Tzanatos Helen A, Tseke Paraskevi P, Pipili Chrisoula, Retsa Kaliopy, Skoutelis George, Grapsa Eirini
Nephrology Department, Aretaieion University Hospital, Athens, Greece.
Ren Fail. 2009;31(2):91-7. doi: 10.1080/08860220802595484.
Patients on hemodialysis (HD) are prone to atherosclerotic cardiovascular complications. In an attempt to determine the significance of several atherosclerotic and thrombogenic parameters as risk factors for atherothrombotic cardiovascular disease (CVD) in these patients, we compared two groups of non-diabetic HD patients matched for age and sex, selected according to the absence (group 1, n = 30) or presence (group 2, n = 30) of symptomatic atherothrombotic vascular disease affecting the coronary, cerebral, or peripheral arteries. Duration of HD, primary renal disease (PRD), presence of hypertension, EPO treatment, and smoking habits were recorded. Serum total cholesterol (TC), triglycerides (TG), HDL-C, LDL-C, TC/HDL-C ratio, lipoprotein(a) (Lp(a)), fibrinogen (FG), plasminogen (PLG), fibronectin (FN), and hematocrit (HCT) were measured pre-HD in a midweek session. The same blood parameters were also assessed in twenty matched clinically healthy subjects (controls). None of the blood parameters differed between groups 1 and 2, except for serum Lp(a) and FN, which were higher in group 2 (p = 0.005 and p = 0.041, respectively). Both groups were not different regarding PRD, duration of HD, and EPO treatment, but the presence of hypertension and smoking habits were more common in group 2 (p = 0.008 and p = 0.045, respectively). Moreover, multiple stepwise logistic regression analysis with Lp(a), FN, hypertension, and smoking showed that the presence of hypertension (p = 0.016) and the Lp(a) (p = 0.027) and FN (p = 0.024) levels, but not smoking, were independent predictors for the presence of atherothrombotic CVD. Our results suggest that hypertension, abnormal lipid particles, and thrombogenic proteins may contribute to the high prevalence of CVD in HD patients.
接受血液透析（HD）的患者易患动脉粥样硬化性心血管并发症。为了确定几种动脉粥样硬化和血栓形成参数作为这些患者动脉粥样硬化血栓形成性心血管疾病（CVD）危险因素的意义，我们比较了两组年龄和性别匹配的非糖尿病HD患者，根据是否存在（第1组，n = 30）或存在（第2组，n = 30）影响冠状动脉、脑动脉或外周动脉的症状性动脉粥样硬化血栓形成性血管疾病进行选择。记录HD持续时间、原发性肾病（PRD）、高血压的存在、促红细胞生成素（EPO）治疗和吸烟习惯。在一周中的中间时段HD前测量血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、TC/HDL-C比值、脂蛋白（a）[Lp（a）]纤维蛋白原（FG）、纤溶酶原（PLG）、纤连蛋白（FN）和血细胞比容（HCT）。还在20名匹配的临床健康受试者（对照组）中评估了相同的血液参数。除血清Lp（a）和FN外，第1组和第2组之间的血液参数均无差异，第2组中的血清Lp（a）和FN较高（分别为p = 0.005和p = 0.041）。两组在PRD、HD持续时间和EPO治疗方面无差异，但高血压的存在和吸烟习惯在第2组中更为常见（分别为p = 0.008和p = 0.045）。此外，对Lp（a）、FN、高血压和吸烟进行的多步逻辑回归分析表明，高血压的存在（p = 0.016）、Lp（a）水平（p = 0.027）和FN水平（p = 0.024），而非吸烟，是动脉粥样硬化血栓形成性CVD存在的独立预测因素。我们的结果表明，高血压、异常脂质颗粒和血栓形成蛋白可能导致HD患者中CVD的高患病率。
