進行性動脈硬化性病変に対し，詳細な病理組織学的検討を行い得た高Lp（a） 血症合併2型糖尿病の1例

We report a case of type 2 diabetes mellitus showing elevated plasma lipoprotein（a）［Lp（a）］levels with various atherosclerotic lesions. A 54-year-old woman diagnosed as having type 2 diabeteswas treated with oral antidiabetic drugs. She had various atherosclerotic lesions, includingcerebral infarction, occlusion of the middle carotid artery and myocardial infarction, along withdiabetes mellitus, hyperlipemia and hypertension and additionally showed a high level of serum Lp（a）. A high plasma level of Lp（a）is considered to be an independent risk factor for atherosclerosis,and it is associated with the development of cerebral infarction, occlusion of the middlecarotid artery and coronary atherosclerosis. Plasma Lp（a）level is predominantly determined bygenetic factors and is not affected by diet or drugs. Aspirin treatment（100 mg/day）lowered theplasma level of Lp（a）by 60%. Pathological findings of the vascular lesions showed that apolipoprotein（a）［apo（a）］, a major apoprotein component of Lp（a）, was deposited in the tunica media ofthe radial artery with rare atherosclerotic lesions and in the inner rim of the fibrous capsular regionwithin the plaque with a large lipid core of the carotid artery. This suggests that Lp（a）stimulatesthe transformation of vascular smooth muscle cells in the tunica media in the early stage of atherosclerosisand that it is associated with fragility of the atherosclerotic lesion in the progressive stage.Hence, plasma Lp（a）levels should be measured for diabetic patients with various atheroscleroticlesions, and aspirin may need to be given to those who have elevated plasma Lp（a）levels in orderto prevent the development of atherosclerotic complications.