UCIBIO/REQUIMTE, Porto, Portugal.
CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), Gandra-Paredes, Portugal.
Oxid Med Cell Longev. 2019 Feb 18;2019:3021785. doi: 10.1155/2019/3021785. eCollection 2019.
Cardiovascular disease (CVD) events are the main causes of death in end-stage renal disease (ESRD) patients on dialysis. The number and severity of CVD events remain inappropriate and difficult to explain by considering only the classic CVD risk factors. Our aim was to clarify the changes and the relationship of lipoprotein subfractions with other CVD risk factors, namely, body mass index (BMI) and adipokines, inflammation and low-density lipoprotein (LDL) oxidation, and the burden of the most prevalent comorbidities, diabetes mellitus (DM) and hypertension (HT). We studied 194 ESRD patients on dialysis and 22 controls; lipid profile, including lipoprotein subpopulations and oxidized LDL (oxLDL), C-reactive protein (CRP), adiponectin, leptin, and paraoxonase 1 activity were evaluated. Compared to controls, patients presented significantly lower levels of cholesterol, high-density lipoprotein cholesterol (HDLc), LDLc, oxLDL, and intermediate and small HDL and higher triglycerides, CRP, adiponectin, large HDL, very-low-density lipoprotein (VLDL), and intermediate-density lipoprotein- (IDL) B. Adiponectin levels correlated positively with large HDL and negatively with intermediate and small HDL, oxLDL/LDLc, and BMI; patients with DM ( = 17) and with DM+HT ( = 70), as compared to patients without DM or HT ( = 69) or only with HT ( = 38), presented significantly higher oxLDL, oxLDL/LDLc, and leptin and lower adiponectin. Obese patients ( = 45), as compared to normoponderal patients ( = 81), showed lower HDLc, adiponectin, and large HDL and significantly higher leptin, VLDL, and intermediate and small HDL. In ESRD, the higher adiponectin seems to favor atheroprotective HDL modifications and protect LDL particles from oxidative atherogenic changes. However, in diabetic and obese patients, adiponectin presents the lowest values, oxLDL/LDLc present the highest ones, and the HDL profile is the more atherogenic. Our data suggest that the coexistence of DM and adiposity in ESRD patients on dialysis contributes to a higher CVD risk, as showed by their lipid and adipokine profiles.
心血管疾病 (CVD) 事件是终末期肾病 (ESRD) 透析患者死亡的主要原因。仅考虑经典 CVD 危险因素，心血管疾病事件的数量和严重程度仍然不适当且难以解释。我们的目的是阐明脂蛋白亚组分的变化及其与其他 CVD 危险因素（即体重指数 (BMI) 和脂肪因子、炎症和低密度脂蛋白 (LDL) 氧化）以及最常见合并症（糖尿病 (DM) 和高血压 (HT)）负担之间的关系。我们研究了 194 名 ESRD 透析患者和 22 名对照者；评估了血脂谱，包括脂蛋白亚群和氧化 LDL (oxLDL)、C 反应蛋白 (CRP)、脂联素、瘦素和对氧磷酶 1 活性。与对照组相比，患者的胆固醇、高密度脂蛋白胆固醇 (HDLc)、LDLc、oxLDL 以及中密度和小密度脂蛋白明显降低，而甘油三酯、CRP、脂联素、大密度脂蛋白、极低密度脂蛋白 (VLDL) 和中间密度脂蛋白 (IDL)-B 则升高。脂联素水平与大密度脂蛋白呈正相关，与中密度和小密度脂蛋白、oxLDL/LDLc 和 BMI 呈负相关；与无 DM 或 HT ( = 69) 或仅有 HT ( = 38) 的患者相比，DM ( = 17) 和 DM+HT ( = 70) 的患者 oxLDL、oxLDL/LDLc 和瘦素显著升高，而脂联素降低。与体脂正常的患者 ( = 81) 相比，肥胖患者 ( = 45) 的 HDLc、脂联素和大密度脂蛋白较低，而瘦素、VLDL 和中密度和小密度脂蛋白显著升高。在 ESRD 中，较高的脂联素似乎有利于保护性 HDL 修饰，并保护 LDL 颗粒免受氧化性致动脉粥样硬化变化。然而，在糖尿病和肥胖患者中，脂联素的数值最低，oxLDL/LDLc 的数值最高，HDL 谱的致动脉粥样硬化性最强。我们的数据表明，ESRD 透析患者中 DM 和肥胖的共存导致更高的 CVD 风险，这反映在他们的脂质和脂肪因子谱中。
