冠心病患者摄入不同量脂肪餐后血脂水平的变化及其对血管内皮功能的影响

Postprandial Lipoprotein Metabolism and Impairment of Endothelial Function in Coronary Heart Disease

目的 :探讨冠心病患者餐后血脂代谢情况及其对血管内皮功能的影响。 方法 :将 40例血清总胆固醇 (TC)水平不高的冠心病患者随机分为两组 ,禁食 12小时后 ,分别接受高脂肪餐饮食(高脂餐组 ,n=2 0 )和低脂肪餐饮食 (低脂餐组 ,n=2 0 )。于空腹、餐后 2、4、5、7小时测定血清 TC、血清甘油三酯 (TG)、低密度脂蛋白胆固醇 (L DL- C)、高密度脂蛋白胆固醇 (HDL- C) ,并同时于空腹状态及餐后 4小时测定内皮依赖性及非依赖性血管舒张功能。 结果 :高脂餐组 ,餐后血清 TG水平显著升高 ,TC、L DL- C、HDL- C无明显改变 ,内皮依赖性血管舒张功能由空腹状态的 (3.38± 2 .34) %降至餐后 4小时的 (1.2 7± 2 .31) % ,差异有非常显著意义 (P<0 .0 1) ,内皮非依赖性血管舒张功能无明显改变 ,餐后 4小时内皮依赖性血管舒张功能的受损程度与餐后 2小时血清 TG升高值呈显著性正相关 (r=0 .5 99,P<0 .0 1) ;低脂餐组餐后血脂水平、内皮依赖性及非依赖性血管舒张功能无明显改变。 结论 :冠心病患者进食高脂餐后内皮依赖性血管舒张功能明显受损 ,且与餐后血清 TG的升高程度密切相关。

Objective:The present study is to evaluate lipoprotein changes after a high or low fat meal,and their effect on the impairment of endothelium dependent vasorelaxation in coronary heart disease. Methods:Forty patients with coronary heart disease(CHD)were randomized into two groups.After fasting for 12 hours,one group was given high fat meal and the other was given low fat meal.Blood samples were drawn for serum total cholesterol,triglyceride,low density lipoprotein cholesterol(LDL C),high density lipoprotein cholesterol(HDL C) in fasting state and at 2,4,5,7hours postprandially.Endothelium dependent and endothelium independent vasorelaxation was measured at fast state and 4 hours postprandially. Results:In high fat meal group,postprandial serum triglyceride elevated significantly.Postprandial serum total cholesterol(TC),LDL C,HDL C did not change.Postprandial endothelium dependent vasorelaxation decreased from(3 38±2 34)% preprandially to (1 27±2 31)% 4 hours postprandially ( p <0 01).No changes in endothelium independent vasorelaxation were found.There was a significant correlation between elevation in 2 hour postprandial triglyceride levels and impairment in 4 hour postprandial endothelium dependent vasorelaxation ( r=0 599,p< 0 01);No changes in serum lipid levels,endothelium dependent and endothelium independent dilatation after the low fat meal were observed. Conclusion:Our results indicate that endothelium dependent vasorelaxation is impaired in CHD after high fat meal.Impairment of endothelium dependent vasorelaxation is correlated with elevation in postprandial serum triglyceride.