Johansson A C, Samuelsson O, Attman P O, Haraldsson B, Moberly J, Knight-Gibson C, Alaupovic P
Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden.
Perit Dial Int. 2000 May-Jun;20(3):306-14.
To investigate whether the specific lipoprotein (LP) abnormalities of peritoneal dialysis (PD) are associated with functional variables of this mode of dialysis.
A survey of the LP profile in relation to peritoneal dialysis capacity (PDC) variables. The LP profile was compared to that of a group of age- and sex-matched controls.
The Peritoneal Dialysis Unit at Sahlgrenska University Hospital in Gothenburg, Sweden.
Twenty-two nondiabetic PD patients (5 women, 17 men) who had been on PD for at least 6 months.
The LP profile included plasma lipids, apolipoproteins (Apo), and individual ApoA- and ApoB-containing LP. The PDC measurement determined peritoneal glucose uptake, protein losses, effective peritoneal surface area, and total weekly creatinine clearance.
The patients had been on PD for 6 to 48 months (mean 15.3 months) and had a total weekly creatinine clearance of 69.7+/-13.3 L/1.73 m2 body surface area, an average peritoneal glucose uptake corresponding to 446+/-162 kcal/24 hour, and a protein loss of 8.1+/-2.5 g/24 hr. The patients had significantly higher total cholesterol (7.1 mmol/L),VLDL-cholesterol (1.0 mmol/L), LDL-cholesterol (4.7 mmol/L), and triglyceride levels (2.5 mmol/L); whereas the HDL-cholesterol level (1.2 mmol/L) was significantly lower than in controls. The PD patients had increased levels of ApoB-containing LPs, both of the cholesterol-rich LP-B and of the triglyceride-rich LP-B complex, reflected in higher plasma concentrations of ApoB, ApoC-III, and ApoE. Furthermore, they had significantly lower levels of LP-A-I:A-II, as well as of ApoA-I and ApoA-II. The LP-A-I:A-II and ApoA-II levels correlated inversely with the duration of PD treatment (r = 0.54, p < 0.01 and r = 0.52, p < 0.05, respectively). The ApoA-II level was inversely correlated with the peritoneal surface area (r = 0.53, p < 0.05). There were no other correlations between LP variables and PDC variables, nor did any of the LP variables correlate with peritoneal glucose uptake or protein losses.
The proatherogenic lipoprotein profile of patients on PD is characterized by increased concentrations of cholesterol-rich and triglyceride-rich ApoB-containing LPs. While the duration of treatment appears to have some influence on the development of this type of dyslipidemia, the pathophysiological links to the dialysis mode must be further explored.
研究腹膜透析（PD）特有的脂蛋白（LP）异常是否与该透析方式的功能变量相关。
一项关于LP谱与腹膜透析能力（PDC）变量关系的调查。将LP谱与一组年龄和性别匹配的对照组进行比较。
瑞典哥德堡萨尔格伦斯卡大学医院腹膜透析科。
22例非糖尿病PD患者（5名女性，17名男性），已接受PD治疗至少6个月。
LP谱包括血浆脂质、载脂蛋白（Apo）以及含ApoA和ApoB的单个LP。PDC测量包括腹膜葡萄糖摄取、蛋白质丢失、有效腹膜表面积和每周总肌酐清除率。
患者接受PD治疗6至48个月（平均15.3个月），每周总肌酐清除率为69.7±13.3L/1.73m²体表面积，平均腹膜葡萄糖摄取量相当于446±162kcal/24小时，蛋白质丢失为8.1±2.5g/24小时。患者的总胆固醇（7.1mmol/L）、极低密度脂蛋白胆固醇（1.0mmol/L）、低密度脂蛋白胆固醇（4.7mmol/L）和甘油三酯水平（2.5mmol/L）显著更高；而高密度脂蛋白胆固醇水平（1.2mmol/L）显著低于对照组。PD患者含ApoB的LP水平升高，包括富含胆固醇的LP-B和富含甘油三酯的LP-B复合物，表现为血浆中ApoB、ApoC-III和ApoE浓度升高。此外，他们的LP-A-I:A-II水平以及ApoA-I和ApoA-II水平显著更低。LP-A-I:A-II和ApoA-II水平与PD治疗持续时间呈负相关（r = 0.54，p < 0.01和r = 0.52，p < 0.05）。ApoA-II水平与腹膜表面积呈负相关（r = 0.53，p < 0.05）。LP变量与PDC变量之间无其他相关性，LP变量与腹膜葡萄糖摄取或蛋白质丢失也无相关性。
PD患者促动脉粥样硬化的脂蛋白谱特征是富含胆固醇和富含甘油三酯的含ApoB的LP浓度升高。虽然治疗持续时间似乎对这种血脂异常的发生有一定影响，但与透析方式的病理生理联系仍需进一步探索。
