Chiang Chih-Kang, Ho Tai-I, Hsu Shih-Ping, Peng Yu-Sen, Pai Mei-Fen, Yang Shao-Yu, Hung Kuan-Yu, Tsai Tun-Jun
Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
Blood Purif. 2005;23(2):134-40. doi: 10.1159/000083529. Epub 2005 Jan 21.
BACKGROUND/AIMS: Hypocholesterolemia is a common finding in hospitalized elderly people, critically ill surgical patients, septic patients and end-stage renal disease patients. The different effect of lipid subfractions on patients with end-stage renal disease has never been demonstrated. We aim to study the effect of lipid subfractions on hospitalization and mortality in maintenance hemodialysis (MHD) patients.
Lipid subfractions, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured in 210 patients with MHD in a single dialysis center. Patients were stratified into three groups based on the tertiles of lipid levels, and differences in patient characteristics and survival were evaluated.
Of a total of 22 deceased patients in our MHD cohort, infection-related mortality (50%) was higher than cardiovascular-related mortality (18.2%). Significant differences (p < 0.05) in the duration and frequency of hospitalization and in mortality events were observed when patients were divided into different subgroups according to the tertiles of baseline TC and LDL-C levels. Patients with lower LDL had significantly lower levels of albumin, TC and TG. The LDL-C tertiles were similar in terms of age, hypertension, diabetes, biochemical results, hematocrit, adequacy of hemodialysis and normalized protein catabolism rate. Both TC and LDL-C predicted survival (p < 0.001), but not TG and HDL-C in the Kaplan-Meier model. The Cox proportional hazard model demonstrated that baseline serum LDL-C was the best lipid subfraction in predicting all-cause death with an adjusted hazard ratio (95% confidence interval) for each 10 mg/dl of 0.752 (0.631-0.898; p = 0.002).
We firstly demonstrated that lipid subfractions, including TC and LDL-C, predict poor outcomes in a MHD cohort with high infection-related mortality.
背景/目的：低胆固醇血症在住院老年人、危重症外科患者、脓毒症患者及终末期肾病患者中很常见。脂质亚组分对终末期肾病患者的不同影响尚未得到证实。我们旨在研究脂质亚组分对维持性血液透析（MHD）患者住院率和死亡率的影响。
在一个透析中心对210例MHD患者测量脂质亚组分，包括总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）。根据脂质水平三分位数将患者分为三组，并评估患者特征和生存率的差异。
在我们的MHD队列中，22例死亡患者中，感染相关死亡率（50%）高于心血管相关死亡率（18.2%）。根据基线TC和LDL-C水平三分位数将患者分为不同亚组时，观察到住院时间和频率以及死亡事件存在显著差异（p<0.05）。LDL水平较低的患者白蛋白、TC和TG水平显著较低。LDL-C三分位数在年龄、高血压、糖尿病、生化结果、血细胞比容、血液透析充分性和标准化蛋白分解代谢率方面相似。在Kaplan-Meier模型中，TC和LDL-C均能预测生存率（p<0.001），但TG和HDL-C不能。Cox比例风险模型显示，基线血清LDL-C是预测全因死亡的最佳脂质亚组分，每10mg/dl的调整后风险比（95%置信区间）为0.752（0.631-0.898；p=0.002）。
我们首次证明，包括TC和LDL-C在内的脂质亚组分可预测感染相关死亡率高的MHD队列的不良结局。
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