终末期肾病患者血液透析对低密度脂蛋白促炎和高密度脂蛋白抗炎特性的有益作用。
Salutary effects of hemodialysis on low-density lipoprotein proinflammatory and high-density lipoprotein anti-inflammatory properties in patient with end-stage renal disease.
机构信息
Division of Nephrology and Hypertension, University of California, Irvine Medical Center, 101 The City Dr, 4th Floor City Tower, Orange, CA 92868, USA.
出版信息
J Natl Med Assoc. 2011 Jun;103(6):524-33. doi: 10.1016/s0027-9684(15)30368-0.
End-stage renal disease (ESRD) causes oxidative stress, inflammation, low-density lipoprotein (LDL) oxidation, high-density lipoprotein (HDL) deficiency and accelerated atherosclerosis. Uptake of oxidized LDL by macrophages results in foam cell and plaque formation. HDL mitigates atherosclerosis via reverse cholesterol transport and inhibition of LDL oxidation. ESRD heightens LDL inflammatory activity and suppresses HDL anti-inflammatory activity. The effect of hemodialysis on the LDL and HDL inflammatory properties is unknown. By removing the potential pro-oxidant/proinflammatory uremic toxins, dialysis may attenuate LDL inflammatory and HDL anti-inflammatory properties. Conversely, exposure to dialyzer membrane and tubing and influx of impurities from dialysate can intensify LDL and HDL inflammatory activities. This study examined the effect of hemodialysis on LDL and HDL inflammatory activities. Plasma samples were obtained from 12 normal control and 26 ESRD patients before and after hemodialysis with (16 patients) or without (10 patients) heparinization. HDL and LDL were isolated and tested for monocyte chemotactic activity in cultured endothelial cells. ESRD patients had increased LDL chemotactic activity, reduced HDL anti-inflammatory activity, paraoxonase and glutathione peroxidase levels, and elevated plasma IL-6 before dialysis. Hemodialysis partially improved LDL inflammatory and HDL anti-inflammatory activities and enhanced patients' HDL ability to suppress their LDL inflammatory activity. The salutary effect on LDL inflammatory activity was significantly greater in patients dialyzed with than those without heparin. ESRD heightens LDL inflammatory and impairs HDL anti-inflammatory activities. Hemodialysis partially improves LDL and HDL inflammatory activities. The salutary effects of hemodialysis are in part mediated by heparin, which is known to possess lipolytic and antioxidant properties.
终末期肾病（ESRD）会导致氧化应激、炎症、低密度脂蛋白（LDL）氧化、高密度脂蛋白（HDL）缺乏和动脉粥样硬化加速。巨噬细胞摄取氧化的 LDL 会导致泡沫细胞和斑块形成。HDL 通过逆向胆固醇转运和抑制 LDL 氧化来减轻动脉粥样硬化。ESRD 会增加 LDL 的炎症活性并抑制 HDL 的抗炎活性。血液透析对 LDL 和 HDL 炎症特性的影响尚不清楚。通过去除潜在的促氧化剂/促炎尿毒症毒素，透析可能会减轻 LDL 的炎症和 HDL 的抗炎特性。相反，暴露于透析器膜和管以及透析液中杂质的流入会加剧 LDL 和 HDL 的炎症活性。本研究探讨了血液透析对 LDL 和 HDL 炎症活性的影响。从 12 名正常对照和 26 名 ESRD 患者中采集血浆样本，这些患者在血液透析前后分别进行了肝素化（16 例）或未肝素化（10 例）。分离 HDL 和 LDL，并在培养的内皮细胞中测试单核细胞趋化活性。ESRD 患者在透析前 LDL 趋化活性增加，HDL 抗炎活性降低，对氧磷酶和谷胱甘肽过氧化物酶水平降低，血浆 IL-6 升高。血液透析部分改善了 LDL 的炎症和 HDL 的抗炎活性，并增强了患者 HDL 抑制 LDL 炎症活性的能力。与未用肝素透析的患者相比，用肝素透析的患者 LDL 炎症活性的改善更为明显。ESRD 会增加 LDL 的炎症和损害 HDL 的抗炎活性。血液透析部分改善了 LDL 和 HDL 的炎症活性。血液透析的有益作用部分是通过肝素介导的，肝素具有脂解和抗氧化特性。
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