Influence of low high-density lipoprotein cholesterolemia induced by probucol on the progression of     coronary atherosclerosis

目的：研究普罗布考的降高密度脂蛋白作用对冠状动脉粥样硬化的影响。

方法：320例患有心绞痛、心肌梗塞的患者分为3组：普罗布考组，32例，500mg/天，至少二年；低HDL-C组（<40mg/dl），152例，不服药；高HDL-C组（对照组，>40mg/dl），136例，不服药。疗前疗后做血管造影，按美国心脏协会分类评价法测出冠状动脉硬化指数。

结果：疗前至疗后的HDL-C水平（mg/dl）：普罗布考组，43.9±10.6~31.1±7.6， P<0.01；低HDL-C组，35.7±7.3~33.1±5.0, P<0.07；对照组，46.4±13.2~52.6±9.8， P<0.01。冠状动脉硬化指数：普罗布考组，7.2±5.9~9.1±6.8，P=0.24；低HDL-C组，8.3±5.4~11.9±6.1，P<0.01；对照组，7.3±5.4~9.9±6.2，P<0.01。

结论：普罗布考虽然明显降低了HDL-C水平但也明显抑制冠状动脉粥样硬化。

讨论：
    1、普罗布考组的HDL-C水平与疗前比明显降低，低HDL-C组无明显变化，对照组明显升高。
    2、普罗布考组的冠状动脉硬化指数与疗前比无明显变化，低HDL-C组和高HDL-C组（对照组）均有明显增加，说明普罗布考有明显抑制冠状动脉粥样硬化作用。
    3、普罗布考降高密度脂蛋白胆固醇但却抗动脉粥样硬化应是其它脂质因素的改善和抗氧化作用所致。
编者提示，最近的研究证明，普罗布考降低的是HDL-C的胆固醇部分，且通过胆固醇酯转移蛋白（CETP）和卵磷酯胆固醇酰基移换酶（LCAT）加强了胆固醇的逆转运。其抗氧化作用和对各致动脉粥样硬化因子基因表达的阻抑作用更是其抗动脉粥样硬化的主要原因。

    The influence of probucol-induced low high-density lipoprotein (HDL) cholesterolemia on the progression of coronary  atherosclerosis was studied in 320 patients with angina pectoris or myocardial infarction, 32 patients with probucol 500 mg/day, 288     patients without probucol, who underwent follow-up angiography at intervals of at least 2 years. The 288 patients were divided into two groups depending on the serum HDL-cholesterol (HDL-C) level at the follow-up angiography: the low HDL-C group had a serum HDL-C level below 40 mg/dl (152 patients) and the control group had 40 mg/dl or above(136 patients). Coronary sclerosis index was defined as the total products of coronary scores (0-6) by segments according to  the American Heart Association reporting system in the branches without angioplasty and was compared between the three   groups. In the probucol group, serum HDL-C level was significantly reduced from 43.9 +/- 10.6 (at baseline) to 31.1 +/- 7.6 mg/dl (at follow-up, p < 0.01) and was lower than that in the other two groups (low HDL-C group 33.1 +/- 5.0 mg/dl, p < 0.07; control group 52.6 +/- 9.8 mg/dl, p < 0.01). Coronary sclerosis index was most increased in the low HDL-C group (8.3 +/- 5.4-->11.9 +/- 6.1, p < 0.01), whereas there was no significant change in the probucol group (7.2 +/- 5.9-->9.1 +/- 6.8, p = 0.24). Our results showed that treatment with probucol inhibits the progression of coronary atherosclerosis despite the decrease in HDL-C level. One possible reason may be remarkable improvement in the other lipid factors,       especially the low-density lipoprotein cholesterol level (165.7 +/- 33.9-->123.7 +/- 29.0 mg/dl, p < 0.01).