Takegoshi T, Kitoh C, Shimada T, Kawai K, Yamazaki Y, Mabuchi H
Department of Internal Medicine, Fukui Prefectural Hospital, Japan.
Nihon Jinzo Gakkai Shi. 1993 Jun;35(6):757-63.
Cerebrovascular and cardiovascular diseases are important predictors for survival in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and account for about half the deaths in these patients. Lipoprotein(a) [Lp(a)] is known to show high values in diabetics with proteinuria, and albuminuric renal disease. The purpose of this study was to determine Lp(a) levels and to investigate the association of Lp(a) and atherosclerotic risk factors in patients treated by CAPD. Lp(a) concentration were measured in 20 CAPD patients in the age range 31 to 83 years. Mean (+/- SD) levels of serum Lp(a) were elevated in the CAPD patients compared to age, sex matched 17 controls (49.5 +/- 27.7 vs. 15.5 +/- 12.4 mg/dl, p < 0.001). The levels of Lp(a) were significantly higher in the diabetic CAPD patients than in non-diabetics. There were significant positive correlations between serum Lp(a) concentrations and fasting blood sugar. However, when the above two groups were matched for age, sex, body mass index and FBS, Lp(a) concentrations were also significantly higher in CAPD patients than those in normal controls. We found no statistically significant correlations of Lp(a) with either age, body mass index, blood pressure, serum lipoprotein, apoprotein, glycated hemoglobin, BUN, creatinine or serum protein levels. There were no correlations between serum Lp(a) levels and albumin and LP(a) concentrations in the dialysate in all CAPD patients. Along with assessment of other known established cardiovascular risk factors such as elevated blood pressure, atherogenic abnormalities of plasma lipids and lipoproteins, and impaired glucose tolerance, we suggest that elevated levels of Lp(a) may lead to the accelerated atherosclerosis in these patients.
脑血管疾病和心血管疾病是持续非卧床腹膜透析（CAPD）患者生存的重要预测因素，约占这些患者死亡原因的一半。已知脂蛋白（a）[Lp（a）]在伴有蛋白尿的糖尿病患者和白蛋白尿肾病患者中水平较高。本研究的目的是测定CAPD治疗患者的Lp（a）水平，并研究Lp（a）与动脉粥样硬化危险因素之间的关联。对20例年龄在31至83岁的CAPD患者测定了Lp（a）浓度。与年龄、性别匹配的17名对照相比，CAPD患者血清Lp（a）的平均（±标准差）水平升高（49.5±27.7 vs. 15.5±12.4mg/dl，p<0.001）。糖尿病CAPD患者的Lp（a）水平显著高于非糖尿病患者。血清Lp（a）浓度与空腹血糖之间存在显著正相关。然而，当上述两组在年龄、性别、体重指数和空腹血糖方面匹配时，CAPD患者的Lp（a）浓度也显著高于正常对照。我们发现Lp（a）与年龄、体重指数、血压、血清脂蛋白、载脂蛋白、糖化血红蛋白、尿素氮、肌酐或血清蛋白水平之间无统计学显著相关性。所有CAPD患者的血清Lp（a）水平与白蛋白及透析液中LP（a）浓度之间均无相关性。除了评估其他已知的既定心血管危险因素，如血压升高、血浆脂质和脂蛋白的致动脉粥样硬化异常以及糖耐量受损外，我们认为Lp（a）水平升高可能导致这些患者动脉粥样硬化加速。
