Attman P O, Alaupovic P, Tavella M, Knight-Gibson C
Department of Nephrology, Sahlgrenska University Hospital, University of Göteborg, Sweden.
Nephrol Dial Transplant. 1996 Jan;11(1):63-9.
To characterize the abnormalities of lipoprotein composition in patients with chronic renal failure (CRF), the lipid and apolipoprotein (apo) concentrations and compositions of major lipoprotein density classes were determined in 20 subjects with moderate to advanced renal failure (GFR 5-59 ml/min) and nine controls. Patients were divided in 14 normotriglyceridaemic (NTG) subjects with triglyceride (TG) levels < or = 1.7 mmol/l (150 mg/dl) and six hypertriglyceridaemic (HTG) subjects with TG > or = 1.7 mmol/l. Lipoproteins were isolated by preparative ultracentrifugation: very low density (VLDL), intermediate density (IDL), low density (LDL) and high density (HDL) lipoproteins.
Although all density classes were characterized by abnormal concentration and composition of some lipid and apo constituents, the most profound changes occurred in IDL and HDL. Cholesterol levels were elevated in VLDL and IDL with little change in LDL and reduced in HDL. TG levels were increased in all density classes. ApoB levels were increased in VLDL, IDL and LDL of all CRF patients reaching the significance levels in VLDL and IDL of HTG (P < 0.01). In IDL, the levels of apoC-peptides and apoE were increased (P < 0.01). ApoC-peptides and apo E were also elevated in VLDL of NTG and HTG, but their increase was only significant in HTG (P < 0.01). In LDL, the concentration of apoC-II and apoC-III was significantly increased (P < 0.05). However, in HDL there was significant (P < 0.01) reduction of apoA-I, apoA-II and apoC-peptides in both patient groups. The major compositional change was a significant increase in the relative contents of apoC-II and apoC-III in VLDL, IDL and LDL (P < 0.01).
Results indicate that the characteristic feature of dyslipoproteinemia in CRF is the accumulation of partially delipidized TG-rich apoB-containing lipoproteins enriched in apoC-peptides and distributed characteristically in the IDL density-range irrespective of fasting TG concentrations. Increased levels of these ¿remnant lipoproteins' and reduced levels of HDL may represent risk factors for atherogenesis and progressive renal disease.
为了描述慢性肾衰竭（CRF）患者脂蛋白组成的异常情况，我们测定了20例中度至重度肾衰竭患者（肾小球滤过率5 - 59 ml/分钟）和9例对照者的脂质及主要脂蛋白密度类别的载脂蛋白（apo）浓度与组成。患者被分为14例正常甘油三酯血症（NTG）患者（甘油三酯（TG）水平≤1.7 mmol/l（150 mg/dl））和6例高甘油三酯血症（HTG）患者（TG≥1.7 mmol/l）。通过制备性超速离心分离脂蛋白：极低密度脂蛋白（VLDL）、中间密度脂蛋白（IDL）、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）。
尽管所有密度类别的某些脂质和载脂蛋白成分的浓度及组成均表现异常，但最显著的变化发生在IDL和HDL中。VLDL和IDL中的胆固醇水平升高，LDL变化不大，HDL中的胆固醇水平降低。所有密度类别的TG水平均升高。所有CRF患者的VLDL、IDL和LDL中的载脂蛋白B水平升高，在HTG患者的VLDL和IDL中达到显著水平（P < 0.01）。在IDL中，载脂蛋白C肽和载脂蛋白E水平升高（P < 0.01）。NTG和HTG患者的VLDL中载脂蛋白C肽和载脂蛋白E也升高，但仅在HTG患者中升高显著（P < 0.01）。在LDL中，载脂蛋白C-II和载脂蛋白C-III的浓度显著升高（P < 0.05）。然而，在HDL中，两组患者的载脂蛋白A-I、载脂蛋白A-II和载脂蛋白C肽均显著降低（P < 0.01）。主要的组成变化是VLDL、IDL和LDL中载脂蛋白C-II和载脂蛋白C-III的相对含量显著增加（P < 0.01）。
结果表明，CRF患者血脂蛋白异常的特征是富含载脂蛋白C肽的部分脱脂富含TG的载脂蛋白B的脂蛋白积累，且无论空腹TG浓度如何，其特征性地分布在IDL密度范围内。这些“残余脂蛋白”水平升高和HDL水平降低可能是动脉粥样硬化和进行性肾病的危险因素。
