完全吸收，我们对6例患者在治疗前和治疗后3-6个月进行了研究。受影响最严重的肢体PRHBF明显增加，从20.4 +/-1.6 ml/min / 100 g增加到31.9 +/-1.8 ml/min / 100 g (P<0.01)，表明该肢体的最大血流量急剧增加。在两名未接受治疗的III型PVD患者中，PRHBF在5个月内没有发生变化。在另外两名III型患者中，PRHBF在治疗的前25天增加了17%，同时全血粘度降低了30%。在接下来的120天里，血液粘度仅下降了4.6%，而PRHBF增加了57%，这表明在III型患者治疗中观察到的PRHBF变化只能最小程度地解释血液粘度的变化。因此，III型HLP患者特别容易发生PVD，并且通过对这种脂质转运障碍的药物治疗可以实现PVD的客观改善。
The purpose of this study was to determine the effect of familial hyperlipoproteinemia (HLP) on peripheral vascular disease (PVD) and the extent to which the vascular disease (PVD) and the extent to which the vascular disease is modified by treatment of the lipoprotein disorder. PVD was detected plethysmographically by observing a diminished peak reactive hyperemia blood (PRHBF) following ischemia. The value for PRHBF in the extremity demonstrating the lowest response in 32 normal subjects (age 19-50 yr) was 39.6+/-1.5 SEM, ml/min per 100 g. Patients with untreated HLP. who had PRHBF below the lower limit of normal, were 2 of 11 type II, 9 of 12 type III, 1 of 10 type IV. As a group, patients with type III HLP showed diminished PRHBF (26.6 +/-3.0 ml/min per 100 g, P <0.01). In view of the high incidence of PVD and the striking reduction in serum lipids and complete resorption of xanthomas observed in type III HLP with therapy, six patients were studied before and after 3-6 months of treatment with a therapeutic diet and clofibrate. PRHBF in the most severely affected extremity increased markedly, from 20.4 +/-1.6 to 31.9 +/-1.8 ml/min per 100 g (P<0.01), indicating a dramatic increase in maximum blood flow to this extremity. In two type III patients with PVD not treated, no change in PRHBF occurred over 5 months. In two other type III patients the PRHBF increased 17% during the first 25 days of therapy concomitant with a 30% reduction in whole blood viscosity. Over the next 120 days, blood viscosity decreased only an additional 4.6% whereas the PRHBF increased 57%, indicating that the observed changes seen in the PRHBF with therapy of type III patients can be only minimally accounted for by changes in the viscosity of the blood. Thus, patients with type III HLP are particularly susceptible to the development of PVD and objective improvement of PVD can occur with medical treatment of this lipid transport disorder.