University of Minnesota School of Medicine, Minneapolis, MN, USA.
J Atheroscler Thromb. 2013;20(2):123-33. doi: 10.5551/jat.12849. Epub 2012 Oct 25.
Cardiovascular disease is increased in patients with chronic kidney disease (CKD) and is the principle cause of morbidity and mortality in these patients. In patients with stage 5 CKD, structural changes in the myocardium have been implicated as the principle cardiovascular processes leading to this increase in morbidity and mortality, while atherosclerotic events including acute myocardial infarction and strokes are responsible for approximately 10-15% of cardiovascular deaths. Dyslipidemia is common in CKD patients and is usually not characterized by elevated cholesterol levels, except in patients with marked proteinuria. Increased triglyceride levels in conjunction with decreased high-density lipoprotein levels are the commonest qualitative abnormality. Characteristically, abnormalities in the metabolism of apolipoprotein (apo) B-containing lipoproteins have been described, including both gut derived (apoB-48) as well as those produced by hepatic synthesis (apoB-100). A decrease in enzymatic delipidation as well as reduced receptor removal of these lipoproteins both contribute to the increased levels of these apo-B-containing particles and their remnants (which are believed to be highly atherogenic). Abnormalities in the metabolism of apoA-containing lipoproteins are also present and these changes contribute to the lower levels of HDL seen. Qualitative abnormalities of these HDL particles may be associated with cellular oxidative injury and contribute to a pro-inflammatory, pro-thrombotic milieu that is frequently present in CKD patients.
心血管疾病在慢性肾脏病（CKD）患者中更为常见，是这些患者发病率和死亡率的主要原因。在 5 期 CKD 患者中，心肌的结构变化被认为是导致发病率和死亡率增加的主要心血管过程，而包括急性心肌梗死和中风在内的动脉粥样硬化事件则占心血管死亡的约 10-15%。血脂异常在 CKD 患者中很常见，但通常不表现为胆固醇水平升高，除了伴有明显蛋白尿的患者。甘油三酯水平升高伴高密度脂蛋白水平降低是最常见的定性异常。特征性地，描述了载脂蛋白（apo）B 脂蛋白代谢的异常，包括肠道来源的（apoB-48）和肝脏合成的（apoB-100）。这些脂蛋白的酶促脱脂作用减少以及受体清除减少都导致这些载 apo-B 颗粒及其残基（被认为具有高度动脉粥样硬化性）水平升高。载 apoA 脂蛋白的代谢异常也存在，这些变化导致 HDL 水平降低。这些 HDL 颗粒的定性异常可能与细胞氧化损伤有关，并导致 CKD 患者中经常存在的促炎、促血栓形成的环境。
