Kovacić Vedran, Sain Milenka, Vukman Valentina
Centar za turisticku i domicilnu hemodijalizu, Dom zdravlja Trogir.
Lijec Vjesn. 2003 Mar-Apr;125(3-4):77-80.
Disorder of blood lipids plays an important role in atherosclerosis progress in patients ongoing chronic haemodialysis (PCHD). These patients have specific features of blood lipids with increment of triglycerides and decrement of HDL-cholesterol. Phenotype of lipid disorder in PCHD is mostly type IV according to Fredrickson (30%), and IIA and IIB fenotypes are less frequent. About 9% of lipid disorders in PCHD are isolated increase of Lp(a). Main reason of hypertriglyceridemia in PCHD is attenuated metabolism of VLDL-cholesterol because of lipoprotein lipasis inhibition. There are changes in lipoproteins quality, specially changes in LDL particle have atherogenic potential. Renal dyslipidemia treatment must be vigorous in the early stages of renal insufficiency. Treatment can be dietary measures (specially omega-3-fatty acids), statins, gemfibrozil, intravenous L-carnitin and bicarbonate given per os. Haemodialysis modifications such as highflux haemodialysis, low molecular weight heparin, vitamin E coated dialyzers and LDL-apheresis in extreme cases have important role in renal dyslipidemia treatment.
血脂紊乱在维持性血液透析患者（PCHD）动脉粥样硬化进展中起重要作用。这些患者血脂具有特定特征，即甘油三酯升高和高密度脂蛋白胆固醇降低。根据弗雷德里克森分类，PCHD患者脂质紊乱的表型大多为IV型（30%），IIA和IIB表型较少见。PCHD中约9%的脂质紊乱是孤立性脂蛋白（a）升高。PCHD患者高甘油三酯血症的主要原因是由于脂蛋白脂酶抑制导致极低密度脂蛋白胆固醇代谢减弱。脂蛋白质量存在变化，特别是低密度脂蛋白颗粒的变化具有致动脉粥样硬化潜力。在肾功能不全早期必须积极治疗肾性血脂异常。治疗方法包括饮食措施（特别是ω-3脂肪酸）、他汀类药物、吉非贝齐、静脉注射左卡尼汀和口服碳酸氢盐。在极端情况下，血液透析的改进措施，如高通量血液透析、低分子量肝素、维生素E涂层透析器和低密度脂蛋白去除术在肾性血脂异常治疗中起重要作用。
