Quantity, function and genetics of HDL as an indicator of CHD.

研究1：高密度脂蛋白的数量和功能作为冠状动脉粥样硬化的指标背景血浆中大部分胆固醇酯化发生在高密度脂蛋白（HDL）部分。低密度（LDL）和极低密度脂蛋白（VLDL）耗尽血浆中胆固醇酯化率可表示为HDL的分级酯化率（FER_<HDL>），反映了HDL对卵磷脂-胆固醇酰基转移酶（LCAT）的反应活性，是HDL的一项重要功能指标。本研究的目的是探讨HDL功能测定在冠状动脉粥样硬化（CA）中的作用，并在考虑常规危险因素的情况下，通过HDL定量和功能测定相结合，建立CA的最佳指标。方法和结果在一项病例和对照研究中[(CA+, n=185)/ (CA-, n=74)血管造影证实的CA]，我们研究了CA与血清高密度脂蛋白胆固醇(C)、高密度脂蛋白减去C、载脂蛋白、脂蛋白(a)和FER_<HDL>之间的关系。CA+患者的HDL- c、HLD2-C、HLD3-C、载脂蛋白a - i和载脂蛋白a - ii的年龄和性别调整值低于CA患者，脂蛋白(a)和FER_<HDL>的年龄和性别调整值高于CA患者，但这些变量与狭窄程度无关。CA+和CA-患者的FER_<HDL>与HDL- c呈密切负相关，但协方差分析显示CA+患者的FER_<HDL>与HDL- c的回归线与CA-患者的FER_<HDL>与HDL- c的回归线存在显著交互作用，提示CA+患者HDL的数量和功能之间的关系发生了改变。logistic回归分析表明，优势比（CA的相对风险）的增加与FER_<HDL>/HDL- c值的增加有关。对FER_<HDL>和HDL- c的比值比及数值进行三维分析发现，FER_<HDL>/HDL- c值最高（0.68）的患者比值比最高（12.6），而比值比最低（1.00）的患者为高HDL- c和高FER_<HDL>值的患者。低HDL- c和中高FER_<HDL>患者的比值比是高HDL- c和FER_<HDL>患者的比值比的10倍，低HDL- c和低FER_<HDL>患者的比值比是高HDL- c和FER_<HDL>患者的比值比的2.3倍，提示高FER_<HDL>在CA中起重要作用，特别是当HDL- c较低时。结论高密度脂蛋白（FER_<HDL>）功能测定与高密度脂蛋白（HDL- c）定量测定相结合可作为诊断冠状动脉粥样硬化的有效指标。少

Study 1 : Quantity and Function of High Density Lipoprotein as an Indicator of CoronaryAtherosclerosis Background Most of the cholesterol esterification in plasma takes place in the high density lipoprotein (HDL) fraction. The rate of cholesterol esterification in low density (LDL)-and very low density lipoprotein (VLDL)-depleted plasma, which can be expressed as the fractional esterification rate in HDL (FER_<HDL>), and which reflects the reactivity of HDL to lecithin : cholesterol acyltransferase (LCAT), is an important functional assay of HDL.The aim of the present study was to investigate the role of this functional assay of HDL in coronary atheroscierosis (CA) and to establish the best indicator for CA through the combination of quantitative and functional assays of HDL while considering conventional risk factors. Mehods and Results in a study of case and control subjects [with (CA+, n=185)/without (CA-, n=74) angiographically proven CA], we examined the association between CA and … More serum levels of HDL-cholesterol (C), HDL subfraction-C,apolipoproteins, lipoprotein (a), and FER_<HDL>. Age-and sex-adjusted values of HDL-C,HLD2-C,HLD3-C,apo A-I,and apo A-II were lower and those of lipoprotein (a) and FER_<HDL> were higher in CA+ patints than in CA-patients, but these variables were not associated with the extent of stenosis. A close negative correlation was observed between FER_<HDL> and HDL-C in both CA+ and CA- patients, but a covariance analysis indicated significant interaction between the regression line of FER_<HDL> vs. HDL-C for CA+ patients and that for CA-oatients, suggesting an altered relationship between the quantity and function of HDL in CA+ patients. A logistic regression analysis indicated that an increased odds ratio (relative risk for CA) was associated with increasing values of FER_<HDL>/HDL-C.A three-dimensional analysis of the odds ratio and values of FER_<HDL> and HDL-C indicated that patients with the highest FER_<HDL>/HDL-C value (0.68) had the highest odds ratio (12.6), but patients who had the lowest odds ratio (1.00) were those with high HDL-C and high FER_<HDL> values. The odds ratio was>10 times higher in patients with low HDL-C and middle or high FER_<HDL> values and 2.3 times higher in patients with low HDL-C and low FER_<HDL> values than in patients with high HDL-C and FER_<HDL> values, which suggests that high values of FER_<HDL> play an important role in CA,especially when HDL-C is low. Conclusion The combination of a functional assay of HDL (FER_<HDL>) with a quantitative assay of HDL (HDL-C) can be a potent indicator for caronary atherosclerosis. Less