Shoji T, Nishizawa Y, Kawagishi T, Tanaka M, Kawasaki K, Tabata T, Inoue T, Morii H
Second Department of Internal Medicine, Osaka City University Medical School, Abeno-ku, Osaka, Japan.
Atherosclerosis. 1997 Jun;131(2):229-36. doi: 10.1016/s0021-9150(97)00054-3.
We compared plasma lipid and lipoprotein parameters between 210 chronic renal failure patients treated by hemodialysis and 223 age- and sex-matched healthy control subjects to examine whether atherogenic lipoprotein changes were present in hemodialysis patients in the absence of hyperlipidemia. The hemodialysis group showed higher levels of plasma triglycerides, very low density lipoprotein (VLDL) cholesterol, and intermediate density lipoprotein (IDL) cholesterol and a lower level of high density lipoprotein (HDL) cholesterol. Low density lipoprotein (LDL) cholesterol of the hemodialysis group was not elevated but their LDL was significantly more triglyceride-enriched than that of controls. Subjects were then divided into five categories according to their plasma triglyceride levels at an interval of 50 mg/dl, and comparison was made between the two groups in the same range of plasma triglycerides. Hemodialysis patients again showed higher levels of VLDL- and IDL-cholesterol, and lower levels of HDL-cholesterol than the control group even in the plasma triglycerides-matched comparisons. Similarly, higher VLDL- and IDL-cholesterol levels in hemodialysis patients were significant in plasma total cholesterol-matched subgroup comparisons. Multiple regression analysis indicated that the relationship between plasma lipid concentrations and individual lipoprotein levels were substantially altered in uremic state. The 95th percentile level of IDL-cholesterol in the nonuremic controls was 15 mg/dl, and 45% of hemodialysis patients exceeded this level. Decreased HDL-cholesterol levels < or = 35 mg/dl were seen in 6% of the control and 38% of the hemodialysis group. Elevated IDL-cholesterol and decreased HDL-cholesterol were persistently found in hemodialysis patients with normal lipid levels. It is concluded that hemodialysis patients exhibited more atherogenic lipoprotein profile than nonuremic subjects with comparable levels of plasma triglycerides and total cholesterol. Especially, increased IDL- and decreased HDL-cholesterol levels in hemodialysis patients persisted even at very low levels of plasma lipids. Since elevated IDL and decreased HDL-cholesterol are implicated in the progression of atherosclerosis, these findings are of clinical importance in the diagnosis of lipoprotein disorder in chronic renal failure.
我们比较了210例接受血液透析治疗的慢性肾衰竭患者与223例年龄和性别匹配的健康对照者的血浆脂质和脂蛋白参数，以检查在无高脂血症的情况下血液透析患者是否存在致动脉粥样硬化的脂蛋白变化。血液透析组的血浆甘油三酯、极低密度脂蛋白（VLDL）胆固醇和中间密度脂蛋白（IDL）胆固醇水平较高，而高密度脂蛋白（HDL）胆固醇水平较低。血液透析组的低密度脂蛋白（LDL）胆固醇没有升高，但其LDL的甘油三酯含量明显高于对照组。然后根据受试者的血浆甘油三酯水平以50mg/dl的间隔分为五类，并在相同血浆甘油三酯范围内对两组进行比较。即使在血浆甘油三酯匹配的比较中，血液透析患者的VLDL和IDL胆固醇水平再次高于对照组，而HDL胆固醇水平低于对照组。同样，在血浆总胆固醇匹配的亚组比较中，血液透析患者较高的VLDL和IDL胆固醇水平也很显著。多元回归分析表明，尿毒症状态下血浆脂质浓度与个体脂蛋白水平之间的关系发生了实质性改变。非尿毒症对照组IDL胆固醇的第95百分位数水平为15mg/dl，45%的血液透析患者超过了该水平。对照组6%的患者和血液透析组38%的患者出现HDL胆固醇水平降低至≤35mg/dl。脂质水平正常的血液透析患者持续存在IDL胆固醇升高和HDL胆固醇降低的情况。结论是，与血浆甘油三酯和总胆固醇水平相当的非尿毒症受试者相比，血液透析患者表现出更具致动脉粥样硬化性的脂蛋白谱。特别是，即使在血浆脂质水平非常低的情况下，血液透析患者的IDL升高和HDL胆固醇降低仍然存在。由于IDL升高和HDL胆固醇降低与动脉粥样硬化的进展有关，这些发现对于慢性肾衰竭脂蛋白紊乱的诊断具有临床重要性。
