De Lima J J, Maranhão R C, Latrilha M da C, Diament J, Romão J E, Krieger E M, Pileggi F
Hypertension Unit, São Paulo University Medical School, Brazil.
Ren Fail. 1997 Jan;19(1):145-54. doi: 10.3109/08860229709026269.
Serum lipoprotein(a) [Lp(a)] concentrations in chronic renal failure patients were investigated in relation to the degree of renal insufficiency, treatment by maintenance hemodialysis, and correction of uremia by renal transplantation with or without cyclosporin immunosuppression. Fast serum levels of Lp(a) (mg/100 mL) were determined in 34 chronic renal failure patients not in need of maintenance dialysis (16 with serum creatinine 2.0-4.0 mg/100 mL; 18 with serum creatinine higher than 4.0 mg/100 mL), 40 patients treated by hemodialysis, 55 successful renal transplant recipients (28 under cyclosporin treatment and 27 receiving no cyclosporin), and 34 healthy controls. Age and sex distributions were similar among groups. Pregnant women; non-White individuals; subjects with obesity, diabetes, nephrotic syndrome, and hepatic and thyroid diseases; and those treated with oral contraceptives or lipid-lowering drugs were excluded from the study. Compared to controls, median Lp(a) was increased in nondialyzed renal failure patients (11 vs. 47.5 p < 0.001) and this was the only lipid abnormally observed in the group. There was no significant difference in Lp(a) levels between nondialized renal failure patients with serum creatinine 2.0-4.0 and > 4.0 mg/100 mL (47 vs. 49, NS). Moreover, Pearson correlation coefficient (r = 0.01, NS) showed that Lp(a) values were not related to serum creatinine in nondialyzed patients, In hemodialysis subjects Lp(a) concentrations (median = 29) were intermediate between those observed in nondialyzed patients and controls but the differences were not significant. Lp(a) levels in renal transplant patients treated with cyclosporin (median = 6) and not receiving cyclosporin (median = 13) were similar and did not differ from controls. Serum Lp(a) increases and attains maximum levels with mild/moderate reduction in renal function, and does not seem to change through late renal failure stages or in relation to the introduction of maintenance hemodialysis treatment. Correction of uremia by successful renal transplant caused normalization of Lp(a) levels regardless of the use of cyclosporin. Increased Lp(a) levels may be the earliest and more consistent lipid alteration seen in predialysis renal failure.
对慢性肾衰竭患者的血清脂蛋白(a)[Lp(a)]浓度进行了研究，探讨其与肾功能不全程度、维持性血液透析治疗以及肾移植纠正尿毒症（有无环孢素免疫抑制）之间的关系。测定了34例不需要维持透析的慢性肾衰竭患者（16例血清肌酐为2.0 - 4.0mg/100mL；18例血清肌酐高于4.0mg/100mL）、40例接受血液透析治疗的患者、55例肾移植成功的受者（28例接受环孢素治疗，27例未接受环孢素治疗）以及34例健康对照者的空腹血清Lp(a)水平（mg/100mL）。各组间年龄和性别分布相似。孕妇、非白种人、肥胖者、糖尿病患者、肾病综合征患者、肝脏和甲状腺疾病患者以及接受口服避孕药或降脂药物治疗的患者被排除在研究之外。与对照组相比，未透析的肾衰竭患者Lp(a)中位数升高（11对47.5，p < 0.001），这是该组中唯一观察到的脂质异常。血清肌酐为2.0 - 4.0mg/100mL和>4.0mg/100mL的未透析肾衰竭患者之间Lp(a)水平无显著差异（47对49，无统计学意义）。此外，Pearson相关系数（r = 0.01，无统计学意义）表明，未透析患者的Lp(a)值与血清肌酐无关。在血液透析患者中，Lp(a)浓度（中位数 = 29）介于未透析患者和对照组之间，但差异不显著。接受环孢素治疗的肾移植患者（中位数 = 6）和未接受环孢素治疗的患者（中位数 = 13）的Lp(a)水平相似，且与对照组无差异。血清Lp(a)在肾功能轻度/中度降低时升高并达到最高水平，在肾衰竭晚期或引入维持性血液透析治疗后似乎没有变化。成功的肾移植纠正尿毒症可使Lp(a)水平恢复正常，无论是否使用环孢素。Lp(a)水平升高可能是透析前肾衰竭中最早出现且更一致的脂质改变。
