碳水化合物代谢紊乱背景下“可能的”家族性高胆固醇血症患者的临床和实验室对照

O. Mitchenko, K. Timokhova
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摘要

目的是研究“可能的”家族性高胆固醇血症(FH)患者根据碳水化合物代谢紊乱程度的临床和实验室相似之处。材料和方法。研究方案包括97例CAD、高血压和血脂异常患者,背景为共病病理(2型糖尿病、肥胖)。根据患者的合并症病理情况将患者分为两组。肥胖组根据是否存在前驱糖尿病进一步分为两个亚组(2A和2B)。结果和讨论。在糖尿病患者中,碳水化合物和脂质紊乱之间的直接关系被揭示出来,脂质动脉粥样硬化水平与糖尿病的不稳定程度高度依赖。在肥胖组中,BMI、WC和血脂变化之间没有明显的相关性。将肥胖组分为2A亚组和2B亚组后,发现两组患者的临床特征和血脂无明显差异,碳水化合物代谢紊乱水平与血脂变化无相关性。“可能”FH (LDL-C≥5.0 mmol/l)的患者群体是异质性的,可能包括在不稳定共病病理背景下继发性血脂异常的患者。以LDL-C≥5.0 mmol/l为标准的“可能”FH检出率在2型糖尿病患者中较高,并随着碳水化合物代谢紊乱程度的降低而降低。肥胖合并前驱糖尿病患者的LDL-C与血糖特征之间没有直接的平行关系和密切的相关性,这并不排除多基因基因突变对血脂特征影响的可能性。
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Clinical and laboratory parallels in patients with «possible» familial hypercholesterolemia on the background of carbohydrate metabolism disorders
The aim – to investigate clinical and laboratory parallels in patients with «possible» familial hypercholesterolemia (FH) depending on the degree of carbohydrate metabolism disorders.Materials and methods. The research protocol included 97 patients with CAD, hypertension and dyslipidemia on the background of comorbid pathology (type 2 diabetes, obesity). Patients were divided into 2 groups depending on concomitant comorbid pathology. The obese group was further divided into two subgroups (2A and 2B) depending on the presence of prediabities.Results and discussion. In the group with diabetes, direct correlations between carbohydrate and lipid disorders were revealed, as well as a high dependence of the level of lipid profile atherogenicity on degree of destabilization of diabetes. In the group with obesity, no significant correlation was found between BMI, WC and changes in the lipid profile. After dividing the obese group into subgroups 2A and 2B, no significant differences in clinical characteristics and lipid profile were found, and there were no correlations between the level of carbohydrate metabolism disorder and lipid changes.Conclusions. The group of patients with «possible» FH (with LDL-C ≥ 5.0 mmol/l) is heterogeneous and may include patients with secondary dyslipidemia on the background of destabilized comorbid pathology. The percentage of detection of «possible» FH according to the criterion of LDL-C ≥ 5.0 mmol/l was higher in patients with type 2 diabetes and decreased in parallel with the decrease in the degree of carbohydrate metabolism disorders. The absence of direct parallelism and close correlations between LDL-C and the characteristics of the glycemic profile in obese patients with prediabities, which does not exclude the possibility of influence of polygenic genetic mutations on the lipid characteristics.
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