Causal associations between intermediate very-low-density lipoprotein cholesterol-to-total lipids ratio and peptic ulcer:A bidirectional Mendelian randomization study

BACKGROUND Previous epidemiologic investigations have consistently demonstrated a strong association between the ratio of cholesterol to total lipids in medium very-lowdensity lipoprotein(VLDL)and the occurrence of peptic ulcers(PU).However,the precise causal relationship between these factors remains ambiguous.Consequently,this study aims to elucidate the potential correlation between the ratio of cholesterol to total lipids in medium VLDL and the incidence of peptic ulcer.AIM To investigate the ratio of cholesterol to total lipids in medium very-low-density lipoprotein(VLDL)association with PU via genetic methods,guiding future clinical research.METHODS Genome-wide association study(GWAS)datasets for the ratio of cholesterol to total lipids in intermediate VLDL and peptic ulcer were retrieved from the IEU OpenGWAS project(https://gwas.mrcieu.ac.uk).For the forward Mendelian randomization(MR)analysis,72 single nucleotide polymorphisms(SNPs)were identified as instrumental variables.These SNPs were selected based on their association with the ratio of cholesterol to total lipids in intermediate VLDL,with peptic ulcer as the outcome variable.Conversely,for the inverse MR analysis,no SNPs were identified with peptic ulcer as the exposure variable and the ratio of cholesterol to total lipids in intermediate VLDL as the outcome.All MR analyses utilized inverse variance weighted(IVW)as the primary analytical method.Additionally,weighted median and MR-Egger methods were employed as supplementary analytical approaches to assess causal effects.Egger regression was used as a supplementary method to evaluate potential directional pleiotropy.Heterogeneity and multiplicity tests were conducted using the leave-one-out method to evaluate result stability and mitigate biases associated with multiple testing.RESULTS The genetically predicted ratio of cholesterol to total lipids in medium VLDL was significantly associated with an elevated risk of peptic ulcer(IVW:OR=2.557,95%CI=1.274-5.132,P=0.008).However,no causal association of peptic ulcer with the ratio of cholesterol to total lipids in medium VLDL was observed in the inverse Mendelian randomization analysis.CONCLUSION In conclusion,our study reveals a significant association between the ratio of cholesterol to total lipids in medium VLDL and an elevated risk of peptic ulcers.However,further validation through laboratory investigations and larger-scale studies is warranted to strengthen the evidence and confirm the causal relationship between these factors.

Chronic Supplementation with L-Isoleucine Alone or in Combination with Exercise Reduces Hepatic Cholesterol Levels with No Effect on Serum Glucose, Insulin, or Lipids in Rats Fed a High Fructose Diet

The thought of using branched-chain amino acids (BCAA) in the prevention and treatment of certain disorders is becoming increasingly popular. Individual BCAA use has been associated with improving glucose tolerance and liver disease. Previous studies have cited improvements in glucose metabolism with a single dose of L-isoleucine (ILE). However, it is still unclear whether chronic consumption of ILE has any direct benefit. The objective of this study was to examine the influence of chronic ILE supplementation alone or in combination with exercise on fasting serum glucose, insulin, lipids, and lipoprotein cholesterol levels;glucose tolerance;and hepatic lipids in rats. Male Sprague-Dawley rats (n = 40) were divided into Control (low fructose diet);High Fructose diet (HF);HF plus 1.5% ILE (HF + ILE);HF plus exercise (HF + EX);and HF plus 1.5% ILE and exercise (HF + ILE + EX). The HF diets consisted of 70% kcalories from fructose. After 6 weeks of treatment, no significant differences were observed between groups for changes in fasting serum glucose, insulin, lipids, or lipoprotein cholesterol levels. However, hepatic total cholesterol was significantly lower in the HF + ILE + EX compared to the Control and HF, while, the HF + ILE had significantly lower hepatic free cholesterol compared to the HF. We also found no differences between groups for serum glucose response following an oral glucose tolerance test. In conclusion, our study shows that ILE supplementation in rats does not influence serum glucose and lipid biomarkers but may have an influence on lipid metabolic pathways within the liver.

Dyslipidemia in Adults with Type 2 Diabetes in a Rural Community in Ganadougou, Mali: A Cross-Sectional Study

Dyslipidemia is a disorder where abnormally lipid concentrations circulate in the bloodstream. The disorder is common in type 2 diabetics (T2D) and is linked with T2D comorbidities, particularly cardiovascular disease. Dyslipidemia in T2D is typically characterized by elevated plasma triglyceride and low high-density lipoprotein cholesterol (HDL-C) levels. There is a significant gap in the literature regarding dyslipidemia in rural parts of Africa, where lipid profiles may not be captured through routine surveillance. This study aimed to characterize the prevalence and demo-graphic profile of dyslipidemia in T2D in the rural community of Ganadougou, Mali. We performed a cross-sectional study of 104 subjects with T2D in Ganadougou between November 2021 and March 2022. Demographic and lipid profiles were collected through cross-sectional surveys and serological analyses. The overall prevalence of dyslipidemia in T2D patients was 87.5% (91/104), which did not differ by sex (P = .368). High low-density lipoprotein cholesterol (LDL-C) was the most common lipid abnormality (78.9%, [82/104]). Dyslipidemia was associated with age and hypertension status (P = .013 and.036, respectively). High total and high LDL-C parameters were significantly associated with hypertension (P = .029 and .006, respectively). In low-resource settings such as rural Mali, there is a critical need to improve infrastructure for routine dyslipidemia screening to guide its prevention and intervention approaches. The high rates of dyslipidemia observed in Gandadougou, consistent with concomitant increases in cardiovascular diseases in Africa suggest that lipid profile assessments should be incorporated into routine medical care for T2D patients in African rural settings.

The Stability of Lipid Rafts-Like Micro-Domains Is Dependent on the Available Amount of Cholesterol

Lipid rafts are sterol and sphingolipid rich membrane domains that possibly may play roles in multiple cellular processes. These domains are still the matter of debate and it is still unknown by which mechanism if any and organisms promote their formation. This study centers on the ease of in vitro formation of lipid rafts-like structures as it relates to the relative availability of sphingolipids, phospholipids, cholesterol, and membrane proteins. Following a 12 h incubation period, isolation and extraction of the lipid rafts-like assemblies, the composition of the structures was evaluated using HPLC. Cholesterol and sphingomyelin were detected at 206 nm and phosphatidylcholine was detected at 254 nm. Identification of lactose permease, a typical membrane protein, was done using FTIR. The thermal stability of the produced structures was also determined. Results show that the addition of cholesterol significantly increased both the amount of insoluble lipid rafts-like structures and their stability, and that the availability of a minimum amount of sphingolipid was necessary to produce larger amounts of more stable structures. However, the addition of phospholipids hindered the formation of lipid rafts-like assemblies and those formed were generally less stable.

Effect of <i>Carica papaya</i>Leaf Extract on Serum Lipids and Liver Metabolic Parameters of Rats Fed a High Cholesterol Diet

Hyperlipidemia plays an important role in the development of atherosclerosis, the main cause of death in the world. In this study, the lipid-lowering effect of Carica papaya leaf in rats fed with a high cholesterol diet was evaluated. Daily doses of C. papaya extract 0, 31, 62 or 125 mg/kg body weight were orally administered in 300 μl polyethylene glycol to hypercholesterolemic rats;it was also administered 62 mg/kg body weight of the extract to rats with normal diet. After a 20-day treatment, the animals were sacrificed;blood and liver were analyzed. Hypercholesterolemic rats showed an increased serum and liver cholesterol, triacylglycerols, and atherogenic index. The C. papaya extract produced a significant decrease of serum and liver cholesterol concentrations in hypercholesterolemic rats, but did not modify serum or liver triacylglycerols;however, the extract reduced the atherogenic index in a dose-dependent manner. C. papaya treatment decreased LDL-C and increased HDL-C in serum significantly. When the oxygen consumption was evaluated in phosphorylating and resting states, the respiratory control in hypercholesterolemic rats mitochondria was lower than in normal diet rats. However, a higher respiratory control in hypercholesterolemic rats mitochondria was observed after C papaya treatment. The liver morphological data are in accordance with serum and liver biochemical values. Our data support that C. papaya has a significant hypocholesterolemic action and HDL-C raising effect on rats fed with a cholesterol-rich diet, however, the precise metabolites responsible of this effect remain unknown.

Coarse-grained simulations of branched bilayer membranes: effects of cholesterol-dependent phase separation on curvature-driven lipid sorting

Our recent coarse-grained (CG) molecular dynamics (MD) simulations of membranes with a hemifused-ribbon (λ-shaped) geometry showed curvature-driven demixing leading to enrich ment in dioleoyl-phosphatidylethanolamine (DOPE) in a negatively-curved region (at C = –0.8 nm–1) of a DOPE/dipalmitoyl-phosphati-dylcholine (DPPC) membrane. Here we extend the analysis with respect to lipid composition and simulation time. Simulations of 12 – 20 μs effective time show that, compared with DOPE of the DOPE/DPPC system, a DPPC/dilinoleyl-PC [di(18:2)PC] membrane showed a similar degree of enrichment of di(18:2)PC in the curved region with C=–0.8 nm–1. For the latter mixture, even weak negative curvatures (C=–0.5 – 0.6 nm–1) caused significant degrees of di(18:2)PC enrichment. In agreement with recent studies of a planar bilayer, a ternary DPPC/ di(18:2)PC/cholesterol 0.42:0.28:0.3 mixture phase-separated into nanoscale raft-like liquid-ordered (Lo) and non-raft liquid-disordered (Ld) phases on a sub-microsecond time scale. The Lo domains were preferentially localized at planar portions, whereas the Ld domains were positioned mainly in curved regions of the membrane. Unlike binary dioleoylphosphatidylcho-line (DOPC)/cholesterol and DPPC/cholesterol mixtures, which showed only a slight enrich ment of cholesterol in the curved region, the ternary mixtures showed considerable migra tion of cholesterol and DPPC from the curved to the planar region. A pronounced degree of lipid segregation due to the preferential distribution of the Ld and Lo domains in the curved and planar regions, respectively, was observed even when the curvature of the fused monolayers (originally ‘cis’ leaflets) was weakened (C= –0.5 nm-1). Overall, the results are consistent with theoretical predictions based on spontaneous curvature of the constituent lipids and the difference in rigidity between the Ld and Lo domains, whereas lipid-lipid interactions, such as PE-PE or DPPC-cholesterol, as well as propensity for interleaflet colocalization (registration) of the Lo and Ld domains appear to significantly amplify curvature-induced lipid demixing in the λ system. Intriguingly, for the DPPC/ di(18:2)PC/cholesterol ternary mixtures, a Lo/Ld domain boundary often moved to the branched point of the membrane, suggesting enhanced flexibility at the domain boundary. We hypothesize that curvature-driven lipid sorting and energetically favored localization of domain boundaries at sharp bends in the membranes may collaborate to assist intracellular lipid sorting.

Ultrasonographic Findings of Selected Liver Parameters and Their Correlation to Lipidaemia in a Nigerian Population

Introduction: This study was conducted in the University of Port Harcourt Teaching Hospital, with the sample analysis conducted in HMG Hospital private laboratory in Rivers State. Methodology: A random sampling technique was employed to select the respondents, while the Taro-Yamene formula was used to calculate the sample size and data analysed with SPSS version 20. Results: The respondents were mainly aged 30 - 39 years, 12 (40.00%), mainly females, 20 (66.67%) and obese, 16 (53.33%). They were also mainly Christians, 25 (83.33%), of Ijaw descent 20 (66.67%) and civil/public servants, 13 (43.33%). The total cholesterol was the highest, 18 (60.00%), normal for triglyceride, 24 (80.00%), low for high density lipoprotein cholesterol, 22 (73.33%) and high for low density lipoprotein cholesterol, 14 (46.67%). Maximum liver span was statistically significant to triglyceride concentration;p-value (0.001) but not for total cholesterol;p-value (0.084), high density lipoprotein cholesterol;p-value (0.477) and low density lipoprotein cholesterol;p-value (0.317). Conclusion: Liver span is a predictive tool for the probable diagnosis of dyslipidaemia.

Effect of dietary supplementation with olive and sunflower oils on lipid profile and liver histology in rats fed high cholesterol diet

Objective: To compare the effects of high-monounsaturated(MUFA) and polyunsaturated fatty acids(PUFA) against the metabolic disorders elicited by a high-cholesterol diet(HC) in rats. Methods: Using in vivo dietary manipulation, rats were fed with different diets containing 4% soybean oil(cholesterol free diet) and 1% HC containing 12% olive oil(HC+OO) enriched with MUFA and 12% sunflower oil(HC+SO) enriched with PUFA for 60 d. Serum lipid levels and hepatic steatosis were evaluated after the treatment period. Results: Comparatively, rats treated with HC+OO diet experienced a decrease in the serum LDL-C, VLDL-C and CT levels compared to those fed with HC+SO diet(P<0.05). Otherwise, HC+OO provoked significant microvesicular steatosis situated in the hepatic acinar zone 1. Conclusions: HC+OO diet has high absorption velocity in the acinar zone 1 of liver compared to the HC+SO diet. Based on this, the reduction of the LDL-C, VLDL-C and CT serum levels in the animals treated with HC+OO diet can be caused by the delay in the FA release to the blood.

血清脂质相关指标与乳腺癌关系的研究进展

脂代谢紊乱与乳腺癌的发生发展及预后密切相关。探索血清脂质相关指标、降脂药物对乳腺癌发病及预后的影响,有助于寻找乳腺癌新的生化标志物,发现新的治疗靶点并对其进行更精准的个体化治疗。本文通过查阅相关文献,就血清脂质相关指标与乳腺癌之间的关系做一综述,为深入研究乳腺癌的发病机制及乳腺癌的预防、诊断及治疗提供新的方向。

Altered Levels of Blood Glucose and Serum Lipids in Sudanese Patients with Ovarian Cancer

Background: The etiology of ovarian cancer is not well-understood;numerous metabolomics profiling, epidemiological, and hospital-based case control studies have associated abnormal levels of blood glucose and serum lipids with the risk and the prognosis of various types of cancers including ovarian cancer. The association between the risk of the incidence of ovarian cancer and the alterations in the levels of blood glucose and serum lipids is not well defined. Objective: In this study we aimed to compare the levels of blood glucose, triacylglycerols, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in patients with different stages of ovarian cancer and healthy controls to determine how they relate to the risk and prognosis of ovarian cancer. Methodology: In a case-control cross sectional study, we enrolled ninety-nine Sudanese women, diagnosed with ovarian cancer but had not received any kind of treatment as the study group, and a control group of forty-one age-matched, apparently healthy women. The patients were classified according to the International Federation of Obstetricians and Gynecologists staging system into two groups: early stages (stage I & II) and late stages (stages III & IV). Blood glucose and serum lipids;triacylglycerols, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol were determined by enzymatic colorimetric methods using commercially available analytical kits. The IBM SPSS version 20 software was used for statistical analysis. A Mann-Whitney U test was used for comparison of the median concentrations of blood glucose, triacylglycerols, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in the study groups. Logistic regression model was used to estimate the relative risk of ovarian cancer in relation to levels of blood glucose and serum lipids. P value of 0.05 was considered significant. Results: Our data indicated significantly higher levels of blood glucose (p < 0.001), triacylglycerols (p = 0.002), and low-density lipoprotein cholesterol (p < 0.001), and lower levels of high-density lipoprotein cholesterol (p = 0.023), in ovarian cancer patients compared to the control subjects. No significant difference was found in the levels of blood glucose or any of the serum lipids between patients in the early stages (stage I & II) and those in late stages (stage III & IV) of ovarian cancer. The logistic regression analysis indicated significant association between the elevated levels of the blood glucose, triacylglycerols and low-density lipoprotein cholesterol and the risk of the ovarian cancer. Conclusion: We conclude that the levels of blood glucose, triacylglycerols, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol differ significantly between ovarian cancer patients and the healthy control subjects. The risk of ovarian cancer was positively associated with the levels of blood glucose, triacylglycerols and low-density lipoprotein cholesterol, and negatively associated with levels of high-density lipoprotein cholesterol. Therefore, determination of blood glucose and serum lipids, particularly, triacylglycerols, low-density lipoprotein cholesterol may be helpful as diagnostic indicators of ovarian cancer (OC).

血脂代谢异常和肥胖患者发生高危前列腺癌的风险可能更高

目的探讨血脂代谢异常和肥胖因素是否影响高危前列腺癌的发生,旨在为前列腺癌的防治提供参考。方法回顾性分析石河子大学第二附属医院(新疆生产建设兵团医院)泌尿外科2016年6月—2022年6月收治的175例前列腺癌患者的临床资料,其中高危前列腺癌组122例,非高危前列腺癌组53例。采用logistic回归分析影响高危前列腺癌发生的独立危险因素,通过受试者工作特征(ROC)曲线评估年龄、胆固醇、身体质量指数(BMI)、前列腺特异性抗原(PSA)等风险因素对高危前列腺癌发生的预测价值及最佳截断值。采用Spearman分析Gleason评分与不同风险因素间的相关性。结果高危前列腺癌组的年龄、BMI、胆固醇水平、PSA水平、肥胖(BIM≥25)及高胆固醇占比均高于非高危前列腺癌组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示年龄(OR=1.097,95%CI:1.005~1.198,P=0.039)、肥胖(OR=4.459,95%CI:1.305~15.239,P=0.017)、PSA(OR=1.170,95%CI:1.069~1.280,P=0.001)、高胆固醇(OR=5.544,95%CI:1.304~23.577,P=0.020)是高危前列腺癌发生的危险因素。ROC曲线显示年龄、胆固醇、BMI、PSA最佳截断值分别为74.50岁(AUC:0.748,95%CI:0.678~0.818)、3.70 mmol/L(AUC:0.800,95%CI:0.731~0.870)、24.97(AUC:0.621,95%CI:0.532~0.711)、18.67 ng/mL(AUC:0.864,95%CI:0.813~0.916),且年龄、胆固醇、BMI、PSA 4项指标联合预测高危前列腺癌的价值最高(AUC:0.931,95%CI:0.895~0.967)。Spearman分析发现前列腺癌患者的年龄(r=0.464,P<0.001)、BMI(r=0.222,P=0.003)、胆固醇(r=0.501,P<0.001)、PSA(r=0.473,P<0.001)与Gleason评分呈正相关。结论肥胖、年龄、PSA及胆固醇水平是高危前列腺癌发生的影响因素,且当患者的年龄≥74.50岁、胆固醇≥3.70 mmol/L、BMI≥24.97、PSA≥18.67 ng/mL时发生高危前列腺癌的可能性更高。

云南省玉溪市健康成人血脂水平调查

目的调查玉溪市表观健康成人血脂水平的分布情况并分析其危险因素。方法从玉溪市人民医院体检中心选取健康体检人群951名(男429名,女522名),年龄18~79岁,排除心脑血管疾病、糖尿病、使用降脂药等因素的影响,通过全自动生化分析仪检测TC、TG、HDL-C、LDL-C、ApoA1和ApoB的浓度,将检测结果按性别、年龄及各种危险因素分组后进行统计学分析。正态分布2组数据比较采用t检验,多组间数据比较采用方差分析。结果女性TC、HDL-C、ApoA1水平显著高于男性,差异有统计学意义(P<0.05),而男性TG水平显著高于女性差异有统计学意义(P<0.05);随着年龄增长,TC、TG、LDL-C和ApoB水平显著增高,差异有统计学意义(P<0.05),60~69岁达高峰,70岁后水平下降。结论通过此研究获得玉溪市表观健康成人血脂水平的分布情况,为临床评估心脑血管疾病的风险,指导临床医师合理制定治疗方案提供了客观依据。

降胆固醇单片复方制剂临床应用中国专家共识

有效的血脂管理可显著降低动脉粥样硬化性心血管疾病(atherosclerotic cardiovascular disease,ASCVD)负担,但目前我国ASCVD患者血脂管理仍面临血脂达标率低、治疗依从性不佳的现状。越来越多的证据显示,他汀和非他汀类药物组成的单片复方制剂(single-pill combination,SPC)对于提高血脂达标率、改善治疗依从性及预防不良心血管事件具有重要意义。为了规范我国降胆固醇SPC的临床应用,中国医师协会心血管内科医师分会组织国内心血管、脑血管、内分泌及药理学专家共同制定了《降胆固醇单片复方制剂临床应用中国专家共识》。本共识对SPC的临床应用优势及临床研究进行了阐述,并制定了ASCVD防治血脂管理路径,对SPC的适用人群、用法用量、不良反应处理等给出了明确的指导意见。

糖尿病肾脏疾病合并脂代谢紊乱的中西医治疗进展

糖尿病肾脏疾病(DKD)发病机制复杂,涉及代谢紊乱、氧化应激、炎症等多个方面。脂代谢作为人体重要的代谢过程之一,与DKD患者疾病进展密切相关。现代医学多通过干预生活方式,使用降糖、降脂药物等手段调节DKD患者糖脂代谢,在一定程度上改善患者预后。中医药治疗DKD合并脂代谢紊乱,在临床制剂及有效成分提取物开发方面,取得一定成果。

血脂水平与中晚期鼻咽癌患者临床特征及生存预后的研究

目的探讨中晚期鼻咽癌患者血清脂质水平与临床特征、生存预后的相关性。方法回顾性分析2008年1月至2018年1月于江南大学附属医院238例初诊Ⅲ~Ⅳ期鼻咽癌患者,收集血清脂质相关指标高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、载脂蛋白E(ApoE)、胆固醇和甘油三酯,采用单因素和多因素Cox回归模型分析、Kaplan-Meier生存曲线和受试者操作特征(ROC)曲线等进行统计分析和临床预后评价。结果年龄≥55岁鼻咽癌患者的ApoA1水平明显高于年龄<55岁鼻咽癌患者(P=0.013)。女性患者HDL-C水平明显高于男性患者(P=0.001)。单因素Cox回归模型分析结果显示,胆固醇与鼻咽癌患者总生存(OS)期差异有统计学意义(HR=1.626,95%CI=1.065~2.482,P=0.024)。进一步对P<0.1的ApoB、ApoE和胆固醇纳入多因素Cox回归模型分析,结果显示高胆固醇是鼻咽癌预后的危险因素(HR=1.613,95%CI=1.058~2.460,P=0.026)。不同基线胆固醇水平下,HDL-C(P=0.024)、LDL-C(P=0.001)和ApoB(P=0.001)水平差异具有统计学意义。低胆固醇患者的生存期比高胆固醇患者长,低胆固醇患者具有更长的总生存期(P=0.025)。ROC曲线分析显示,胆固醇预测鼻咽癌预后的曲线下面积差异具有统计学意义,提示胆固醇对中晚期鼻咽癌患者生存具有预测能力(AUC=0.581,95%CI=0.505~0.656,P=0.037)。结论中晚期鼻咽癌患者不同临床特征间血脂存在明显差异;血清胆固醇是预测鼻咽癌患者预后的因素,且高胆固醇是鼻咽癌患者的危险因素,与患者不良预后相关。

血小板胆固醇、脂筏与功能间的关系探究

[目的]探究胆固醇对血小板脂筏含量和血小板功能的调控作用。[方法]利用体外孵育甲基β环糊精(MβCD)和体内提升外周血总胆固醇水平来移除和负载血小板胆固醇。霍乱毒素B染色联合流式细胞术检测血小板脂筏含量;荧光抗体染色结合流式细胞术检测P选择素和活化型整合素αⅡbβ3的表达水平;Annexin V标记结合流式细胞术检测磷脂外翻水平;体外实验体系及鼠尾出血实验检测血小板的聚集能力。[结果]B淋巴细胞上脂筏的含量随着胆固醇的移除而降低,体外孵育MβCD移除血小板胆固醇反而显著提高其脂筏水平(P<0.05)。与此一致,体内胆固醇负载增加B淋巴细胞上的脂筏含量却降低血小板的脂筏含量(P<0.05)。移除胆固醇后增加的脂筏并不利于血小板的活化与聚集功能。体内胆固醇的负载下调血小板脂筏含量(P<0.05),增强其应答低浓度刺激剂的活化聚集与凝血能力,此增强作用在移除胆固醇后消失。[结论]血小板胆固醇是调控血小板脂筏含量和血小板功能的关键调节因子,可负向调节脂筏,促进血小板活化并增强其凝血功能。

中国缺血性卒中及短暂性脑缺血发作患者血脂长期管理科学声明

中国缺血性卒中(ischemic stroke,IS)及TIA疾病负担沉重。LDL-C水平升高是卒中复发的独立危险因素,积极评估患者LDL-C不达标的原因,制订进一步治疗策略、监测频率以提高达标率具有重要临床意义。为加强医务工作者对IS及TIA疾病长期管理及监测的认识,规范长期血脂管理临床实践,中国卒中学会医疗质量管理与促进分会组织相关脑血管病临床医学专家,基于循证证据和临床实践、经多轮专家意见收集和研讨,拟定本科学声明。本科学声明对IS及TIA患者长期血脂管理、长期血脂监测及重点患者血脂管理等方面进行了阐述,以期为提升IS及TIA患者的长期血脂管理临床规范提供参考。

不同Child-Pugh分级酒精性肝硬化患者临床特征分析

目的:探究酒精性肝硬化(ALC)患者血脂水平与Child-Pugh分级之间的关系。方法:选取2020年8月至2022年2月在首都医科大学附属北京地坛医院住院的ALC患者348例,其中Child-Pugh A+B级患者共有245例,Child-Pugh C级患者103例,记录患者的性别、年龄、实验室指标;通过单因素和多因素二元Logistic回归得出判断Child-Pugh C级的独立危险因素;绘制受试者工作特征曲线(ROC),得出曲线下面积(AUC)来评估诊断价值,并根据约登指数计算cut-off值。结果:与Child-Pugh A+B级患者相比,Child-Pugh C级患者WBC、AST、TBil、PT、INR水平都显著高于前者,而RBC、Hgb、PLT、Alb均低于前者;TC、TG、HDL-C、LDL-C水平低于前者,尤其是HDL-C水平降低更为明显。以所属的Child-Pugh等级作为因变量,通过单因素和多因素Logistic回归显示,年龄(OR=0.932,95%CI=0.899~0.966,P<0.001),WBC(OR=1.196,95%CI=1.053~1.360,P=0.006),PLT(OR=0.989,95%CI=0.982~0.995,P=0.001),CHE(OR=0.999,95%CI=0.998~0.999,P<0.001),HDL-C(OR=0.252,95%CI=0.082~0.779,P=0.017)是Child-Pugh C级的独立危险因素。进一步绘制HDL-C的ROC曲线,得出AUC为0.783,显著高于TC、TG、LDL-C的AUC,分别为0.611、0.550、0.623,显示了HDL-C较好的诊断价值;并根据约登指数得出HDL-C的cut-off值是0.645 mmol/L。结论:ALC患者的HDL-C水平对Child-Pugh分级有一定的参考价值。

甲状腺结节发生与糖脂代谢水平的相关性分析

目的分析甲状腺结节发生与糖脂代谢水平的相关性。方法选取厦门弘爱医院(2022年1—12月)接受甲状腺检查者100例,根据患者的检查结果不同分组,其中检查结果为甲状腺结节的患者50例为研究组,检查结果为未发生甲状腺结节的患者50例为对照组。分析患者的基础资料,明确甲状腺结节发生与糖脂代谢水平[空腹血糖(fasting plasma glucose,FPG)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)及高密度脂蛋白胆固醇(high density lipid-cholesterol,HDL-C)]的相关性。结果研究组FPG、TC、TG和LDL-C水平较对照组更高,差异有统计学意义(P<0.05)。而在HDL-C指标相比之下,差异无统计学意义(P>0.05)。因FT3、FT4、TSH均有不确定值为等级资料行Spearman秩相关分析。TSH与FPG、TC、LDL-C、HDL-C均呈正相关(r值分别为0.105、0.635、0.143、0.704、0.619,P<0.01),而FT3与FPG、TC、LDL-C、HDL-C均呈负相关(r值分别为-0.568、-0.676、-0.352、-0.702、-0.764,P<0.01),FT4与FPG、TC、LDL-C、HDL-C均呈负相关(r值分别为-0.401、-0.547、-0.425、-0.639、-0.493,P<0.01)。结论血清FPG、TC、TG、LDL-C升高,HDL-C降低,为甲状腺结节诱发因素。

新疆发酵驼乳中复合益生菌通过调节胆汁酸代谢对db/db小鼠脂质代谢的影响

文章从胆汁酸代谢的角度研究驼乳源复合益生菌对血脂的调节作用及机制。8只db/m小鼠作为正常对照组,32只db/db糖尿病小鼠分为模型组,阳性药组,复合益生菌低、高剂量组,每组8只。检测血糖血脂相关基本生化指标,制作肝脏组织切片进行分析;超高效液相色谱-串联质谱分析仪(UPLC/MS-MS)检测胆汁酸谱的变化,实时荧光定量聚合酶链式反应(RT-PCR)和蛋白质印迹法检测胆固醇代谢相关基因及蛋白表达。结果表明,复合益生菌可以显著降低db/db小鼠血清中糖化血红蛋白、总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平,减少肝脏脂肪变性,降低肝细胞内脂质空泡数量和体积;复合益生菌干预后,血清中总胆汁酸(TBA)降低,粪便中TBA升高,血清与粪便中初级胆汁酸(PBA)与次级胆汁酸(SBA)的比值降低;血清中游离胆汁酸占比升高,粪便中结合胆汁酸占比升高;胆汁酸中法尼醇X受体(FXR)及武田G蛋白偶联受体5(TGR5)的激动剂石胆酸(LCA)与鹅去氧胆酸(CDCA)含量升高,FXR的抑制剂牛磺-α-鼠胆酸(T-α-MCA)与牛磺-β-鼠胆酸(T-β-MCA)含量减少;复合益生菌干预后,小鼠肝脏中FXR表达增加,结肠中过氧化物酶体增殖物激活受体γ(PPARγ)与肝X受体α(LXRα)表达显著增加,胆固醇吸收蛋白NPC1样细胞内胆固醇转运蛋白1(NPC1L1)表达显著降低。因此复合益生菌可以改善db/db小鼠糖脂代谢,改善db/db小鼠胆汁酸组成结构,增加胆汁酸中FXR和TGR5的激动剂LCA与CDCA,减少胆汁酸中FXR的抑制剂T-α-MCA与T-β-MCA,促进FXR以及TGR5的表达,调节小鼠肝脏脂代谢;复合益生菌可能通过PPARγ-LXRα-NPC1L1通路,抑制肠道对胆固醇的吸收,调节脂代谢。