VAP检测血浆脂蛋白亚组分的新进展及应用分析
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摘要
越来越多的证据强调特殊的血浆脂蛋白亚组分,如脂蛋白残粒(RLP)、脂蛋白(a)[Lp(a)]、高密度脂蛋白(HDL)亚型(HDL2、HDL3)以及颗粒浓度,如小而密低密度脂蛋白颗粒(sd-LDL-P)等在心血管疾病(CVD)进展中的关键作用。这些指标型别和数量上的改变与CVD风险和治疗选择密切相关。垂直梯度离心(VAP)参考经典的超速离心血脂检测原理,能较为完整地分离血浆脂蛋白颗粒,并对其内部的胆固醇水平、体积、密度和型别进行综合分析,为相关疾病的早期筛查、风险评价和治疗选择提供较为全面的血脂检测数据,弥补了传统血脂项目的空白。过去20年,北美地区在VAP的应用中积累了大量的科研及临床资料。文章简要介绍了VAP在血浆脂蛋白亚组分和颗粒检测方法学上的特点及其在CVD风险评估中的应用新进展。
More evidence is accentuating the special subfractions of plasma lipoproteins,including remnant-like lipoprotein particles(RLP),lipoproteins(a) [Lp(a)],high-density lipoprotein(HDL) subfractions(HDL2 and HDL 3) and particle concentration,like small density low-density lipoprotein particle(sd-LDL-P), in the progression of cardiovascular disease(CVD). The changes of pattern and number of these indicators are closely related to CVD risk and treatment strategy. Vertical auto profile(VAP) refers to the classical principle of ultracentrifuge lipid determination,which can effectively realize complete separation of plasma lipoprotein particles. After the comprehensive analysis of lipoprotein internal cholesterol level,volume,density and particle pattern,VAP provides comprehensive blood lipid data for the early screening and risk evaluation of related diseases,making up for the gaps in traditional blood lipid programs. VAP has accumulated a large amount of scientific researches and clinical data in North America over the past 20 years. This review briefly introduces its characteristics in plasma lipoprotein subfractions and particle determination and presents new progress of its application in CVD risk management.
More evidence is accentuating the special subfractions of plasma lipoproteins,including remnant-like lipoprotein particles(RLP),lipoproteins(a) [Lp(a)],high-density lipoprotein(HDL) subfractions(HDL2 and HDL 3) and particle concentration,like small density low-density lipoprotein particle(sd-LDL-P), in the progression of cardiovascular disease(CVD). The changes of pattern and number of these indicators are closely related to CVD risk and treatment strategy. Vertical auto profile(VAP) refers to the classical principle of ultracentrifuge lipid determination,which can effectively realize complete separation of plasma lipoprotein particles. After the comprehensive analysis of lipoprotein internal cholesterol level,volume,density and particle pattern,VAP provides comprehensive blood lipid data for the early screening and risk evaluation of related diseases,making up for the gaps in traditional blood lipid programs. VAP has accumulated a large amount of scientific researches and clinical data in North America over the past 20 years. This review briefly introduces its characteristics in plasma lipoprotein subfractions and particle determination and presents new progress of its application in CVD risk management.
引文
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[17]乔蕊,张捷.脂蛋白(a)--血脂家族的重要一员[J].检验医学,2017,32(7):561-565.
[18]VON ECKARDSTEIN A,SCHULTE H,CULLEN P,et al.Lipoprotein(a)further increases the risk of coronary events in men with high global cardiovascular risk[J].J Am Coll Cardiol,2001,37(2):434-439.
[19]SULTAN S M,SCHUPF N,DOWLING M M,et al.Review of lipid and lipoprotein(a)abnormalities in childhood arterial ischemic stroke[J].Int J Stroke,2014,9(1):79-87.
[20]Emerging Risk Factors Collaboration,ERQOU S,KAPTOGE S,et al.Lipoprotein(a)concentration and the risk of coronary heart disease,stroke,and nonvascular mortality[J].JAMA,2009,302(4):412-423.
[21]MARCOVINA S M,ALBERS J J.Lipoprotein(a)measurements for clinical application[J].J Lipid Res,2016,57(4):526-537.
[22]YEANG C,CLOPTON PC,TSIMIKAS S.Lipoprotein(a)-cholesterol levels estimated by vertical auto profile correlate poorly with Lp(a)mass in hyperlipidemic subjects:implications for clinical practice interpretation of Lp(a)-mediated risk[J].J Clin Lipidol,2016,10(6):1389-1396.
[23]SHARMA S,MERCHANT J,FLEMING S E.Lp(a)-cholesterol is associated with HDL-cholesterol in overweight and obese African American children and is not an independent risk factor for CVD[J].Cardiovasc Diabetol,2012,11:10.
[24]PIRILLO A,NORATA G D,CATAPANO A L.Highdensity lipoprotein subfractions-what the clinicians need to know[J].Cardiology,2013,124(2):116-125.
[25]CAMONT L,CHAPMAN M J,KONTUSH A.Biological activities of HDL subpopulations and their relevance to cardiovascular disease[J].Trends Mol Med,2011,17(10):594-603.
[26]MASCARENHAS-MELO F,PALAVRA F,MARADOD,et al.Emergent biomarkers of residual cardiovascular risk in patients with low HDL-c and/or high triglycerides and average LDL-c concentrations:focus on HDLsubpopulations,oxidized LDL,adiponectin,and uric acid[J].Scientific World Journal,2013,2013:387849.
[27]BURILLO E,MARTíN-FUENTES P,MATEO-GALLEGO R,et al.Omega-3 fatty acids and HDL.How do they work in the prevention of cardiovascular disease?[J].Curr Vasc Pharmacol,2012,10(4):432-441.
[28]KULKARNI K R,MARCOVINA S M,KRAUSS R M,et al.Quantification of HDL2 and HDL3 cholesterol by the Vertical Auto Profile-Ⅱ(VAP-Ⅱ)methodology[J].JLipid Res,1997,38(11):2353-2364.
[29]MANGAT R,SU JW,LAMBERT J E,et al.Increased risk of cardiovascular disease in type 1 diabetes:arterial exposure to remnant lipoproteins leads to enhanced deposition of cholesterol and binding to glycated extracellular matrix proteoglycans[J].Diabet Med,2011,28(1):61-72.
[30]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-950.
[31]MAY H T,NELSON J R,KULKARNI K R,et al.A new ratio for better predicting future death/myocardial infarction than standard lipid measurements in women>50 years undergoing coronary angiography:the apolipoprotein A1remnant ratio(Apo A1/[VLDL3+IDL])[J].Lipids Health Dis,2013,12:55.
[2]ARGUELLES W,LLABRE M M,PENEDO F J,et al.Relationship of change in traditional cardiometabolic risk factors to change in coronary artery calcification among individuals with detectable subclinical atherosclerosis:the multi-ethnic study of atherosclerosis[J].Int J Cardiol,2014,174(1):51-56.
[3]ALLAIRE J,VORS C,COUTURE P,et al.LDL particle number and size and cardiovascular risk:anything new under the sun?[J].Curr Opin Lipidol,2017,28(3):261-266.
[4]KANNEL W B,CASTELLI W P,MCNAMARA P M.Serum lipid fractions and risk of coronary heart disease.The Framingham study[J].Minn Med,1969,52(8):1225-1230.
[5]SUPERKO H R,KING S 3rd.Lipid management to reduce cardiovascular risk:a new strategy is required[J].Circulation,2008,117(4):560-568.
[6]SCHARNAGL H,NAUCK M,WIELAND H,et al.The Friedewald formula underestimates LDL cholesterol at low concentrations[J].Clin Chem Lab Med,2001,39(5):426-431.
[7]SUPERKO H R.Advanced lipoprotein testing and subfractionation are clinically useful[J].Circulation,2009,119(17):2383-2395.
[8]MORRIS P B,BALLANTYNE C M,BIRTCHER KK,et al.Review of clinical practice guidelines for the management of LDL-related risk[J].J Am Coll Cardiol,2014,64(2):196-206.
[9]CROMWELL W C,OTVOS J D,KEYES M J,et al.LDL particle number and risk of future cardiovascular disease in the Framingham offspring study-implications for LDL management[J].J Clin Lipidol,2007,1(6):583-592.
[10]VAKKILAINEN J,STEINER G,ANSQUER J C,et al.Relationships between low-density lipoprotein particle size,plasma lipoproteins,and progression of coronary artery disease:the Diabetes Atherosclerosis Intervention Study(DAIS)[J].Circulation,2003,107(13):1733-1737.
[11]MCLEAN D S,RAVID S,BLAZING M,et al.Effect of statin dose on incidence of atrial fibrillation:data from the Pravastatin or Atorvastatin Evaluation and Infection TherapyThrombolysis in Myocardial Infarction 22(PROVE IT-TIMI 22)and Aggrastat to Zocor(A to Z)trials[J].Am Heart J,2008,155(2):298-302.
[12]BARTER P J,BALLANTYNE C M,CARMENA R,et al.Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy:report of the thirty-person/tencountry panel[J].J Intern Med,2006,259(3):247-258.
[13]AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices,COLE T G,CONTOIS J H,et al.Association of apolipoprotein B and nuclear magnetic resonance spectroscopy-derived LDL particle number with outcomes in 25 clinical studies:assessment by the AACCLipoprotein and Vascular Diseases Division Working Group on Best Practices[J].Clin Chem,2013,59(5):752-770.
[14]SETH D,GARMO H,WIGERTZ A,et al.Lipid profiles and the risk of endometrial cancer in the Swedish AMORISstudy[J].Int J Mol Epidemiol Genet,2012,3(2):122-133.
[15]FREEDMAN D S,OTVOS J D,JEYARAJAH E J,et al.Sex and age differences in lipoprotein subclasses measured by nuclear magnetic resonance spectroscopy:the Framingham Study[J].Clin Chem,2004,50(7):1189-1200.
[16]QIN S Y,LIU J,JIANG H X,et al.Association between baseline lipoprotein(a)levels and restenosis after coronary stenting:meta-analysis of 9 cohort studies[J].Atherosclerosis,2013,227(2):360-366.
[17]乔蕊,张捷.脂蛋白(a)--血脂家族的重要一员[J].检验医学,2017,32(7):561-565.
[18]VON ECKARDSTEIN A,SCHULTE H,CULLEN P,et al.Lipoprotein(a)further increases the risk of coronary events in men with high global cardiovascular risk[J].J Am Coll Cardiol,2001,37(2):434-439.
[19]SULTAN S M,SCHUPF N,DOWLING M M,et al.Review of lipid and lipoprotein(a)abnormalities in childhood arterial ischemic stroke[J].Int J Stroke,2014,9(1):79-87.
[20]Emerging Risk Factors Collaboration,ERQOU S,KAPTOGE S,et al.Lipoprotein(a)concentration and the risk of coronary heart disease,stroke,and nonvascular mortality[J].JAMA,2009,302(4):412-423.
[21]MARCOVINA S M,ALBERS J J.Lipoprotein(a)measurements for clinical application[J].J Lipid Res,2016,57(4):526-537.
[22]YEANG C,CLOPTON PC,TSIMIKAS S.Lipoprotein(a)-cholesterol levels estimated by vertical auto profile correlate poorly with Lp(a)mass in hyperlipidemic subjects:implications for clinical practice interpretation of Lp(a)-mediated risk[J].J Clin Lipidol,2016,10(6):1389-1396.
[23]SHARMA S,MERCHANT J,FLEMING S E.Lp(a)-cholesterol is associated with HDL-cholesterol in overweight and obese African American children and is not an independent risk factor for CVD[J].Cardiovasc Diabetol,2012,11:10.
[24]PIRILLO A,NORATA G D,CATAPANO A L.Highdensity lipoprotein subfractions-what the clinicians need to know[J].Cardiology,2013,124(2):116-125.
[25]CAMONT L,CHAPMAN M J,KONTUSH A.Biological activities of HDL subpopulations and their relevance to cardiovascular disease[J].Trends Mol Med,2011,17(10):594-603.
[26]MASCARENHAS-MELO F,PALAVRA F,MARADOD,et al.Emergent biomarkers of residual cardiovascular risk in patients with low HDL-c and/or high triglycerides and average LDL-c concentrations:focus on HDLsubpopulations,oxidized LDL,adiponectin,and uric acid[J].Scientific World Journal,2013,2013:387849.
[27]BURILLO E,MARTíN-FUENTES P,MATEO-GALLEGO R,et al.Omega-3 fatty acids and HDL.How do they work in the prevention of cardiovascular disease?[J].Curr Vasc Pharmacol,2012,10(4):432-441.
[28]KULKARNI K R,MARCOVINA S M,KRAUSS R M,et al.Quantification of HDL2 and HDL3 cholesterol by the Vertical Auto Profile-Ⅱ(VAP-Ⅱ)methodology[J].JLipid Res,1997,38(11):2353-2364.
[29]MANGAT R,SU JW,LAMBERT J E,et al.Increased risk of cardiovascular disease in type 1 diabetes:arterial exposure to remnant lipoproteins leads to enhanced deposition of cholesterol and binding to glycated extracellular matrix proteoglycans[J].Diabet Med,2011,28(1):61-72.
[30]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-950.
[31]MAY H T,NELSON J R,KULKARNI K R,et al.A new ratio for better predicting future death/myocardial infarction than standard lipid measurements in women>50 years undergoing coronary angiography:the apolipoprotein A1remnant ratio(Apo A1/[VLDL3+IDL])[J].Lipids Health Dis,2013,12:55.