Bartens W, Nauck M, Schollmeyer P, Wanner C
Department of Medicine, University Clinic Freiburg, Würzburg, Germany.
Perit Dial Int. 1996 Jan-Feb;16(1):27-33.
To analyze the relationship between lipoprotein(a) [Lp(a)] and fibrinogen as potential cardiovascular risk factors in patients on continuous ambulatory peritoneal dialysis (CAPD).
A total of 47 uremic patients receiving CAPD, 21 with coronary artery disease (CAD), 26 without CAD.
Lp(a) levels were determined by an immunoradiometric assay. Since Lp(a) serum concentrations vary depending on the size, apoprotein(a) [apo(a)] isoforms were determined (Westernblot). Fibrinogen was quantified according to Clauss.
The mean Lp(a) serum concentration was 43 +/- 5 mg/dL (SEM) (median 33 mg/dL) in CAPD patients and 21 +/- 2 mg/dL (8 mg/dL) in controls (p < 0.01). Patients with low molecular weight apo(a) isoforms exhibited substantially elevated Lp(a) levels when compared with patients with high molecular isoforms (p < 0.01). In addition, we found elevated fibrinogen levels in the CAPD patients (538 +/- 61 mg/dL) compared with healthy controls (288 +/- 46 mg/dL). Twenty-one CAPD patients (45%) were suffering from CAD. Patients with CAD had higher Lp(a) levels (54 +/- 5 mg/dL vs 34 +/- 4 mg/dL) as well as higher fibrinogen concentrations (628 +/- 59 mg/dL vs 459 +/- 46 mg/dL). Furthermore, a positive correlation between the fibrinogen levels and the Lp(a) serum concentration was observed (r = 0.45, p = 0.01).
We suggest that elevated Lp(a) levels are influenced by the allelic variation of the apo(a) isoform. In addition to the typical dyslipidemia found in CAPD patients, high levels of Lp(a) and fibrinogen may contribute to the elevated risk of coronary artery disease and other cardiovascular complications.
分析持续性非卧床腹膜透析（CAPD）患者中脂蛋白(a)[Lp(a)]和纤维蛋白原作为潜在心血管危险因素之间的关系。
共有47例接受CAPD的尿毒症患者，其中21例患有冠状动脉疾病（CAD），26例无CAD。
采用免疫放射分析法定量Lp(a)水平。由于Lp(a)血清浓度因大小而异，因此测定载脂蛋白(a)[apo(a)]异构体（蛋白质免疫印迹法）。根据克劳斯法对纤维蛋白原进行定量。
CAPD患者的平均Lp(a)血清浓度为43±5mg/dL（标准误）（中位数33mg/dL），对照组为21±2mg/dL（8mg/dL）（p<0.01）。与高分子量异构体患者相比，低分子量apo(a)异构体患者的Lp(a)水平显著升高（p<0.01）。此外，我们发现CAPD患者的纤维蛋白原水平（538±61mg/dL）高于健康对照组（288±46mg/dL）。21例CAPD患者（45%）患有CAD。CAD患者的Lp(a)水平较高（54±5mg/dL对34±4mg/dL），纤维蛋白原浓度也较高（628±59mg/dL对459±46mg/dL）。此外，观察到纤维蛋白原水平与Lp(a)血清浓度呈正相关（r=0.45，p=0.）。
我们认为Lp(a)水平升高受apo(a)异构体等位基因变异的影响。除了CAPD患者中典型的血脂异常外，高水平的Lp(a)和纤维蛋白原可能导致冠状动脉疾病和其他心血管并发症的风险增加。
