Lokesh Shanmugam, Kadavanu Tony Mathew, Green Siva Ranganathan, Dutta Tarun Kumar, Hemachandar Radhakrishnan, Ramachandrappa Arun Kumar, Tiwari Shashank Rakesh, Govindasamy Ezhumalai
Associate Professor, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
Assistant Professor, Department of General Medicine, Mahatma Gandhi Medical College & Research Institute, SBV University , Puducherry, India .
J Clin Diagn Res. 2016 Sep;10(9):OC15-OC19. doi: 10.7860/JCDR/2016/21897.8523. Epub 2016 Sep 1.
Lipid abnormalities and increase in inflammatory markers are common among patients with End Stage Renal Disease (ESRD) and it tends to persist/worsen even after initiating Intermittent Haemodialysis (IHD). The cardiovascular mortality and morbidity remains significantly high in this population.
The present study was carried out to assess the pattern of lipid abnormality in our population and to find its association with inflammatory markers.
It was a cross-sectional, observational study on ESRD patients undergoing Haemodialysis (HD) in comparison with age and sex matched healthy individuals in a tertiary care hospital. About 40 adult male and female patients aged >18 years, undergoing chronic HD for more than 6 months were enrolled in Group A. Patients who were alcoholics, tobacco consumers and those on steroids and hypolipidemic drugs were excluded. Group B consisted of healthy, age and sex matched controls. Serum lipid profile, lipoprotein A, apolipoprotein A1, apolipoprotein B and apo B/A1 ratio, serum uric acid, homocysteine, hs-CRP and testosterone levels were estimated among patients undergoing intermittent HD and healthy individuals. Chi-square/Fisher's-exact test was used for comparing ratios. A p-value of <0.05 was considered statistically significant.
The mean Total Cholesterol (TC), Low Density Lipoprotein (LDL) and Non-HDL High Density Lipoprotein cholesterol was significantly lower in HD patients as compared to control group with all the three parameters attaining statistical significance (p<0.005). The mean lipoprotein A level was significantly higher (p=0.037), while Apo A1 was found to be significantly lower (p=0.001) in patients receiving HD. Inflammatory markers like uric acid was high (p<0.005) and serum testotsterone level in male HD patient was significantly low (p<0.005).
The mean values of traditional serum lipid profile remained lower in HD patients than the control group. The abnormalities in lipoprotein A and apolipoproteins were more pronounced in patients undergoing HD. The mean level of testosterone also was found to be lower in male patients receiving HD. Hence, estimation of lipoprotein A, apolipoproteins and inflammatory markers may serve as a potential tool in cardiovascular risk stratification.
脂质异常和炎症标志物升高在终末期肾病（ESRD）患者中很常见，并且即使在开始间歇性血液透析（IHD）后仍倾向于持续存在/恶化。该人群的心血管死亡率和发病率仍然显著较高。
本研究旨在评估我们人群中脂质异常的模式，并找出其与炎症标志物的关联。
这是一项横断面观察性研究，在一家三级护理医院中，将接受血液透析（HD）的ESRD患者与年龄和性别匹配的健康个体进行比较。A组纳入了约40名年龄大于18岁、接受慢性HD超过6个月的成年男性和女性患者。排除了酗酒者、吸烟者以及正在使用类固醇和降血脂药物的患者。B组由健康的、年龄和性别匹配的对照组组成。对接受间歇性HD的患者和健康个体进行血清脂质谱、脂蛋白A、载脂蛋白A1、载脂蛋白B和载脂蛋白B/A1比值、血清尿酸、同型半胱氨酸、高敏C反应蛋白和睾酮水平的评估。采用卡方检验/费舍尔精确检验来比较比率。p值<0.05被认为具有统计学意义。
与对照组相比，HD患者的平均总胆固醇（TC）、低密度脂蛋白（LDL）和非高密度脂蛋白胆固醇显著更低，这三个参数均具有统计学意义（p<0.005）。接受HD的患者中，平均脂蛋白A水平显著更高（p=0.037），而载脂蛋白A1显著更低（p=0.001）。尿酸等炎症标志物水平较高（p<0.005），男性HD患者的血清睾酮水平显著较低（p<0.005）。
HD患者传统血清脂质谱的平均值低于对照组。脂蛋白A和载脂蛋白的异常在接受HD的患者中更为明显。接受HD的男性患者的平均睾酮水平也较低。因此，脂蛋白A、载脂蛋白和炎症标志物的评估可能是心血管风险分层的潜在工具。
