高水平脂蛋白相关磷脂酶A2与慢性肾脏病患者发生动脉粥样硬化相关

目的:分析慢性肾脏病(CKD)患者血浆脂蛋白相关磷脂酶A2(Lp-PLA2)的变化水平,探讨CKD患者发生动脉粥样硬化的危险因素。方法:采用横断面研究,选取2017年11月-2020年1月在东莞东华医院行血浆LpPLA2水平检测及颈动脉彩超检查的CKD 1-2期患者67例为CKD 1-2组,选取CKD 3-5期患者96例为CKD 3-5组,同时选取健康体检者61例为对照组,比较3组间血浆Lp-PLA2、肾小球滤过率(e GFR)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、载脂蛋白A(apo A)、载脂蛋白B(apo B)等指标的差异。运用logistic回归分析CKD患者发生动脉粥样硬化的危险因素。结果:CKD患者总胆固醇、HDL-C及apo A较对照组低,甘油三酯、LDL-C及apo B较对照组高,且CKD 3-5组与对照组间差异有统计学意义(P均0. 05)。CKD患者Lp-PLA2水平随CKD分期增加而升高,且较对照组高(P 0. 01)。CKD患者中,动脉粥样硬化患者具有较高的血浆Lp-PLA2水平(318. 39±18. 22 vs166. 15±15. 58,P 0. 01)。相关性分析显示Lp-PLA2与e GFR呈负相关(r=-0. 263,P=0. 001)。logistic回归分析显示Lp-PLA2及年龄是CKD患者动脉粥样硬化发生的独立危险因素,优势比分别为1. 007与1. 132。结论:CKD患者血浆Lp-PLA2水平升高,Lp-PLA2高水平是CKD患者发生动脉粥样硬化的独立危险因素。

Correlation between lipoprotein-associated phospholipase A2 and atherosclerosis in patients with chronic kidney disease

Objective: To analyze the changes of lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risk factors of atherosclerosis in patients with chronic kidney disease (CKD). Methods: Totally, 67 cases of stage CKD1-2 and 96 cases of stage CKD3-5 and 61 cases of healthy controls who underwent Lp-PLA2 determination and color Doppler ultrasound examination of the carotid artery were selected in Donghua Hospital from November 2017 to January 2020 in a cross-sectional study. Serum Lp-PLA2, estimated glomerular filtration rate, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), apolipoprotein A (apoA), apolipoprotein B (apoB) and other indexes were compared among groups. Logistic regression was used to analyze the risk factors of atherosclerosis in patients with CKD. Results: Total cholesterol, HDL-C and apoA in patients with CKD were significantly lower, and triglycerides, LDL-C and apoB in patients with CKD were significantly higher than those in the healthy group, and there were statistically significant difference between CKD3-5 group and healthy group (P<0.05). Lp-PLA2 increased with CKD staging, and was significantly higher in CKD group than in healthy conrol group (205.48±20.75, 273.50±17.16 vs 143.46±13.85, P<0.001). The CKD patients with atherosclerosis had a higher Lp-PLA2 (318.39±18.22 vs 166.15±15.58, P<0.001). Correlation analysis showed that Lp-PLA2 was negatively correlated with eGFR (r=-0.263, P=0.001). Logistic regression analysis showed that Lp-PLA2 and age were independent risk factors for the development of atherosclerosis in patients with CKD, with odds ratio of 1.007 and 1.132 respectively. Conclusions: Lp-PLA2 increased in the CKD patients. High level of Lp-PLA2 is the independent risk factor of atherosclerosis in patients with CKD.