Hernández E, Praga M, Alamo C, Araque A, Morales J M, Alcazar J M, Ruilope L M, Rodicio J L
Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain.
Nephron. 1996;72(2):145-9. doi: 10.1159/000188832.
Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic and cardiovascular complications in the general population and in hemodialysis patients. Increased Lp(a) levels have been also described as a possible predictor of vascular access occlusion in patients on chronic hemodialysis. We have studied prospectively the relationship between vascular access survival and Lp(a) levels in 40 hemodialysis patients. The Lp(a) plasma concentrations were measured by enzyme-linked immunosorbent assay in all patients in April 1993. Throughout the following year, evolution and survival of their vascular accesses were analyzed. Failure of vascular access was established when there were complications requiring surgical repair or transluminal angioplasty. Fourteen patients showed failure of vascular access, and the cumulative survival of vascular accesses after 1 year of follow-up was 63.8%. The Lp(a) levels were higher in patients with failure of vascular access than in the others (35.2 +/- 31 vs. 22.4 +/- 25 md/dl), but this difference did not reach statistical significance (p = 0.064). The vascular access survival in patients with Lp(a) levels > 75th percentile (52.5 mg/dl) was significantly lower than in the remaining patients (40 vs. 72%; p = 0.045). This difference increased when we analyzed the patients with Lp(a) levels > 90th percentile (76 md/dl; 25 vs. 68%; p = 0.002). Our results suggest that patients with the highest levels of Lp(a) are at risk of developing complications in their vascular accesses, and they also have lower vascular access survival.
脂蛋白(a)[Lp(a)]是普通人群和血液透析患者发生动脉粥样硬化及心血管并发症的独立危险因素。Lp(a)水平升高也被认为是慢性血液透析患者血管通路闭塞的一个可能预测指标。我们前瞻性地研究了40例血液透析患者血管通路存活情况与Lp(a)水平之间的关系。1993年4月采用酶联免疫吸附测定法测量了所有患者的血浆Lp(a)浓度。在接下来的一年中，分析了他们血管通路的演变和存活情况。当出现需要手术修复或腔内血管成形术的并发症时，判定血管通路失败。14例患者出现血管通路失败，随访1年后血管通路的累积存活率为63.8%。血管通路失败患者的Lp(a)水平高于其他患者(35.2±31 vs. 22.4±25 mg/dl)，但这一差异未达到统计学显著性(p = 0.064)。Lp(a)水平>第75百分位数(52.5 mg/dl)的患者血管通路存活率显著低于其余患者(40% vs. 72%；p = 0.045)。当我们分析Lp(a)水平>第90百分位数(76 mg/dl)的患者时，这一差异增大(分别为25%和68%；p = 0.002)。我们的结果表明，Lp(a)水平最高的患者有发生血管通路并发症的风险，并且他们的血管通路存活率也较低。
