长期血液透析和腹膜透析患者血脂水平及其相关因素分析

Analysis of serum lipid level and related factors in long-term hemodialysis and peritoniadialysis

目的 观察血液透析和腹膜透析对终末期肾衰竭患者血脂的影响及相关因素。方法 血透患者 3 6例 ,腹透 (CAPD)患者 2 5例 ,对照组 3 5例 ,分别检测开始透析时及透析后 12个月时的血脂、血浆白蛋白、血清肌酐 (Scr)水平。结果 腹透组患者 12个月后血清总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)、极低密度脂蛋白胆固醇 (VLDL C)、载脂蛋白B(ApoB)及脂蛋白 (a) [Lp(a) ]较透析前明显增高 ,HDL C、ApoA1较透析前明显降低 ;血透组患者 12个月后HDL C明显降低 ;二组患者透析前ApoA1明显低于对照组 ,ApoB、Lp(a)明显高于对照组 ,二组患者透析前均有明显的低蛋白血症 ,透析后血浆白蛋白明显降低 ,腹透患者尤其显著。血浆白蛋白水平与血脂呈显著相关。结论 尿毒症患者透析前即存在血脂异常 ,透析治疗并不能消除高脂血症 ,甚至加重高脂血症 ,以腹透患者明显。营养不良。

Objective To investigate the changes of serum lipid level and related factors in long-term hemodialysis(HD)and peritoniadialysis(PD).Methods The serum lipid level,albumin and creatinine were measured before and after dialysis 12 months in 36 cases with hemodialysis,25 cases with peritoniadialysis and 35 cases in control.Results In PD group,the serum concentrations of TG,TC,LDL-C,VLDL-C,ApoB,Lp(a) were obviously increased and HDL-C?ApoA1 obviously decreased after dialysis 12 months;In HD group,HDL-C obviously decreased after dialysis.In both groups,the serum ApoB,Lp(a) were markedly increased,ApoA1 and albumin decreased before dialysis.After long-term dialysis,the serum albumin becomes lower than before.The albumin was associated with TG?VLDL-C?ApoB?Lp(a) in dialysis patients.Conclusion The serum lipid level was abnormal in uremia patients before dialysis.Dialysis can not corrected,even worsen the abnormity of serum lipid concentrations,especially in PD group.Dystrophia and low serum albumin were the main causes of the abnormity.