背景:无功能腺瘤(NFA)患者,伴轻度自主皮质醇分泌(MACS)和库欣综合征(CS)的腺瘤显示心血管风险增加。
目的:为了确定NFA中脂蛋白异常的程度,MACS,CS。
方法:我们对NFA患者(n=167)进行了单中心横断面研究,MACS(n=213),2015年1月至2022年7月之间的CS(n=142)和参考对象(n=202)。富含甘油三酯的脂蛋白颗粒(TRLP),低密度脂蛋白颗粒(LDLP),高密度脂蛋白颗粒(HDLP),使用核磁共振波谱测量了它们的亚类和大小。多变量逻辑分析调整了年龄,性别,BMI,吸烟,高血压,糖尿病和降脂药物治疗。
结果:在年龄和性别调整分析中,所有患者类别都显示出非常大的TRLP增加,与参考受试者相比,较大的TRLP和较大的TRL大小(比值比(OR)范围为1.22~2.08)和总LDLP(OR范围为1.22~1.75),LDL和HDL大小降低.在完全调整的分析中,LDLP浓度在所有患者类别中保持升高(比值比范围从1.31至1.84)。总胆固醇,LDL胆固醇,在年龄和性别校正分析中,甘油三酯和载脂蛋白B在所有患者类别中均较高,而在完全校正分析中,apoB在所有患者类别中均保持升高.在排除接受降脂治疗的受试者后,在所有患者类别中均观察到类似的LDLP和apoB升高。
结论:患者明显,温和,甚至没有皮质醇过量显示脂蛋白异常,特别是,高LDLP和apoB浓度,这可能导致高心脏代谢风险。
BACKGROUND: Patients with nonfunctioning adenomas (NFA), adenomas with mild autonomous cortisol secretion (MACS) and Cushing syndrome (CS) demonstrate an increased cardiovascular risk.
OBJECTIVE: To determine the extent of lipoprotein abnormalities in NFA, MACS, and CS.
METHODS: We conducted a single-center cross-sectional study of patients with NFA (n = 167), MACS (n = 213), CS (n = 142) and referent subjects (n = 202) between January 2015 and July 2022. Triglyceride-rich lipoprotein particles (TRLP), low density lipoprotein particles (LDLP), high density lipoprotein particles (HDLP), their subclasses and sizes were measured using nuclear magnetic resonance spectroscopy. Multivariable logistic analyses were adjusted for age, sex, BMI, smoking, hypertension, diabetes and lipid lowering drug therapy.
RESULTS: In age- and sex-adjusted analysis, all patients categories demonstrated increased very large TRLP, large TRLP and greater TRL size (odds ratio (OR) ranging from 1.22 to 2.08) and total LDLP (OR ranging from 1.22 to 1.75) and decreased LDL and HDL size compared to referent subjects. In fully adjusted analysis, LDLP concentrations remained elevated in all patient categories (odds ratios ranging from 1.31 to 1.84). Total cholesterol, LDL cholesterol, triglycerides and apolipoprotein B were also higher in all patient categories in age- and sex-adjusted analysis with apoB remaining elevated in all patient categories in fully adjusted analysis. Similar LDLP and apoB elevations were observed in all patient categories after excluding subjects on lipid lowering therapy.
CONCLUSIONS: Patients with overt, mild, and even absent cortisol excess demonstrate lipoprotein profile abnormalities, in particular, high LDLP and apoB concentrations, which conceivably contribute to high cardiometabolic risk.