终末期肾病患者的脂蛋白(a)和载脂蛋白(a)表型

Lipoprotein(a) and apolipoprotein(a) phenotypes in patients with end-stage renal disease.

作者信息

Kim S B, Yang W S, Kang E S, Min W K, Park J S

机构信息

Department of Internal Medicine, College of Medicine, University of Ulsan, Seoul, Korea.

出版信息

Perit Dial Int. 1997 May-Jun;17(3):236-42.

PMID:9237283

Abstract

OBJECTIVE

To evaluate the distribution pattern of apolipoprotein(a) [Apo(a)] phenotypes in Koreans and the effect of dialysis modality on serum lipoprotein(a) [Lp(a)] concentration according to apo(a) phenotype in patients with end-stage renal disease (ESRD).

DESIGN

Cross-sectional study.

SETTING

A university hospital.

PARTICIPANTS

153 normal controls, 99 hemodialysis (HD) patients and 82 continuous ambulatory peritoneal dialysis (CAPD) patients.

MAIN OUTCOME MEASURES

Fasting serum Lp(a), lipids, and apo(a) phenotypes were measured.

RESULTS

The frequencies of the subjects with apo(a) phenotypes of high-molecular weight only, including S3, S4, or S5 or null type were 95.4% of control, 100% of HD patients, and 95.1% of CAPD patients. The frequent apo(a) phenotypes in Koreans consisted of S4, S4S5, S5, and S5S5 isoforms. Significant difference was found in serum Lp(a) concentration among controls and HD and CAPD patients [median (Interquartile range): 0.05 g/L, (0.01-0.19); 0.19 g/L, (0.10-0.35); 0.63 g/L, (0.28-0.90), p < 0.001]. Lp(a) levels in CAPD patients were significantly higher than in HD patients for all four common apo(a) isoforms found in Korean subjects. CAPD patients had higher total and LDL cholesterol levels, and higher ApoB levels than HD patients. Significant differences were found in serum albumin levels between controls and HD and CAPD patients (44 +/- 3 g/L, 40 +/- 4 g/L, 32 +/- 7 g/L, respectively, p < 0.05). There were significant inverse correlations between serum albumin and Lp(a) (r = -0.33, p < 0.01), total cholesterol (r = -0.31, p < 0.01), LDL (r = -0.39, p < 0.01) or ApoB (r = -0.35, p < 0.01) in ESRD patients. A significant positive correlation was found between serum albumin and ApoA1 (r = 0.24, p < 0.01).

CONCLUSION

These findings indicate that Koreans have mainly high molecular weight apo(a) phenotypes and serum Lp(a) is elevated in CAPD patients compared to HD patients for common apo(a) phenotypes, which may contribute to the frequent cardiovascular mortality in CAPD patients.

摘要

目的

评估韩国人载脂蛋白(a)[Apo(a)]表型的分布模式，以及终末期肾病（ESRD）患者中透析方式根据apo(a)表型对血清脂蛋白(a)[Lp(a)]浓度的影响。

设计

横断面研究。

地点

一家大学医院。

参与者

153名正常对照者、99名血液透析（HD）患者和82名持续性非卧床腹膜透析（CAPD）患者。

主要观察指标

测量空腹血清Lp(a)、血脂和apo(a)表型。

结果

仅具有高分子量apo(a)表型（包括S3、S4或S5或无效型）的受试者频率在对照组中为95.4%，HD患者中为100%，CAPD患者中为95.1%。韩国人中常见的apo(a)表型由S4、S4S5、S5和S5S5亚型组成。对照组与HD患者和CAPD患者的血清Lp(a)浓度存在显著差异[中位数（四分位间距）：0.05 g/L，(0.01 - 0.19)；0.19 g/L，(0.10 - 0.35)；0.63 g/L，(0.28 - 0.90)，p < 0.001]。对于韩国受试者中发现的所有四种常见apo(a)亚型，CAPD患者的Lp(a)水平显著高于HD患者。CAPD患者的总胆固醇和低密度脂蛋白胆固醇水平以及ApoB水平高于HD患者。对照组与HD患者和CAPD患者的血清白蛋白水平存在显著差异（分别为44 ± 3 g/L、40 ± 4 g/L、32 ± 7 g/L，p < 0.05）。在ESRD患者中，血清白蛋白与Lp(a)（r = -0.33，p < 0.01）、总胆固醇（r = -0.31，p < 0.01）、低密度脂蛋白（r = -0.39，p < 0.01）或ApoB（r = -0.35，p < 0.01）之间存在显著负相关。血清白蛋白与ApoA1之间存在显著正相关（r = 0.24，p < 0.01）。