Shoji T, Nishizawa Y, Kawagishi T, Kawasaki K, Taniwaki H, Tabata T, Inoue T, Morii H
Second Department of Internal Medicine, Osaka City University Medical School, Japan.
J Am Soc Nephrol. 1998 Jul;9(7):1277-84. doi: 10.1681/ASN.V971277.
Patients with chronic renal failure often show accumulation of intermediate-density lipoprotein (IDL). Because recent studies have emphasized the atherogenicity of IDL in the general population, we evaluated the relationship between this lipoprotein and aortic atherosclerosis in uremic patients treated with hemodialysis. Aortic pulse wave velocity (PWV) was measured as a noninvasive index of sclerotic change of aorta in 205 hemodialysis patients and 184 age- and gender-matched healthy subjects. Fasting plasma lipoproteins were fractionated by ultracentrifugation into very low-density lipoprotein (VLDL), IDL, LDL, and HDL. Plasma lipoprotein (a) (Lp(a)) was measured by a latex immunoturbidimetric assay. Aortic PWV was significantly higher in the hemodialysis patients than in the control subjects. The hemodialysis group showed a significant increase in VLDL and IDL cholesterol, whereas their LDL and HDL cholesterol were lower than the control levels. Lp(a) levels did not differ between the two groups. In the hemodialysis population, VLDL, IDL, and LDL cholesterol correlated positively with aortic PWV adjusted for age, gender, smoking, and BP, whereas Lp(a) did not. Multiple regression analyses indicated that plasma triglycerides, independent of HDL cholesterol, had a significant association with aortic PWV in the hemodialysis patients but not in the control subjects. Further analyses revealed that aortic PWV in the hemodialysis patients had a significant and independent association with IDL cholesterol, whereas aortic PWV in the control subjects had significant and independent associations with HDL cholesterol and Lp(a). These results demonstrate that IDL is the lipoprotein fraction most closely associated with aortic PWV in the hemodialysis patients.
慢性肾衰竭患者常出现中密度脂蛋白（IDL）蓄积。由于近期研究强调了IDL在普通人群中的致动脉粥样硬化性，我们评估了这种脂蛋白与接受血液透析治疗的尿毒症患者主动脉粥样硬化之间的关系。测量了205例血液透析患者和184例年龄及性别匹配的健康受试者的主动脉脉搏波速度（PWV），作为主动脉硬化改变的无创指标。空腹血浆脂蛋白通过超速离心法分为极低密度脂蛋白（VLDL）、IDL、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）。采用乳胶免疫比浊法测定血浆脂蛋白（a）[Lp（a）]。血液透析患者的主动脉PWV显著高于对照组。血液透析组的VLDL和IDL胆固醇显著升高，而其LDL和HDL胆固醇低于对照组水平。两组间Lp（a）水平无差异。在血液透析人群中，经年龄、性别、吸烟和血压校正后，VLDL、IDL和LDL胆固醇与主动脉PWV呈正相关，而Lp（a）则无此相关性。多元回归分析表明，在血液透析患者中，独立于HDL胆固醇的血浆甘油三酯与主动脉PWV显著相关，而在对照组中则不然。进一步分析显示，血液透析患者的主动脉PWV与IDL胆固醇存在显著且独立的相关性，而对照组的主动脉PWV与HDL胆固醇和Lp（a）存在显著且独立的相关性。这些结果表明，IDL是与血液透析患者主动脉PWV最密切相关的脂蛋白组分。
