Boaz M, Matas Z, Biro A, Katzir Z, Green M, Fainaru M, Smetana S
Department of Internal Medicine A, E. Wolfson Medical Center, Holon, Israel.
Am J Kidney Dis. 1999 Sep;34(3):438-44. doi: 10.1016/s0272-6386(99)70070-3.
Hemodialysis (HD) patients have accelerated cardiovascular morbidity and mortality rates compared with the general population. Identifying the factors that predict major coronary events in this population can direct the focus on prevention. This cross-sectional study compares known and suspected cardiovascular risk factors in HD patients with and without prevalent cardiovascular disease (CVD). In 76 HD patients (prevalent CVD, 44 of 76 patients), serum lipid, lipoprotein, apolipoprotein (Apo), plasma fibrinogen, tissue plasminogen activator (TPA), plasminogen activator inhibitor (PAI-1), and factor VII levels were measured using standard kits. Serum malondialdehyde (MDA; a marker of oxidative stress) was measured using spectrophotometry. Predictor variables were compared using analysis of variance and chi-squared tests, as appropriate. CVD prevalence was modeled using multiple logistic regression analysis, and odds ratios (OR) were calculated. Serum lipid, lipoprotein, Apo, plasma TPA, PAI-1, and factor VII values did not differ significantly from laboratory norms or discriminate for prevalent CVD in HD patients. Plasma fibrinogen levels were significantly elevated in HD patients compared with laboratory norms (369.4 +/- 130.02 v 276.7 +/- 77.7 mg/dL; P < 0.0001) but were not significantly different in HD patients with and without prevalent CVD. Serum MDA levels, both before and after the midweek HD treatment, were significantly elevated in all HD patients compared with laboratory norms (pretreatment, 2.6 +/- 0.8 nmol/mL; posttreatment, 2.1 +/- 0.3 v 0.91 +/- 0.09 nmol/mL; P < 0.01) and were significantly elevated in HD patients with prevalent CVD versus those without (pretreatment, 2.8 +/- 0.6 v 2.4 +/- 0.4 nmol/mL; P < 0.01; posttreatment, 2.3 +/- 0.4 v 1.94 +/- 0.2 nmol/mL; P < 0.01). Only serum MDA levels, both before and after the midweek treatment, contributed to the explanation of variation in CVD prevalence. OR for CVD in the highest versus lowest tertile of pretreatment MDA level was 2.71 (95% confidence interval [CI], 1.42 to 5.19). ORs for CVD in the highest versus lowest tertile of posttreatment MDA level was 3.65 (95% CI, 1.6 to 8.32).
与普通人群相比，血液透析（HD）患者心血管疾病的发病率和死亡率加速上升。确定该人群中预测主要冠状动脉事件的因素可将重点放在预防上。这项横断面研究比较了有和没有心血管疾病（CVD）的HD患者已知和疑似的心血管危险因素。在76例HD患者（76例中有44例患有CVD）中，使用标准试剂盒测量血清脂质、脂蛋白、载脂蛋白（Apo）、血浆纤维蛋白原、组织纤溶酶原激活物（TPA）、纤溶酶原激活物抑制剂（PAI - 1）和因子VII水平。使用分光光度法测量血清丙二醛（MDA；氧化应激标志物）。根据情况，使用方差分析和卡方检验比较预测变量。使用多元逻辑回归分析对CVD患病率进行建模，并计算比值比（OR）。HD患者的血清脂质、脂蛋白、Apo、血浆TPA、PAI - 1和因子VII值与实验室标准无显著差异，也不能区分HD患者中是否患有CVD。与实验室标准相比，HD患者的血浆纤维蛋白原水平显著升高（369.4±130.02对276.7±77.7mg/dL；P<0.0001），但在有和没有CVD的HD患者中无显著差异。与实验室标准相比，所有HD患者在周中HD治疗前后的血清MDA水平均显著升高（治疗前，2.6±0.8nmol/mL；治疗后，2.1±0.3对0.91±0.09nmol/mL；P<0.01），并且患有CVD的HD患者比未患CVD的患者血清MDA水平显著升高（治疗前，2.8±0.6对2.4±0.4nmol/mL；P<0.01；治疗后，2.3±0.4对1.94±0.2nmol/mL；P<0.01）。只有周中治疗前后的血清MDA水平有助于解释CVD患病率的变化。治疗前MDA水平最高三分位数与最低三分位数相比，CVD的OR为2.71（95%置信区间[CI]，1.42至5.19）。治疗后MDA水平最高三分位数与最低三分位数相比，CVD的OR为3.65（95%CI，1.6至8.32）。
