血透与腹透患者血清脂蛋白(a)的变化及意义

Changes of lipoprotein(a) and other lipids in patients with hemodialysis and peritoneal dialysis

目的 :观察血透 (HD)与腹透 (PD)患者之间脂蛋白 (a) [lipoprotein(a) ,Lp(a) ]及脂质水平影响的差别及其临床意义。 方法 :对 68例HD患者及 50例PD患者的临床及实验室资料作研究 ,比较两种透析方式对血Lp(a)及脂质水平影响的差别 ,分析血Lp(a)与其他相关因素特别是与心脑血管事件的关系。 结果 :HD与PD患者血Lp(a)水平均较对照组呈显著性升高 (P <0 0 5) ,其中PD组较HD组更高 (P <0 0 1) ;HD组血Tch较对照组及PD组均呈显著性下降 (P <0 0 5)、血HDL C较对照组呈显著性下降 (P <0 0 1) ;PD组血TG较对照组及HD组均呈显著性升高 (P <0 0 5) ;血ApoA、ApoB10 0与对照组间无统计学差异。HD与PD患者血Lp(a)水平与超声心动图异常(P <0 0 5)、ECG异常 (P <0 0 0 1)及心脑血管事件的发生 (P <0 0 1)、2 4h腹水蛋白质浓度 (P <0 0 1)、血Tch及LDL C浓度 (P <0 0 5)、纤维蛋白原 (P <0 0 5)呈正相关 ;而与血浆白蛋白浓度 (P <0 0 5)、2 4h腹水Lp(a)浓度 (P <0 0 5)呈负相关。 结论 :HD与PD患者普遍存在严重的脂质代谢变化 ,其中以血Lp(a)、TG、HDL C变化尤为显著 ,PD组由于长期吸收大量葡萄糖 ,因此脂质代谢紊乱更为明显。Lp(a)有可能是HD。

Objective:To investigate the changes of lipoprotein(a)[Lp(a)] and other lipids in patients with end stage renal disease(ESRD)treated by hemodialysis(HD) and peritoneal dialysis(PD). Methodology:Clinical data and laboratory data of 118 dialyzed patients(68 patients on HD and 50 patients on PD)were collected and analyzed.The effects of different dialysis modes on Lp(a)and other lipids were compared and the roles of Lp(a)in the complications in these groups of patients were examined. Results:The average serum level of Lp(a) was significantly higher in HD and PD patients than in the control group( P <0 05),and the average serum level of Lp(a) was significantly higher in PD group than in HD group.The average serum level of Tch was significantly lower in HD group than in PD group and in the control group (both P <0 05).The average serum level of HDL C of HD group was significantly lower than that of the control.The average serum level of triglycerides(TG) was significantly higher in PD group than in HD group and in the control group (both P <0 05).No difference was found in serum ApoA and ApoB100 in the patient groups and the control( P >0 05).The serum Lp(a) level was positively correlated with protein concentration in the 24 hours peritoneal fluid and with Tch and LDL C level of serum and fibrinogen level of serum( P <0 05).The positive correlation was also found between the serum level of Lp(a) and clinical manifestations (abnormal echocardiography,ECG and cardiac and cerebral vascular events).The negative correlation was discovered between the plasma level of albumin and the Lp(a) concentration in 24 hours peritoneal fluid( P <0 05). Conclusion:Complicated changes of lipid metabolism are associated with hemodialysis and peritoneal dialysis.The increasing serum level of Lp(a) and TG and decreasing serum level of HDL C may be the risk factors for incurring cardiac and/or cerebral vascular events.