Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA.
J Ren Nutr. 2013 May;23(3):203-6. doi: 10.1053/j.jrn.2013.01.022.
End-stage renal disease (ESRD) is associated with a significant propensity for development of atherosclerosis and cardiovascular mortality. The atherogenic diathesis associated with ESRD is driven by inflammation, oxidative stress, and dyslipidemia. Reduced high-density lipoprotein cholesterol (HDL-C) level and high-density lipoprotein (HDL) dysfunction are the hallmarks of ESRD-related dyslipidemia. Clinical and laboratory studies have revealed that ESRD is associated with significantly reduced serum apolipoprotein A-I (ApoA-I) and HDL-C level as well as altered HDL composition. Furthermore, although ESRD is associated with impaired HDL antioxidant and anti-inflammatory properties in most patients, in a small subset, HDL may in fact have a pro-oxidant and proinflammatory effect. Therefore, it is no surprise that serum HDL-C level is not a dependable indicator of cardiovascular disease burden in ESRD, and markers such as HDL function are critical to accurately identifying patients at risk for cardiovascular disease and mortality in ESRD.
终末期肾病（ESRD）与动脉粥样硬化和心血管死亡率的发生有很大的相关性。与 ESRD 相关的动脉粥样硬化倾向是由炎症、氧化应激和血脂异常引起的。高密度脂蛋白胆固醇（HDL-C）水平降低和高密度脂蛋白（HDL）功能障碍是 ESRD 相关血脂异常的标志。临床和实验室研究表明，ESRD 与血清载脂蛋白 A-I（ApoA-I）和 HDL-C 水平显著降低以及 HDL 组成改变有关。此外，尽管在大多数患者中，ESRD 与 HDL 的抗氧化和抗炎特性受损有关，但在一小部分患者中，HDL 实际上可能具有促氧化和促炎作用。因此，血清 HDL-C 水平并不是 ESRD 患者心血管疾病负担的可靠指标也就不足为奇了，而 HDL 功能等标志物对于准确识别 ESRD 患者发生心血管疾病和死亡的风险至关重要。
