Shah B, Nair S, Sirsat R A, Ashavaid T F, Nair K G
Nephrology Section, PD Hinduja National Hospital's Research Centre, Mahim, Bombay.
J Postgrad Med. 1994 Apr-Jun;40(2):57-60.
Indian studies on lipid profile abnormalities in chronic renal failure (CRF) have varied from no abnormalities at all to significant abnormality (hypertriglyceridemia and reduced HDL) as described in the Western literature. Moreover, there is no Indian study on the effect of renal transplantation on the abnormal lipid profile of CRF. The aim of our study was to determine the lipid profile of CRF patients on conservative treatment, end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) treatment and renal transplant patients. We also looked at the effect of fish oil rich in polyunsaturated fatty acids (Max-EPA) on hypertriglyceridemia of CRF. The study included 4 groups; Gp I: control subjects (n = 9, age = 30 +/- 5 yrs), Gp II: CRF patients on conservative treatment (n = 9, age = 49 +/- 17 yrs), Gp III: ESRD patients on HD for at least 3 months (n = 19, age = 53 +/- 9 yrs), Gp IV: 3 months post-renal transplant patients (n = 9, age 31 +/- 11 yrs). The lipids and lipoproteins analysed include total cholesterol, HDL, LDL, triglycerides, Apo A1 and Apo B. It was observed that in Gp II patients triglycerides were significantly elevated (p < .05) and Apo A1/Apo B significantly abnormally lower (p < .001) compared to Gp I. In Gp IV patients, there was no significant difference in lipid profile compared to Gp I. With the use of Max-EPA in 5 patients with hypertriglyceridemia, there was a significant improvement in hypertriglyceridemia (p < .05). Our study suggests: 1) significant hypertriglyceridemia does develop in a majority of CRF patients. The abnormality probably improves with dialysis treatment and renal transplantation. 2) A lower Apo A1/Apo B ratio in CRF patients may account for higher risk of atherosclerosis. 3) Fish oil rich in polyunsaturated fatty acids improves hypertriglyceridemia of CRF.
印度关于慢性肾衰竭（CRF）脂质谱异常的研究结果各不相同，从完全没有异常到出现如西方文献中所描述的显著异常（高甘油三酯血症和高密度脂蛋白降低）。此外，尚无印度的研究探讨肾移植对CRF异常脂质谱的影响。我们研究的目的是确定接受保守治疗的CRF患者、接受维持性血液透析（HD）治疗的终末期肾病（ESRD）患者以及肾移植患者的脂质谱。我们还研究了富含多不饱和脂肪酸的鱼油（Max-EPA）对CRF患者高甘油三酯血症的影响。该研究包括4组：第一组（Gp I）：对照组（n = 9，年龄 = 30 ± 5岁）；第二组（Gp II）：接受保守治疗的CRF患者（n = 9，年龄 = 49 ± 17岁）；第三组（Gp III）：接受HD治疗至少3个月的ESRD患者（n = 19，年龄 = 53 ± 9岁）；第四组（Gp IV）：肾移植术后3个月的患者（n = 9，年龄31 ± 11岁）。所分析的脂质和脂蛋白包括总胆固醇、高密度脂蛋白、低密度脂蛋白甘油三酯、载脂蛋白A1和载脂蛋白B。结果发现，与第一组相比，第二组患者的甘油三酯显著升高（p < .05），载脂蛋白A1/载脂蛋白B显著异常降低（p < .001）。与第一组相比，第四组患者的脂质谱无显著差异。在5例高甘油三酯血症患者中使用Max-EPA后，高甘油三酯血症有显著改善（p < .05）。我们的研究表明：1）大多数CRF患者确实会出现显著的高甘油三酯血症。这种异常可能会随着透析治疗和肾移植而改善。2）CRF患者较低的载脂蛋白A1/载脂蛋白B比值可能是动脉粥样硬化风险较高的原因。3）富含多不饱和脂肪酸的鱼油可改善CRF患者的高甘油三酯血症。
