代謝症候群與高膽固醇對於非糖尿病病患之單核白血球附著內皮細胞能力影響

Effect of metabolic syndrome and hypercholesterolemia on adhesion of monocytes to cultured endothelium in nondiabetic subjects

李奕德(I-Te Lee)

指導教授 ： 許惠恒 ； 黃建寧

中山醫學大學/醫學院/醫學研究所/碩士(2005年)

https://doi.org/10.6834/CSMU.2005.00049

摘要

背景﹕白血球與內皮細胞之間的交互作用在動脈硬化的發展過程中扮演著極重要的角色。過去的研究發現在血中膽固醇過高的病人，其白血球較容易附著在內皮細胞上。但已知是心臟血管疾病危險因子的代謝症候群患者，目前仍不清楚是否會造成其白血球異常附著在內皮細胞的現象。
目的﹕研究在非糖尿病的高膽固醇患者，其白血球附著在內皮細胞的情形與代謝症候群的相關性。
方法﹕收集研究對象為非糖尿病患，其血中低密度膽固醇(low-density lipoprotein cholesterol, LDL cholesterol)介於130到210 mg/dl之間。受試者經隔夜空腹後，測量其血脂肪指標、血糖及胰島素濃度。病人並接受75克口服葡萄糖的耐受性試驗以排除糖尿病的診斷。在此糖水試驗中，同時測第30、60、90及120分鐘的血糖及胰島素濃度。另外收集並培養人類臍靜脈的內皮細胞，以提供與受試者血中的單核白血球附著的測試使用。
結果﹕總共有48位受試者完成所有的研究評估，根據單核白血球附著在人類臍靜脈內皮細胞上的數目，將受試者分為相等人數的兩組(即每組24人)﹕一組為高單核白血球附著組，另一組為低單核白血球附著組。發現高單核白血球附著組的受試者，不論其血中總膽固醇濃度(245 + 5 vs. 229 + 4 mg/dl, P = 0.021)及低密度膽固醇濃度(162 + 4 vs. 146 + 3 mg/dl, P = 0.003)均較低單核白血球附著組較高。而單核白血球附著在人類臍靜脈內皮細胞上的數目也與血中低密度膽固醇濃度成正向相關(r = 0.407, P = 0.002)。然而，根據修正national cholesterol education program (NCEP)的adult treatment panel III (ATP III)代謝症候群定義，受試者是否符合代謝症候群之診斷在單核白血球附著在人類臍靜脈內皮細胞上的數目並沒有差別。另外，有關胰島素抗性的指標，如﹕homeostasis model assessment insulin resistance (HOMA IR)、葡萄糖及胰島素對於口服葡萄糖耐受性試驗的反應，在是否符合代謝症候群的受試者表現都相似。
結論﹕此篇研究證實在非糖尿病的高膽固醇病患，其單核白血球附著在人類臍靜脈內皮細胞上的數目與患者血中總膽固醇濃度及低密度膽固醇濃度的相關性比是否具有代謝症候群更明顯。

關鍵字

內皮細胞 ； 高膽固醇 ； 代謝症候群 ； 單核白血球

並列摘要

Background: The interaction of leukocytes and endothelium plays an important role in the development of atherosclerosis. Previous studies found that the adhesion of leukocytes to endothelium is greater in subjects with hypercholesterolemia. It is not clear if metabolic syndrome, a contributing risk factor of cardiovascular disease, is related to this adhesion.

Aim: To investigate the relationship between leukocyte adhesion and the components of metabolic syndrome in a group of nondiabetic patients with hypercholesterolemia.

Methods: Nondiabetic subjects with low-density lipoprotein (LDL) cholesterol between 130 and 210 mg/dl were enrolled in this study. Subjects’ fasting blood was obtained for measurement of lipoprotein concentrations, glucose and insulin levels. The 75g oral glucose tolerance test (OGTT) was performed for excluding diabetes and collecting the plasma concentrations of glucose and insulin at 0, 30, 60, 90 and 120 min. Human umbilical vein endothelial cells had been prepared for subjects’ monocyte adhesion.

Results: A total of 48 subjects completed all of the study. According to the number of monocyte adhesion to human umbilical vein endothelial cells, study subjects were divided into high monocyte-adhesion and low monocyte-adhesion groups (n = 24 in each group). Plasma concentrations of total cholesterol (245 + 5 vs. 229 + 4 mg/dl, P = 0.021) and LDL cholesterol (162 + 4 vs. 146 + 3 mg/dl, P = 0.003) were both higher in the high monocyte-adhesion group than in the low monocyte-adhesion group. Monocyte adhesion was positively correlated to plasma concentrations of LDL cholesterol (r = 0.407, P = 0.002). However, there was no difference in monocyte adhesion to endothelium between subjects with or without metabolic syndrome, based on the modified criteria from the adult treatment panel III (ATP III) of the national cholesterol education program (NCEP). Insulin resistance index, presented as homeostasis model assessment insulin resistance (HOMA IR), and glucose or insulin responses to OGTT were similar between groups.
Conclusion: Our study demonstrated that monocyte adhesion to endothelium bears a stronger relationship with the plasma concentration LDL (and total) cholesterol than with characteristics of metabolic syndrome.

並列關鍵字

endothelium ； hypercholesterolemia ； metabolic syndrome ； monocyte

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