低分子肝素对糖尿病肾衰竭透析患者血脂代谢的临床观察

Changes of Lipids Metabolism in Diabetic Patients with Lower Molecular Weight Heparing Hemodialysis

目的 :通过应用低分子肝素及普通肝素对糖尿病肾衰进行血透 ,了解低分子肝素对糖尿病肾衰血脂代谢的影响。方法 :将 32例糖尿病肾衰患者随机分成实验组 (LMWH组 ,n =16 )和对照组 (UFH组 ,n =16 ) ,LMWH组和UFH组分别使用低分子肝素和普通肝素进行血液透析一年 ,观察两组患者血脂变化情况。结果 :实验过程中LMWH组患者血清胆固醇 (CH)及甘油三酯 (TG)水平明显下降 ,高密度脂蛋白 (HDL)、载脂蛋白A(ApoA1)明显升高 ,均有明显差异 ,具统计学意义。UFH组中CHOL无明显变化 ,TG及LDL明显升高 ,HDL明显降低 ,均有统计学差异。同时对LMWH组和UFH组之间进行比较显示 ,在透析开始时CH、TG、HDL、LDL、ApoA1及ApoB均无统计学差异 ;透析一年后LMWH组与UFH组相比 ,CH、TG、LDL进一步下降 ,HDL、ApoA1明显上升 ,而且具有统计学意义。结论 :LMWH透析可以改善糖尿病肾衰患者的血脂代谢。

Objective:To study the changes of lipids metabolism in diabetic patients with lower molecular weight heparing hemodialysis (LMWH HD), we conducted a comparative study of lipids metabolism in patients on LMWH HD and patients on standard heparing ( unfractionated heparing, UFH)hemodialysis. Methods:32 diabetic hemodialysis patients were randomized into two groups, 16 patients were in the LMWH HD group with lower molecular weight heparing while another 16 in the standard heparing group with unfractionated heparing. Both groups were dialyzed for one year.Results:The serum cholesterol(CHOL),triglyceride(TG)were found decreased and high-density lipoprotein(HDL),ApoA 1 increased in LMWH group, while serum TG, LDL increased and HDL decreased in UFH group. No significant difference of ApoB change was found between the two groups. The comparison between LMWH and UFH group showed that there is no significant difference of CHOL? TG? HDL? LDL ?ApoA 1, and ApoB at the beginning of hemodialysis, while after 1 year of hemodialysis( P <0.05),there were significant differences of TG? HDL? and LDL between the two groups.Conclusions:LMWH is effective in improving lipids metabolism in diabetic hemodialysis patients.