Helal Imed, Smaoui Wided, Hamida Fethi Ben, Ouniss Monder, Aderrahim Ezzeddine, Hedri Hafedh, Elyounsi Fethi, Maiz Hedi Ben, Abdallah Taieb Ben, Kheder Adel
Department of Internal Medicine A and Laboratory of Kidney Pathology 02, Charles Nicolle Hospital, Boulevard 9 Avril, 1006 Tunis, Tunisia.
Saudi J Kidney Dis Transpl. 2010 Jan;21(1):59-62.
Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 74 patients with ESRD (38 males, 36 females), maintained either on chronic HD (n= 50) or chronic PD (n= 24) and age and sex matched 20 healthy subjects as controls. The lipid profile, homocysteine (Hcy) and C reactive protein (CRP) were measured. When compared to a healthy population, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A (Apo A), CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C), Apo B, albumin (ALB). A significant difference was noted concerning the rates of Apo B, HDL-C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant difference with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardiovascular risk in dialysis patients.
心血管疾病是终末期肾病(ESRD)患者发病和死亡的主要原因。我们研究的目的是评估血液透析(HD)和腹膜透析(PD)患者广泛的心血管状况。我们研究了74例ESRD患者(38例男性,36例女性),他们维持慢性HD(n = 50)或慢性PD(n = 24)治疗,并将年龄和性别匹配的20名健康受试者作为对照。测量了血脂谱、同型半胱氨酸(Hcy)和C反应蛋白(CRP)。与健康人群相比,HD患者呈现出明显的致动脉粥样硬化特征,总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(Apo A)、CRP、Hcy水平升高以及高密度脂蛋白胆固醇(HDL-C)、Apo B、白蛋白(ALB)浓度降低证明了这一点。在Apo B、HDL-C、TC、ALB和Hcy的比率方面存在显著差异。在这些PD患者中也发现了与HD患者相同的生物学紊乱。还注意到Apo A浓度较低。在白蛋白、Apo A、HDL-Cl和Hcy的比率方面与参照组存在显著差异。与PD患者相比,HD患者的LDL-C浓度显著降低。本研究中观察到的特殊代谢变化证实了肾功能受损患者无论透析类型如何都有患心血管疾病的明显倾向。我们建议将与尿毒症相关的危险因素纳入评估透析患者心血管风险的指标中。