Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Clin Exp Nephrol. 2012 Oct;16(5):767-72. doi: 10.1007/s10157-012-0615-5. Epub 2012 Feb 29.
Non-high-density lipoprotein cholesterol (non-HDL-C) has been proposed as a predictor of cardiovascular disease (CVD) in the general population. The aim of this study was to evaluate the utility of non-HDL-C in predicting CV mortality in chronic hemodialysis (HD) patients.
We calculated the serum non-HDL-C level of 259 HD patients by subtracting their HDL-C levels from their total cholesterol. Cox proportional hazards models were used to estimate the hazards ratio (HR) for CV mortality and the 95% confidence interval (CI). A receiver-operating characteristic (ROC) analysis was performed to estimate the relationship between sensitivity and specificity of a diagnostic parameter.
There were 44 deaths (17.0%) during the follow-up period, 33 (12.7%) of which were due to CVD. A multivariate Cox analysis with adjustments for age, diabetes, dialysis vintage, systolic blood pressure, serum albumin, and lipid levels showed that non-HDL-C was an independent predictor of CV mortality (HR 1.015, 95% CI 1.004-1.025, p = 0.0083). An ROC analysis showed that the plots of the non-HDL-C levels yielded significant specificity and sensitivity for predicting the risk of CVD mortality in HD patients [area under the curve (AUC) 0.62416; p = 0.0366; cutoff value 111.0 mg/dl]. The Kaplan-Meier survival curves of HD patients showed significant differences in CV mortality according to their tertiles with respect to serum non-HDL-C levels (p = 0.0165).
The results of this study suggest that serum non-HDL-C level is a significant CV mortality predictor of chronic HD patients.
非高密度脂蛋白胆固醇（non-HDL-C）已被提出作为预测心血管疾病（CVD）的指标在一般人群中。本研究旨在评估非高密度脂蛋白胆固醇在预测慢性血液透析（HD）患者心血管死亡率中的作用。
我们通过从总胆固醇中减去高密度脂蛋白胆固醇水平来计算 259 例 HD 患者的血清非高密度脂蛋白胆固醇水平。Cox 比例风险模型用于估计心血管死亡率的风险比（HR）和 95%置信区间（CI）。进行接收者操作特征（ROC）分析以估计诊断参数的敏感性和特异性之间的关系。
在随访期间发生了 44 例死亡（17.0%），其中 33 例（12.7%）死于 CVD。多变量 Cox 分析调整了年龄、糖尿病、透析龄、收缩压、血清白蛋白和血脂水平，显示非高密度脂蛋白胆固醇是心血管死亡率的独立预测因子（HR 1.015，95%CI 1.004-1.025，p=0.0083）。ROC 分析表明，非高密度脂蛋白胆固醇水平的曲线对于预测 HD 患者 CVD 死亡率的风险具有显著的特异性和敏感性[曲线下面积（AUC）0.62416；p=0.0366；截断值 111.0mg/dl]。HD 患者的 Kaplan-Meier 生存曲线根据血清非高密度脂蛋白胆固醇水平的三分位数显示出心血管死亡率的显著差异（p=0.0165）。
本研究结果表明，血清非高密度脂蛋白胆固醇水平是慢性 HD 患者心血管死亡率的重要预测指标。
