Milionis H J, Elisaf M S, Tselepis A, Bairaktari E, Karabina S A, Siamopoulos K C
Laboratory of Biochemistry, University of Ioannina, Greece.
Am J Kidney Dis. 1999 Jun;33(6):1100-6. doi: 10.1016/S0272-6386(99)70147-2.
Patients with renal failure have an increased incidence of atherosclerotic disease. Numerous studies have shown that these patients show increased serum lipoprotein(a) [Lp(a)] concentrations compared with the control population. However, variable alleles at the apolipoprotein(a) [apo(a)] gene locus determine to a large extent the Lp(a) concentration in the general population. We therefore undertook the present study to evaluate apo(a) phenotypes and Lp(a) serum concentrations in a large number of patients with renal disease. Seventy-nine patients treated by hemodialysis (HD), 47 patients treated by continuous ambulatory peritoneal dialysis (CAPD), 68 patients with mild/moderate chronic renal failure (CRF) and serum creatinine levels of 1.8 to 8 mg/dL, and 73 healthy controls were studied. All patients showed significantly elevated median serum Lp(a) concentrations in comparison with controls: HD patients, 15.7 mg/dL (P < 0.01); CAPD patients, 20 mg/dL (P < 0. 005); CRF patients, 15.1 mg/dL (P < 0.01) versus controls, 7 mg/dL. The greater Lp(a) values in all groups were not explained by differences in isoform frequencies, whereas their increase was apo(a)-type specific. Thus, patients in all groups with high-molecular-weight (HMW) apo(a) isoforms showed a significant elevation of Lp(a) levels, whereas serum Lp(a) concentrations in patients with low-molecular-weight (LMW) isoforms were not significantly different from controls, except for CAPD patients, who presented increased serum Lp(a) concentrations. We conclude that in patients with renal failure, even of mild/moderate degree, as well as in patients with end-stage renal disease undergoing HD or CAPD, elevated Lp(a) concentrations are mainly observed in those with HMW apo(a) phenotypes.
肾衰竭患者动脉粥样硬化疾病的发病率增加。大量研究表明，与对照组人群相比，这些患者的血清脂蛋白(a)[Lp(a)]浓度升高。然而，载脂蛋白(a)[apo(a)]基因位点的可变等位基因在很大程度上决定了普通人群中的Lp(a)浓度。因此，我们进行了本研究，以评估大量肾病患者的apo(a)表型和血清Lp(a)浓度。研究了79例接受血液透析(HD)治疗的患者、47例接受持续性非卧床腹膜透析(CAPD)治疗的患者、68例轻度/中度慢性肾衰竭(CRF)且血清肌酐水平为1.8至8mg/dL的患者以及73名健康对照者。与对照组相比，所有患者的血清Lp(a)中位数浓度均显著升高：HD患者为15.7mg/dL(P<0.01)；CAPD患者为20mg/dL(P<0.005)；CRF患者为15.1mg/dL(P<0.01)，而对照组为7mg/dL。所有组中较高的Lp(a)值不能用异构体频率的差异来解释，而其升高是apo(a)类型特异性的。因此，所有组中具有高分子量(HMW)apo(a)异构体的患者Lp(a)水平显著升高，而具有低分子量(LMW)异构体的患者血清Lp(a)浓度与对照组无显著差异，但CAPD患者的血清Lp(a)浓度有所升高。我们得出结论，在肾衰竭患者中，即使是轻度/中度患者，以及接受HD或CAPD治疗的终末期肾病患者，Lp(a)浓度升高主要见于具有HMW apo(a)表型的患者。
