维持性血液透析患者的冠状动脉危险因素：罪魁祸首是谁——血液透析还是慢性肾衰竭？
Coronary risk factors in maintenance hemodialysis patients: Who is the culprit - hemodialysis or chronic renal failure?
作者信息
Gupta Kapil, Mahajan Rajiv
机构信息
Department of Biochemistry, Adesh Institute of Medical Sciences and Research, Bathinda-151 109, India.
出版信息
Int J Appl Basic Med Res. 2011 Jan;1(1):11-4. doi: 10.4103/2229-516X.81973.
OBJECTIVE
Dyslipidemia, common in uremic patients subjected to maintenance hemodialysis (HD), represents an independent risk factor for atherosclerosis; but the association between long-term HD and uremic dyslipidemia is not crystal clear. The present study was aimed to ascertain any association.
MATERIALS AND METHODS
The effects of chronic renal failure (CRF) and HD duration on serum lipids, lipoproteins and homocysteine (HC) were studied in 84 patients suffering from CRF subjected to maintenance HD and were compared with 68 healthy, age-, sex- and race-matched control cohorts.
RESULTS
Increase in serum free cholesterol (FC), triglycerides, very low-density lipoprotein cholesterol and HC levels, and decrease in esterified cholesterol (EC), EC/FC ratio, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol levels were highly significant (P < 0.001) in pre-dialysis patients compared to controls. Further disturbances were observed (P < 0.05) by repeated HD, resulting in further significant increase in FC, and decrease in EC/FC ratio and HDL-C levels after 40 dialysis schedules.
CONCLUSION
Levels of HDL-C, plasma FC, and ratio of EC/FC appeared to be clearly altered by HD duration, submitting patients to a greater risk of atherosclerosis due to maintenance HD.
目的
血脂异常在接受维持性血液透析（HD）的尿毒症患者中很常见，是动脉粥样硬化的独立危险因素；但长期血液透析与尿毒症血脂异常之间的关联尚不清楚。本研究旨在确定它们之间的任何关联。
材料与方法
对84例接受维持性血液透析的慢性肾衰竭（CRF）患者，研究慢性肾衰竭和血液透析时间对血清脂质、脂蛋白和同型半胱氨酸（HC）的影响，并与68名年龄、性别和种族匹配的健康对照队列进行比较。
结果
与对照组相比，透析前患者血清游离胆固醇（FC）、甘油三酯、极低密度脂蛋白胆固醇和HC水平升高，而酯化胆固醇（EC）、EC/FC比值、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇水平降低，差异有高度统计学意义（P < 0.001）。重复血液透析后观察到进一步的紊乱（P < 0.05），在40次透析后，FC进一步显著升高，EC/FC比值和HDL-C水平进一步显著降低。
结论
HDL-C水平、血浆FC和EC/FC比值似乎明显受血液透析时间的影响，使维持性血液透析患者患动脉粥样硬化的风险更高。
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