Goldberg I J
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032.
Am J Kidney Dis. 1993 Jan;21(1):87-90. doi: 10.1016/s0272-6386(12)80728-1.
Abnormalities in circulating lipoprotein concentrations are a characteristic finding both in patients with uremia and in patients undergoing dialysis. These patients tend to have elevated triglyceride (TG) concentrations and low concentrations of high-density lipoprotein (HDL) cholesterol. Elevations of low-density lipoprotein (LDL) are not usually observed unless the patients have undergone renal transplantation and are receiving therapy with immune suppressive medications. Hypertriglyceridemia and low HDL may be the consequence of decreased actions of lipoprotein lipase (LPL), the endothelial cell-bound enzyme that degrades circulating lipoprotein triglyceride. A poorly characterized circulating inhibitor to this enzyme is found in uremic plasma. Preliminary data suggest that high-flux dialysis with polysulfone (PS) membranes improves the lipoprotein abnormalities and decreases circulating LPL inhibitors. Whether such therapy will alter the incidence of coronary morbidity and mortality in patients with end-stage renal failure remains to be tested.
循环脂蛋白浓度异常是尿毒症患者和接受透析患者的典型表现。这些患者往往甘油三酯（TG）浓度升高，高密度脂蛋白（HDL）胆固醇浓度降低。除非患者接受了肾移植并正在接受免疫抑制药物治疗，否则通常不会观察到低密度脂蛋白（LDL）升高。高甘油三酯血症和低HDL可能是脂蛋白脂肪酶（LPL）活性降低的结果，LPL是一种结合在内皮细胞上的酶，可降解循环中的脂蛋白甘油三酯。在尿毒症血浆中发现了一种对该酶作用不明确的循环抑制剂。初步数据表明，使用聚砜（PS）膜进行高通量透析可改善脂蛋白异常并降低循环LPL抑制剂。这种治疗是否会改变终末期肾衰竭患者冠心病的发病率和死亡率仍有待检验。
