Lins R L, Matthys K E, Billiouw J M, Dratwa M, Dupont P, Lameire N H, Peeters P C, Stolear J C, Tielemans C, Maes B, Verpooten G A, Ducobu J, Carpentier Y A
ZNA - Jan Palfijn, Merksem, Brussels, Belgium.
Clin Nephrol. 2004 Oct;62(4):287-94. doi: 10.5414/cnp62287.
Patients with end-stage renal disease commonly present with an atherogenic lipid profile characterized by the accumulation of triglyceride-rich, apoprotein B-containing "remnant" lipoproteins, small dense low-density lipoprotein, and low levels of high-density lipoprotein. They are at increased cardiovascular risk and may benefit from drastic lipid-lowering treatment with atorvastatin, a potent, broadacting lipid regulator. This study aims to assess the effects of atorvastatin on the lipid profile in hemodialysis patients, to determine wether atorvastatin is also effective at lowering lipid levels in this particular high-risk subgroup.
In this randomized, placebo-controlled, double-blind study in hemodialysis patients with hypercholesterolemia (n = 42, mean total cholesterol 243 +/- 33 mg/dl (6.3 +/- 0.8 mmol/l)), the efficacy of 4-weekly increasing doses of atorvastatin (10 - 40 mg daily) was investigated. Lipids and apoproteins were measured in plasma and isolated lipoprotein fractions.
Mean total cholesterol and low-density lipoprotein cholesterol progressively decreased with increasing doses of atorvastatin (total cholesterol -33%, low-density lipoprotein cholesterol -43% after 12 weeks), while high-density lipoprotein cholesterol remained unchanged. Plasma levels of apoprotein B and apoprotein E were also significantly reduced by atorvastatin 10 mg, while up-titration to 20 and 40 mg daily provided additional benefits by lowering triglycerides and apoprotein C-III. At week 12, the fraction of small dense low-density lipoprotein was significantly reduced from 23% - 18%, and apoprotein B-containing intermediate-density lipoproteins were no longer detectable.
In conclusion, atorvastatin not only treated hypercholesterolemia but also favorably affected the uremic lipid profile in patients on hemodialysis. Atorvastatin 4-weekly dose escalation up to 40 mg daily was well-tolerated. Further prospective studies are needed to evaluate the impact of this improved lipid profile on morbidity and mortality.
终末期肾病患者通常呈现致动脉粥样硬化的血脂谱，其特征为富含甘油三酯、载脂蛋白B的“残余”脂蛋白、小而密低密度脂蛋白蓄积，以及高密度脂蛋白水平降低。他们心血管风险增加，可能从使用阿托伐他汀进行的强效、广泛作用的降脂治疗中获益，阿托伐他汀是一种强效的血脂调节剂。本研究旨在评估阿托伐他汀对血液透析患者血脂谱的影响，以确定阿托伐他汀在这一特定高危亚组中降低血脂水平是否也有效。
在这项针对高胆固醇血症血液透析患者（n = 42，平均总胆固醇243 +/- 33 mg/dl（6.3 +/- 0.8 mmol/l））的随机、安慰剂对照、双盲研究中，研究了每4周递增剂量的阿托伐他汀（每日10 - 40 mg）的疗效。在血浆和分离的脂蛋白组分中测量脂质和载脂蛋白。
随着阿托伐他汀剂量增加，平均总胆固醇和低密度脂蛋白胆固醇逐渐降低（12周后总胆固醇降低33%，低密度脂蛋白胆固醇降低43%），而高密度脂蛋白胆固醇保持不变。阿托伐他汀10 mg也显著降低了血浆载脂蛋白B和载脂蛋白E水平，而每日滴定至20和40 mg通过降低甘油三酯和载脂蛋白C-III带来了额外益处。在第12周时，小而密低密度脂蛋白的比例从23%显著降至18%，且不再能检测到含载脂蛋白B的中密度脂蛋白。
总之，阿托伐他汀不仅治疗了高胆固醇血症，还对血液透析患者的尿毒症血脂谱产生了有利影响。阿托伐他汀每周剂量递增至每日40 mg耐受性良好。需要进一步进行前瞻性研究来评估这种改善后的血脂谱对发病率和死亡率的影响。
