Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA.
Clin J Am Soc Nephrol. 2011 Dec;6(12):2861-70. doi: 10.2215/CJN.03650411. Epub 2011 Oct 27.
Conventional lipid profiles usually cannot predict cardiovascular outcomes in chronic disease states. We hypothesized that novel lipoprotein subfraction concentrations and LDL particle size measurements better predict mortality in maintenance hemodialysis (MHD) patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Mortality-predictability of LDL particle diameter and lipoprotein subfraction concentrations, measured by novel ion mobility, was examined in a cohort of 235 hemodialysis patients who were followed for up to 6 years using Cox models with adjustment for important covariables.
Patients were 54 ± 14 years old (mean ± SD) and included 45% women with total, LDL and HDL cholesterol levels of 143 ± 42, 76 ± 29, and 37 ± 12 mg/dl, respectively. Over 6 years, 71 patients (31%) died. Conventional lipid profile was not associated with mortality. The death hazard ratio (HR, 95% confidence interval) of the highest versus lowest quartiles of very small and large LDL particle concentrations were 2.43 (1.03 to 5.72) and 0.38 (0.15 to 0.96), respectively. Across increasing quartiles of LDL particle diameter, death HRs were 1.00, 0.93 (0.46 to 1.87), 0.43 (0.21 to 0.89), and 0.45 (0.31 to 1.00), respectively.
Whereas conventional lipid profile cannot predict mortality in MHD patients, larger novel LDL particle diameter or higher large LDL particle concentrations appear predictive of greater survival, whereas higher very small LDL particle concentration is associated with higher death risk. Examining lipoprotein subfraction modulation in chronic diseases is indicated.
传统的血脂谱通常无法预测慢性病患者的心血管结局。我们假设新型脂蛋白亚组分浓度和 LDL 颗粒大小测量值能更好地预测维持性血液透析（MHD）患者的死亡率。
设计、地点、参与者和测量：通过新的离子淌度法，在 235 名接受 MHD 治疗的患者队列中，检查 LDL 颗粒直径和脂蛋白亚组分浓度的死亡率预测能力，使用 Cox 模型进行分析，调整了重要的协变量。
患者的年龄为 54 ± 14 岁（均值 ± 标准差），其中 45%为女性，总胆固醇、LDL 胆固醇和 HDL 胆固醇水平分别为 143 ± 42、76 ± 29 和 37 ± 12 mg/dl。在 6 年的随访期间，有 71 名患者（31%）死亡。传统的血脂谱与死亡率无关。最高与最低四分位的非常小和大 LDL 颗粒浓度的死亡危险比（HR，95%置信区间）分别为 2.43（1.03 至 5.72）和 0.38（0.15 至 0.96）。随着 LDL 颗粒直径的四分位数增加，死亡 HR 分别为 1.00、0.93（0.46 至 1.87）、0.43（0.21 至 0.89）和 0.45（0.31 至 1.00）。
虽然传统的血脂谱不能预测 MHD 患者的死亡率，但较大的新型 LDL 颗粒直径或较高的大 LDL 颗粒浓度似乎与更高的生存率相关，而较高的非常小的 LDL 颗粒浓度与更高的死亡风险相关。在慢性疾病中检查脂蛋白亚组分的调节是必要的。
