Clin Lab. 2022 Aug 1;68(8). doi: 10.7754/Clin.Lab.2022.220102.
Patients with peritoneal dialysis commonly have severe disorders of lipid metabolism, with particularly severe changes in serum lipoprotein(α) [Lp(α)]. Serum Lp(α) may play a role in the risk of mortality in peritoneal dialysis patients. The aim was to investigate the correlation between high serum Lp(α) levels and all-cause mortality and death from cardiovascular events and infection in peritoneal dialysis patients.
Three hundred and ninety-two patients with end-stage kidney disease who started peritoneal dialysis treatment between March 1, 2007 and May 31, 2020, were selected. Clinical data of all enrolled patients after 3 months of peritoneal dialysis were collected. Based on the median value of serum Lp(α) level, all enrolled patients were divided equally into a high serum Lp(α) level group (> 275.95 mg/L, n = 196) and a low serum Lp(α) level group (< 275.95 mg/L, n = 196). SPSS25.0 statistical software was used to analyze the factors affecting serum Lp(α) levels and the correlation between high serum Lp(α) levels and all-cause mortality and death from cardiovascular events and infection in peritoneal dialysis patients.
Binary multivariate logistic regression analysis showed that higher low-density lipoprotein (LDL) levels (OR = 1.614, 95% CI: 1.261 - 2.068, p = 0.000) and high Body Mass Index (BMI) levels (OR = 1.063, 95% CI: 1.004 - 1.126, p = 0.036) were the risk factors for the high serum Lp(α) levels. High serum albumin levels (OR = 0.959, 95% CI: 0.927 - 0.991, p = 0.014) and high parathyroid hormone levels (OR = 0.999, 95% CI: 0.997 - 1.000, p = 0.010) were protective factors for the high serum Lp(α) levels. The cumulative survival of patients in the high serum Lp(α) level group was lower in death from cardiovascular events as shown by Kaplan-Meier survival analysis (Log-rank test χ2 = 4.348, p = 0.037). Multivariate Cox regression analysis showed that high serum Lp(α) levels were an independent risk factor for death from cardiovascular events in peritoneal dialysis patients (HR = 1.002, 95% CI: 1.001 - 1.003, p = 0.001).
The occurrence of high serum Lp(α) levels in peritoneal dialysis patients was positively associated with LDL and BMI, and negatively associated with serum albumin and parathyroid hormone levels. High serum Lp(α) levels were related to the risk of death from cardiovascular events in peritoneal dialysis patients.
腹膜透析患者常伴有严重的脂代谢紊乱，血清脂蛋白（α）[Lp（α）]变化尤为明显。血清 Lp（α）可能在腹膜透析患者的死亡风险中发挥作用。目的是探讨高血清 Lp（α）水平与腹膜透析患者全因死亡率以及心血管事件和感染死亡的相关性。
选取 2007 年 3 月 1 日至 2020 年 5 月 31 日开始腹膜透析治疗的 392 例终末期肾病患者。收集所有纳入患者腹膜透析后 3 个月的临床资料。根据血清 Lp（α）水平中位数，将所有纳入患者等分为高血清 Lp（α）水平组（>275.95mg/L，n=196）和低血清 Lp（α）水平组（<275.95mg/L，n=196）。采用 SPSS25.0 统计软件分析影响血清 Lp（α）水平的因素以及高血清 Lp（α）水平与腹膜透析患者全因死亡率和心血管事件及感染死亡的相关性。
二项多元逻辑回归分析显示，较高的低密度脂蛋白（LDL）水平（OR=1.614，95%CI：1.261-2.068，p=0.000）和较高的身体质量指数（BMI）水平（OR=1.063，95%CI：1.004-1.126，p=0.036）是高血清 Lp（α）水平的危险因素。较高的血清白蛋白水平（OR=0.959，95%CI：0.927-0.991，p=0.014）和较高的甲状旁腺激素水平（OR=0.999，95%CI：0.997-1.000，p=0.010）是高血清 Lp（α）水平的保护因素。Kaplan-Meier 生存分析显示，高血清 Lp（α）水平组患者心血管事件死亡的累积生存率较低（Log-rank 检验 χ2=4.348，p=0.037）。多因素 Cox 回归分析显示，高血清 Lp（α）水平是腹膜透析患者心血管事件死亡的独立危险因素（HR=1.002，95%CI：1.001-1.003，p=0.001）。
腹膜透析患者高血清 Lp（α）水平的发生与 LDL 和 BMI 呈正相关，与血清白蛋白和甲状旁腺激素水平呈负相关。高血清 Lp（α）水平与腹膜透析患者心血管事件死亡风险相关。
