Mahrooz Abdolkarim, Zargari Mehryar, Sedighi Omid, Shaygani Hamed, Gohari Ghorban
Department of Clinical Biochemistry and Genetics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Clin Invest Med. 2012 Jun 1;35(3):E144-51. doi: 10.25011/cim.v35i3.16590.
Investigations, in which oxidized-low density lipoprotein (ox-LDL), serum paraoxonase (PON1) and homocysteine (Hcy) are considered together as important agents involved in the development of oxidative and atherogenic events in non-diabetic hemodialysis (HD) population, are limited. This case-control study was designed to evaluate these parameters in the patients and control subjects and to determine the correlations among the factors.
Forty-nine age- and sex- matched subjects, including 28 non-diabetic HD patients (paired pre-and post-dialysis samples) and 21 control subjects, were enrolled. Ox-LDL and Hcy levels were measured with ELISA and EIA methods, respectively. Arylesterase activity of PON1 was measured by spectrophotometric assay.
Compared with the control group, ox-LDL levels were significantly increased both before (p=0.001) and after HD (p=0.036). Arylesterase activity-to-HDL ratio in HD patients was significantly higher than control subjects (p=0.003). Homocysteine levels in the ESRD patients were higher than control subjects both in pre-dialysis and post-dialysis. There was a significant positive correlation (r= 0.25, p= 0.026) between ox-LDL and homocysteine in samples obtained before HD. Logistic regression analysis revealed ox-LDL levels (OR=3.02, p < 0.001) and arylesterase activity/HDL ratio (OR=2.43, p=0.01) to be associated with the increased risk of ESRD.
Ox-LDL levels and arylesterase activity/HDL ratio indicated the strongest association with ESRD risk. These factors, especially ox-LDL as an indicator of oxidative stress, may be biomarkers in evaluating the status of non-diabetic ESRD patients. Because of the pathogenic relationship between ox-LDL and homocysteine as nontraditional risk factors of atherosclerosis, therapeutic strategies adopted to reduce them may be useful in decrease of high prevalence of cardiovascular mortality in dialysis patients. In addition, measurement of PON1 activity to HDL ratio is possibly a more valuable biomarker than arylesterase activity alone in non-diabetic ESRD.
将氧化型低密度脂蛋白（ox-LDL）、血清对氧磷酶（PON1）和同型半胱氨酸（Hcy）共同视为参与非糖尿病血液透析（HD）人群氧化和动脉粥样硬化事件发生的重要因素的研究较为有限。本病例对照研究旨在评估患者和对照受试者中的这些参数，并确定各因素之间的相关性。
纳入49名年龄和性别匹配的受试者，包括28名非糖尿病HD患者（透析前后配对样本）和21名对照受试者。分别采用ELISA法和EIA法测定ox-LDL和Hcy水平。通过分光光度法测定PON1的芳基酯酶活性。
与对照组相比，HD前（p = 0.001）和HD后（p = 0.036）ox-LDL水平均显著升高。HD患者的芳基酯酶活性与HDL的比值显著高于对照受试者（p = 0.003）。终末期肾病（ESRD）患者透析前和透析后的同型半胱氨酸水平均高于对照受试者。HD前采集的样本中，ox-LDL与同型半胱氨酸之间存在显著正相关（r = 0.25，p = 0.026）。逻辑回归分析显示，ox-LDL水平（OR = 3.02，p < 0.001）和芳基酯酶活性/HDL比值（OR = 2.43，p = 0.01）与ESRD风险增加相关。
ox-LDL水平和芳基酯酶活性/HDL比值与ESRD风险的关联最为密切。这些因素，尤其是作为氧化应激指标的ox-LDL，可能是评估非糖尿病ESRD患者病情的生物标志物。由于ox-LDL和同型半胱氨酸作为动脉粥样硬化的非传统危险因素之间存在致病关系，采取降低它们的治疗策略可能有助于降低透析患者心血管疾病高死亡率。此外，在非糖尿病ESRD中，测定PON1活性与HDL的比值可能比单独测定芳基酯酶活性是更有价值的生物标志物。
