Nishizawa Y, Shoji T, Nishitani H, Yamakawa M, Konishi T, Kawasaki K, Morii H
Second Department of Internal Medicine, Osaka City University Medical School, Japan.
Kidney Int. 1993 Dec;44(6):1352-9. doi: 10.1038/ki.1993.388.
We examined the effects of a fibric acid, clinofibrate, on lipoprotein metabolism in 12 hyperlipidemic patients with uremia treated on continuous ambulatory peritoneal dialysis during a 24 week treatment. Daily dose of clinofibrate was 200 mg for the initial four weeks, 400 mg for the second four weeks, and 600 mg for the subsequent 16 weeks. Serum and very-low density lipoprotein (VLDL) triglyceride were decreased by 36% and 48%, respectively. Neither total cholesterol nor apolipoprotein B changed significantly, whereas cholesterol was decreased in VLDL and increased in low (LDL) and high density lipoprotein (HDL) fractions. Post-heparin plasma lipoprotein lipase (LPL) before treatment was not lower than the normal value, and we found no change in LPL activity following clinofibrate. Hepatic triglyceride lipase also did not change. Apolipoprotein (apo) C-II/C-III ratio was low as compared to the normal value before treatment, and the ratio was increased by 38% after the treatment. Decrease in VLDL triglyceride was associated with increase in apo C-II/C-III ratio in all the cases. Abnormal enrichment with triglyceride of LDL and HDL fractions was improved by clinofibrate. Although one patient had a transient and asymptomatic elevation of serum creatine phosphokinase, no patient had muscle pain. There was no accumulation of the drug in the 24 week trial. These results suggest that clinofibrate is an effective and safe approach to the management of dyslipidemia in CAPD patients.
我们研究了氯贝丁酯（一种纤维酸类药物）对12例接受持续性非卧床腹膜透析治疗的尿毒症高脂血症患者脂蛋白代谢的影响，治疗为期24周。氯贝丁酯的日剂量在最初4周为200mg，接下来4周为400mg，随后16周为600mg。血清甘油三酯和极低密度脂蛋白（VLDL）甘油三酯分别下降了36%和48%。总胆固醇和载脂蛋白B均无显著变化，而VLDL中的胆固醇下降，低密度脂蛋白（LDL）和高密度脂蛋白（HDL）中的胆固醇增加。治疗前的肝素后血浆脂蛋白脂肪酶（LPL）不低于正常值，我们发现氯贝丁酯治疗后LPL活性没有变化。肝甘油三酯脂肪酶也未改变。治疗前载脂蛋白（apo）C-II/C-III比值低于正常值，治疗后该比值增加了38%。在所有病例中，VLDL甘油三酯的下降与apo C-II/C-III比值的增加相关。氯贝丁酯改善了LDL和HDL组分中甘油三酯的异常富集。尽管有1例患者血清肌酸磷酸激酶出现短暂且无症状的升高，但无患者出现肌肉疼痛。在24周的试验中未发现药物蓄积。这些结果表明，氯贝丁酯是治疗持续性非卧床腹膜透析患者血脂异常的一种有效且安全的方法。
