Bossola Maurizio, Giungi Stefania, Panocchia Nicola, Vulpio Carlo, Luciani Giovanna, Tazza Luigi
Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy.
J Nephrol. 2008 Mar-Apr;21(2):197-204.
Being overweight and obesity are associated with improved survival in hemodialysis (HD) patients, based on mechanisms that are presently uncertain. We compared traditional and uremia-related cardiovascular risk factors in HD patients stratified according to their body mass index (BMI).
One hundred sixteen HD patients were stratified into 4 groups according to the BMI: underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9) and obese (> or =30). Blood samples were obtained before the HD session to measure serum albumin, high-sensitivity C-reactive protein, fibrinogen, ferritin, total cholesterol, LDL cholesterol, HDL cholesterol, apolipoprotein A-I and apolipoprotein B-100, apolipoprotein B (apoB) to apolipoprotein A (apoA) ratio and Lp(a) lipoprotein.
There were 3 underweight (excluded from the analysis), 58 normal weight, 35 overweight and 20 obese patients. Their mean age was 62.1 +/- 14.1 years. There were 68 men and 45 women. Mean dialytic age was 5.32 +/- 3.2 years. The mean BMI of the study population was 25.2 +/- 4.1. The prevalence of smoking habit was similar in the 3 groups (17.2%, 8.5% and 25%, respectively; p=0.28). The prevalence of hypertension was higher in overweight (77.1%) and obese (65%) patients than in leaner counterparts (53.4%), although the difference was not significant. Conversely, diabetes prevalence was significantly higher in overweight and obese patients (22.8% and 30%, respectively) than in normal weight patients (6.9%; p=0.02). The serum levels of total cholesterol, HDL cholesterol, LDL cholesterol, Lp(a) lipoprotein, apolipoprotein A-I, apolipoprotein B-100, and apoA/apoB ratio were similar in the 3 BMI groups. Triglycerides levels were significantly higher in obese (221.2 +/- 132.7 mg/dL) and overweight (230.5 +/- 119.3 mg/dL) patients than in those of normal weight (154.6 +/- 78.8 mg/dL; p=0.02). Most of the uremia-related cardiovascular risk factors (anemia, hyperparathyroidism, chronic inflammation) were comparable among BMI categories as well as the levels of C-reactive protein, fibrinogen and ferritin.
The present study suggests that almost all traditional and uremia-related cardiovascular risk factors do not differ significantly among different categories of BMI in hemodialysis patients.
超重和肥胖与血液透析（HD）患者生存率的提高相关，但其机制目前尚不清楚。我们比较了根据体重指数（BMI）分层的HD患者的传统心血管危险因素和与尿毒症相关的心血管危险因素。
116例HD患者根据BMI分为4组：体重过轻（<18.5）、正常体重（18.5 - 24.9）、超重（25.0 - 29.9）和肥胖（≥30）。在HD治疗前采集血样，以测量血清白蛋白、高敏C反应蛋白、纤维蛋白原、铁蛋白、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白A - I和载脂蛋白B - 100、载脂蛋白B（apoB）与载脂蛋白A（apoA）的比值以及脂蛋白（a）。
有3例体重过轻患者（排除在分析之外），58例正常体重患者，35例超重患者和20例肥胖患者。他们的平均年龄为62.1±14.1岁。有68名男性和45名女性。平均透析年龄为5.32±3.2年。研究人群的平均BMI为25.2±4.1。三组的吸烟习惯患病率相似（分别为17.2%、8.5%和25%；p = 0.28）。超重（77.1%）和肥胖（65%）患者的高血压患病率高于较瘦的患者（53.4%），尽管差异不显著。相反，超重和肥胖患者的糖尿病患病率（分别为22.8%和30%）显著高于正常体重患者（6.9%；p = 0.02）。三组BMI患者的总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、脂蛋白（a）、载脂蛋白A - I、载脂蛋白B - 100和apoA/apoB比值的血清水平相似。肥胖（221.2±132.7mg/dL）和超重（230.5±119.3mg/dL）患者的甘油三酯水平显著高于正常体重患者（154.6±78.8mg/dL；p = 0.02）。大多数与尿毒症相关的心血管危险因素（贫血、甲状旁腺功能亢进、慢性炎症）在不同BMI类别中以及C反应蛋白、纤维蛋白原和铁蛋白水平方面相当。
本研究表明，在血液透析患者中，几乎所有传统心血管危险因素和与尿毒症相关的心血管危险因素在不同BMI类别之间没有显著差异。
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