Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
J Clin Lipidol. 2017 Jul-Aug;11(4):945-954.e3. doi: 10.1016/j.jacl.2017.06.004. Epub 2017 Jun 13.
The association of dyslipidemia with mortality has not been fully evaluated in patients on peritoneal dialysis (PD). Moreover, changes in lipids levels over time and associated death risk have not yet been studied in this population.
We studied the association of time-updated serum lipid concentrations with all-cause and cardiovascular (CV) mortalities in a 10-year cohort of 749 incident PD patients.
Association was assessed using time-varying Cox proportional hazard regression models with adjustment for multiple variables including statin therapy.
During a median follow-up of 36 (interquartile range, 21-61) months, 273 all-cause and 107 CV deaths occurred. Compared with those with total cholesterol (TC) of 180 to <210 or low-density lipoprotein cholesterol (LDL-C) of 100 to <130 mg/dL, hazard ratios (95% confidence interval) of the lowest TC (<150 mg/dL) and LDL-C (<70 mg/dL) were 2.32 (1.61-3.35) and 2.02 (1.45-2.83) for all-cause mortality and 1.87 (1.04-3.37) and 1.92 (1.13-3.26) for CV mortality, respectively. Lower triglyceride (<100 mg/dL) and high-density lipoprotein cholesterol (<30 mg/dL) levels were associated with higher all-cause mortality (1.66 [1.11-2.47] and 1.57 [1.08-2.29]) but not with CV mortality.
Contrary to the general population, lower TC and LDL-C levels over time were significantly associated with both worse survival and increased CV mortality in incident PD patients. Although lower triglyceride and high-density lipoprotein cholesterol concentrations were associated with significantly higher all-cause mortality, they failed to show any clear association with CV mortality. The underlying mechanisms responsible for this apparent paradox await further investigations.
在腹膜透析（PD）患者中，血脂异常与死亡率的关系尚未得到充分评估。此外，在该人群中，血脂水平随时间的变化及其相关死亡风险尚未得到研究。
我们研究了在一个为期 10 年的 749 例新诊断 PD 患者队列中，随时间变化的血清脂质浓度与全因和心血管（CV）死亡率之间的关联。
使用时间变化的 Cox 比例风险回归模型评估关联，该模型调整了多个变量，包括他汀类药物治疗。
在中位数为 36（四分位距，21-61）个月的随访期间，发生了 273 例全因死亡和 107 例 CV 死亡。与总胆固醇（TC）为 180-<210 或低密度脂蛋白胆固醇（LDL-C）为 100-<130 mg/dL 的患者相比，TC 最低（<150 mg/dL）和 LDL-C 最低（<70 mg/dL）的危险比（95%置信区间）分别为 2.32（1.61-3.35）和 2.02（1.45-2.83），全因死亡率和 CV 死亡率分别为 1.87（1.04-3.37）和 1.92（1.13-3.26）。较低的三酰甘油（<100 mg/dL）和高密度脂蛋白胆固醇（<30 mg/dL）水平与全因死亡率升高相关（1.66 [1.11-2.47] 和 1.57 [1.08-2.29]），但与 CV 死亡率无关。
与一般人群相反，随时间推移 TC 和 LDL-C 水平降低与新诊断 PD 患者的生存状况恶化和 CV 死亡率增加显著相关。虽然较低的三酰甘油和高密度脂蛋白胆固醇浓度与全因死亡率显著升高相关，但与 CV 死亡率没有明显关联。这种明显悖论的潜在机制有待进一步研究。
