Samuelsson O, Mulec H, Knight-Gibson C, Attman P O, Kron B, Larsson R, Weiss L, Wedel H, Alaupovic P
Department of Nephrology, University of Göteborg, Sweden.
Nephrol Dial Transplant. 1997 Sep;12(9):1908-15. doi: 10.1093/ndt/12.9.1908.
Chronic renal insufficiency is accompanied by specific alterations of the lipoprotein metabolism. It has been suggested that the renal dyslipoproteinaemia of renal insufficiency contributes to the progression of glomerular and tubular lesions, with subsequent deterioration of renal function. The objective of this prospective study was to investigate whether the specific lipoprotein abnormalities of renal insufficiency are associated with the rate of decline of renal function in patients with moderately advanced chronic renal failure.
A patient population of 73 adult non-diabetic patients with primary chronic renal disease were followed with repeated measurements of the glomerular filtration rate (GFR) for an average of 3.2 (SD 0.7) years. Forty-three of these patients had chronic glomerulonephritis as the underlying renal disease. Patient characteristics including plasma levels of lipids and apolipoproteins were determined at entry and were prospectively related, using linear regression, to the rate of progression.
The mean GFR at entry was 41.3 (SD 15.3) ml/min x 1.73 m2 BSA. The average rate of progression was a decline in GFR of -2.8 (SD 3.7) ml/min x 1.73 m2 BSA per year. In the whole patient study group total cholesterol, low-density lipoprotein (LDL) cholesterol, and apolipoprotein B (apoB) were all significantly associated with a more rapid decline in renal function, whereas triglycerides, high-density lipoprotein (HDL) cholesterol, and apolipoprotein A (apoA) were not. In the more homogeneous subgroup of patients with chronic glomerulonephritis the association between dyslipidaemia and the rate of progression was even more pronounced. In this subgroup of patients also serum triglycerides and apoE were significantly associated with a higher rate of progression. Both the initial blood pressure and proteinuria were also significantly associated with a more rapid decline in renal function in the whole study group as well as in patients with chronic glomerulonephritis. The associations between these variables with the rate of progression were all independent of the entry GFR values.
These results indicate that the lipoprotein abnormalities of renal insufficiency contribute to the progression of renal failure in human chronic renal disease.
慢性肾功能不全伴有脂蛋白代谢的特定改变。有人提出，肾功能不全的肾性血脂异常血症会促进肾小球和肾小管病变的进展，进而导致肾功能恶化。这项前瞻性研究的目的是调查肾功能不全的特定脂蛋白异常是否与中度晚期慢性肾衰竭患者的肾功能下降速率相关。
对73名患有原发性慢性肾病的成年非糖尿病患者进行随访，平均重复测量肾小球滤过率（GFR）3.2（标准差0.7）年。其中43名患者的潜在肾病为慢性肾小球肾炎。在入组时测定患者特征，包括血脂和载脂蛋白的血浆水平，并使用线性回归前瞻性地分析其与进展速率的关系。
入组时的平均GFR为41.3（标准差15.3）ml/min×1.73 m2体表面积。平均进展速率为每年GFR下降-2.8（标准差3.7）ml/min×1.73 m2体表面积。在整个患者研究组中，总胆固醇、低密度脂蛋白（LDL）胆固醇和载脂蛋白B（apoB）均与肾功能更快下降显著相关，而甘油三酯、高密度脂蛋白（HDL）胆固醇和载脂蛋白A（apoA）则不然。在更具同质性的慢性肾小球肾炎患者亚组中，血脂异常与进展速率之间的关联更为明显。在该亚组患者中，血清甘油三酯和apoE也与更高的进展速率显著相关。在整个研究组以及慢性肾小球肾炎患者中，初始血压和蛋白尿也均与肾功能更快下降显著相关。这些变量与进展速率之间的关联均独立于入组时的GFR值。
这些结果表明，肾功能不全的脂蛋白异常会促进人类慢性肾病中肾衰竭的进展。
