血脂代谢紊乱与维持性血液透析患者的心血管并发症

Dyslipidemia and the cardiovascular complications in patients with maintaining hemodialysis

目的:分析血脂主要成分与维持性血液透析患者心血管并发症的关系。资料来源:应用计算机检索Medline数据库1997-01/2004-12与血脂代谢紊乱及终末期肾功能衰竭血液透析心血管并发症相关的文章,检索词“lipid,cardiovasculardisease,chronicrenalfailure”,并限定文章语言种类为English。计算机检索清华全文数据库2001-01/2004-12关于血脂代谢紊乱及终末期肾功能衰竭血液透析心血管并发症相关的文章,限定文章语言种类为中文,检索词“血脂,血液透析,心血管并发症”。资料选择:对资料进行初审,选取包括处理组和对照组的文献,筛除明显不随机的研究,对剩余的文献开始查找全文。纳入标准为①随机对照研究。②实验或临床研究包含平行对照组。排除标准:重复性研究。资料提炼:共收集到329篇关于血脂代谢紊乱及终末期肾功能衰竭血液透析心血管并发症的随机和未随机研究文章,35个实验或临床研究符合纳入标准。排除的294篇文章,211篇为未随机研究或重复性研究,83篇为综述类文章。资料综合:35个试验包括约10521例患者,证实了高三酰甘油、低高密度脂蛋白胆固醇是并发心血管疾病的维持性血液透析患者血脂特点,而血脂异常与老龄、糖尿病等因素一起诱发冠状动脉缺血、动脉粥样斑块形成或动脉硬化等,加速血液透析患者心血管并发症的发生发展。积极的综合康复治疗及药物降脂治疗等可有效纠正血脂异常,并减少终末期肾功能衰竭患者心血管并发症的患病率。结论:血脂代谢紊乱是维持性血液透析患者心血管并发症的主要致病因素之一,通过对血液透析患者采用合适的透析处方、并长期辅以综合康复治疗及药物治疗等措施积极纠正血脂代谢紊乱,可有效降低血液透析患者心血管疾病患病率,提高其生活质量。

OBJECTIVE:To analyze the association between the main components of blood lipid and the cardiovascular complications in patients with maintaining hemodialysis.DATA SOURCES:English articles about dyslipidemia and the cardiovascular complications in hemodialysis patients with end-stage renal failure were searched in Medline by using the Keywords of ' dyslipidemia,cardiovascular disease,chronic renal failure' published between January 1997 and February 2004.China National Knowledge Infrastructure(CNKI) database was searched with computer to identify articles related to dyslipidemia and the cardiovascular complications in hemodialysis patients with end stage renal failure published in Chinese between January 2001 and December 2004,and the keywords were' blood lipid,hemodialysis,cardiovascular complication' in Chinese.STUDY SELECTION:Trials and including the treatment group and control group were selected, and obvious non randomized studies were excluded,and then the full texts of the rest literatures were searched.Inclusion criteria:① randomized control study;② experimental or clinical study including parallel control group.Exclusion criteria:repetitive study.DATA EXTRACTION:A total of 329 articles of randomized or non randomized study about dyslipidemia and cardiovascular complication in hemodialysis patients with end stage renal failure were collected,and 35 experimental or clinical studies were in accordance with the inclusion criteria.Among the 294 excluded articles,211 were non randomized or repetitive studies,and 83 were reviews.DATA SYNTHESIS:Totally 10 521 patients were involved in the 35 trials,which proved that hypertriglyceridemia and low high density lipoprotein cholesterol were the characteristics of the blood lipid of maintaining hemodialysis patients accompanied by cardiovascular disease,and dyslipidemia together with age,diabetes mellitus contributed to the onset of coronary artery ischemia,formation of arteriosclerotic plaques or arteriosclerosis,and then accelerated the occurrence and development of cardiovascular complications in hemodialysis patients.Active and comprehensive rehabilitation treatment and drug therapy for decreasing lipid may effectively correct dyslipidemia,and reduce the prevalence rate of cardiovascular complications in hemodialysis patients with end stage renal failure.CONCLUSION:Dyslipidemia is one of the main factors contribute to cardiovascular disease in maintaining hemodialysis patients.Proper dialysis prescription plus long term comprehensive rehabilitation treatment and drug therapy for the active correction of dyslipidemia may decrease the prevalence rate of cardiovascular complications in hemodialysis patients, and improve their quality of life.