가족성 고콜레스테롤 환자의 투약 후 경과, LDL감소 효과 확인 후 증량계획, apoprotein B/A ratio
상기 30대 남자
rosuvastatin 5 mg 투여 후
추적검사가 늦긴 했으나 비교시 LDL은 35% 감소함 (224 --> 157)
아래 수치를 목표로
추후 rosuvastain 10mg + ezetimibe 10mg 으로 증량 계획
초기 검사는 아니지만 투약중에 ApoB/A ratio 는 1.23
HDL과 LDL은 서로 수치에 영향을 미칠 수 있어 상기 비율을 참조할 수도 있다.
Unlike lipoprotein cholesterol, the lipid-transporting apolipoprotein (apo), apoB, remains with the lipoproteins without undergoing any changes. ApoB is an essential structural component of very low-density lipoproteins, intermediate-density lipoproteins, and low-density lipoproteins. Because each particle of these lipoproteins contains one molecule of apoB, the total atherogenic particles number can be accurately estimated by measuring the plasma level of this apoprotein. 전체 VLDL, IDL, LDL 입자의 숫자를 반영한다.
In contrast, apoA-I, the major structural constituent of antiatherogenic high-density lipoproteins, exchanges between lipoproteins and the number of apoprotein molecules varies between lipoprotein particles. Nevertheless, levels of apoA-I in plasma are strongly correlated with HDL levels. HDL의 주요 단백성분이며 만족스럽게 농도를 반영하나 HDL 입자는 1~5개 까지의 apoA1을 가지고 있다. 남자에서 120미만, 여자에서 140 미만은 낮은 HDL을 말해준다.
For example, in cases where LDL-C is in the health-related reference interval, high apoB levels may indicate an increased number of small, dense lowdensity lipoprotein particles, which are the most atherogenic particles.
The apoB/apoA-I ratio reflects the balance of atherogenic and antiatherogenic lipoproteins in plasma. Multiple clinical and epidemiological studies have confirmed that the apoB/apoA-I ratio is a superior marker for cardiovascular disease compared with lipids and lipoproteins or their ratios
The cut-off values for the apoB/apoA-I ratio that define a high cardiovascular risk were proposed to be 0.9 for men and 0.8 for women
; 유럽 가이드라인에서 유효한 인자는 될 수 있으나 진단이나 치료의 목표로서는 유용하지 않다고 기술되어 있다.
참조> 2016 ESC/EAS Guidelines for the Management
of Dyslipidaemias
The Apolipoprotein B/Apolipoprotein A-I Ratio as a Potential Marker of Plasma Atherogenicity, Disease Markers
Volume 2015 (2015), Article ID 591454, 7 pages
Figure 10: The INTERHEART study: odds ratio for acute myocardial infarction in men and women pooled together in relation to the apolipoprotein B (apoB)/apoA-I ratio expressed in deciles (log-plot). Figure reproduced from THE LANCET, vol 364: 937, Yusuf et al, ©2004, with permission from Elsevier.
동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연
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