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目的 观察奥利司他对中国肥胖患者血清小而密低密度脂蛋白 (LDL)水平的影响。方法 这是一项随机、双盲、安慰剂对照研究。采用 3 %～ 1 6 %聚丙烯酰胺梯度凝胶电泳的方法测定血清LDL颗粒的大小。 68例符合入选标准的肥胖患者被随机分成奥利司他组和安慰剂组 ,治疗 2 4周。在治疗前和治疗后测量血清LDL颗粒的大小。结果 奥利司他治疗 2 4周后 ,平均LDL直径有明显的增大 (2 5 3nm比 2 5 9nm ,P =0 0 0 1 ) ,但安慰剂组在治疗前后没有明显的改变 (2 5 9nm比 2 5 6nm ,P =0 1 52 )。LDL直径的变化值在奥利司他组明显高于安慰剂组 (0 6nm比 - 0 2nm ,P =0 0 0 1 )。小而密LDL的比例在奥利司他组从 60 %下降到 2 8 9% (P =0 0 0 3) ,而在安慰剂组没有明显的改变(56 5 %比 56 5 % ,P =1 0 0 0 ) ,两组间差异有显著性 (P =0 0 39)。结论 奥利司他减重治疗 2 4周后 ,LDL的直径有显著增加 ,血清小而密LDL的比例有明显下降 ,这种改变较安慰剂组更为明显。奥利司他减重治疗可以通过降低小而密LDL的水平来减少心血管的危险性
Objective To observe the effect of orlistat on serum small dense density lipoprotein (LDL) in Chinese obese patients. Method This is a randomized, double-blind, placebo-controlled study. The size of serum LDL particles was determined by 3% ~ 16% polyacrylamide gradient gel electrophoresis. Sixty obese patients who met the inclusion criteria were randomized to either orlistat and placebo for 24 weeks. Serum LDL particle size was measured before treatment and after treatment. Results The mean LDL diameter was significantly increased after orlistat treatment for 24 weeks (253 nm vs. 259 nm, P = 0 0 01), but there was no significant change in the placebo group before and after treatment (25 9 nm vs. 256 6 nm, P = 0 1 52). The change of LDL diameter was significantly higher in orlistat group than in placebo group (0 6 nm vs -0 2 nm, P = 0 0 0 1). The proportion of small, dense LDL decreased from 60% to 299% in the orlistat group (P = 0 0 0 3), while there was no significant change in the placebo group (56 5% vs. 56 5%, P = 1 0 0 0), the difference between the two groups was significant (P = 0 0 39). Conclusion Orlistat 24 weeks after weight loss treatment, LDL diameter increased significantly, the proportion of small and dense serum LDL decreased significantly, this change is more obvious than the placebo group. Orlistat’s weight-loss treatment can reduce the risk of cardiovascular disease by reducing the level of small, dense LDL