Kaysen George A, Dalrymple Lorien S, Grimes Barbara, Chertow Glenn M, Kornak John, Johansen Kirsten L
Department of Medicine, University of California Davis, CA, USA.
Nephrol Dial Transplant. 2014 Feb;29(2):430-7. doi: 10.1093/ndt/gft370. Epub 2013 Sep 5.
Few studies have examined the changes in lipoproteins over time and how inflammation is associated with lipoprotein concentrations among patients with end-stage renal disease on dialysis. One possible explanation for the association of low LDL cholesterol concentration and adverse outcomes is that inflammation reduces selected apolipoprotein concentrations.
Serum samples were collected from a subsample of patients enrolled into the Comprehensive Dialysis Study every 3 months for up to 1 year. We examined the relation between temporal patterns in levels of inflammatory markers and changes in apolipoproteins (apo) A1 and B and the apo B/A1 ratio using linear mixed effects modeling and adjusting for potential confounders.
We enrolled 266 participants from 56 dialysis facilities. The mean age was 62 years, 45% were women and 26% were black. Apo A1 was lower among patients with higher Quetelet's (body mass) index (BMI), diabetes mellitus and atherosclerosis. Apo B was lower among older patients, patients with higher serum creatinine and patients with lower BMI. Over the course of a year, apo A1 changed inversely with serum concentrations of the acute phase proteins C-reactive protein (CRP) and α1 acid glycoprotein (α1AG), while apo B did not. Changes in α1AG were more strongly associated with changes in apolipoprotein concentrations than were changes in CRP; increases in α1AG were associated with decreases in apo A1 and increases in the apo B/A1 ratio.
Changes in inflammatory markers were associated with changes in apo A1, but not apo B over 1 year, suggesting that reductions in high-density lipoprotein cholesterol are associated with inflammation, either of which could mediate cardiovascular risk, but not supporting a hypothesis linking increased risk of low levels of apo B containing lipoproteins to the risk associated with inflammation.
很少有研究探讨终末期肾病透析患者脂蛋白随时间的变化以及炎症与脂蛋白浓度之间的关联。低密度脂蛋白胆固醇浓度低与不良结局相关的一种可能解释是，炎症会降低特定载脂蛋白的浓度。
从参与综合透析研究的患者子样本中每3个月采集一次血清样本，为期1年。我们使用线性混合效应模型并对潜在混杂因素进行调整，研究炎症标志物水平的时间模式与载脂蛋白（apo）A1和B的变化以及apo B/A1比值之间的关系。
我们从56个透析机构招募了266名参与者。平均年龄为62岁，45%为女性，26%为黑人。在体重指数（BMI）较高、患有糖尿病和动脉粥样硬化的患者中，apo A1较低。在老年患者、血清肌酐较高的患者和BMI较低的患者中，apo B较低。在一年的时间里，apo A1与急性期蛋白C反应蛋白（CRP）和α1酸性糖蛋白（α1AG）的血清浓度呈负相关，而apo B则不然。与CRP的变化相比，α1AG的变化与载脂蛋白浓度的变化相关性更强；α1AG的升高与apo A1的降低和apo B/A1比值的升高相关。
炎症标志物的变化与apo A1的变化相关，但在1年时间里与apo B无关，这表明高密度脂蛋白胆固醇的降低与炎症相关，二者均可能介导心血管风险，但不支持将含apo B的脂蛋白水平低的风险增加与炎症相关风险联系起来的假设。
