Haffner S M, Gruber K K, Aldrete G, Morales P A, Stern M P, Tuttle K R
Department of Medicine, University of Texas Health Science Center, San Antonio 78284-7873.
J Am Soc Nephrol. 1992 Nov;3(5):1156-62. doi: 10.1681/ASN.V351156.
Subjects with chronic renal failure have a greatly increased risk of coronary heart disease and dyslipidemia. Relatively few studies have examined the relationship of chronic renal failure to lipoprotein (Lp)(a) concentrations, an important risk factor for coronary heart disease. Diabetic subjects have been reported to have both increased Lp(a) concentrations and an increased risk of renal failure, thereby possibly confounding the Lp(a)-renal failure association. The association between Lp(a) and chronic renal failure in 359 control subjects and 111 subjects with renal failure was examined. Lp(a) (in milligrams per deciliter) was elevated in subjects with chronic renal failure, regardless of ethnicity (Mexican Americans, 19.8 +/- 2.7 versus 14.1 +/- 1.3; P = 0.03; non-Hispanic white patients, 24.9 +/- 3.0 versus 16.3 +/- 1.2; P = 0.006;). These differences persisted after adjustment for diabetes and ethnicity (P < 0.001). The type of treatment for chronic renal failure (diet, hemodialysis, or peritoneal dialysis) did not have an effect on Lp(a) concentrations. Lp(a) levels were not correlated with the level of creatinine in subjects with chronic renal failure. Thus, the elevation of Lp(a) levels in renal failure must occur early in renal failure, or alternatively, elevated Lp(a) levels may promote progression to chronic renal failure. These results indicate that Lp(a) concentrations are increased in chronic renal failure and may increase the risk for coronary heart disease in these subjects.
慢性肾衰竭患者患冠心病和血脂异常的风险大幅增加。相对较少的研究探讨了慢性肾衰竭与脂蛋白(a) [Lp(a)]浓度之间的关系，而Lp(a)浓度是冠心病的一个重要风险因素。据报道，糖尿病患者的Lp(a)浓度升高且肾衰竭风险增加，从而可能混淆了Lp(a)与肾衰竭之间的关联。研究人员检测了359名对照受试者和111名肾衰竭受试者中Lp(a)与慢性肾衰竭之间的关联。无论种族如何（墨西哥裔美国人，19.8±2.7对14.1±1.3；P = 0.03；非西班牙裔白人患者，24.9±3.0对16.3±1.2；P = 0.006），慢性肾衰竭患者的Lp(a)（毫克/分升）均升高。在对糖尿病和种族进行校正后，这些差异仍然存在（P < 0.001）。慢性肾衰竭的治疗方式（饮食、血液透析或腹膜透析）对Lp(a)浓度没有影响。慢性肾衰竭患者的Lp(a)水平与肌酐水平不相关。因此，肾衰竭时Lp(a)水平的升高肯定在肾衰竭早期就已出现，或者说，升高的Lp(a)水平可能促进病情发展为慢性肾衰竭。这些结果表明，慢性肾衰竭患者的Lp(a)浓度升高，可能会增加这些患者患冠心病的风险。
