维持性血液透析患者脂蛋白(a)水平及相关因素的研究

目的 探讨我国维持性血液透析(MHD)患者脂蛋白(a)[Lp(a)]的相关因素及其与心血管疾病的关系.方法 选取2020年4月至9月在北京同仁医院透析中心进行规律血液透析的119例患者.Lp(a)正常组84例,Lp(a)升高组35例.收集患者一般资料、实验室检查、透析相关资料以及近6月来新发心血管事件情况.将Lp(a)...

A study of Lipoprotein(a) and related factors in maintenance hemodialysis patients

Objective To explore the related factors of Lp(a)and its relationship with cardiovascular disease in maintenance hemodialysis(MHD)patients in China.Methods A total of 119 patients receiving regular hemodialysis in Beijing Tongren Hospital from April to September 2020 were selected.There were 84 cases in the normal Lp(a)group and 35 cases in the elevated Lp(a)group.General information,laboratory examination,dialysis related information and new cardiovascular events in the last 6 months were collected.LP(a)30mg/dL was divided into elevated LP(a)group and normal LP(a)group.Spearman correlation analysis was used to analyze the factors related to LP(a),and multivariate logistic regression analysis was used to analyze the risk factors of cardiovascular events.Results Compared with the normal group,the serum iron level of the elevated group was lower[(9.36±3.81)μmol/L vs.(12.89±6.01)μmol/L,P<0.001],and the transferrin saturation level was lower[(21.68±9.32)%vs.(29.75±14.66)%,P=0.001],and the difference was statistically significant..The proportion of new cardiovascular events was significantly higher in the elevated LP(a)group(31.4%vs.1.2%,P<0.001).Lp(a)was negatively correlated with serum iron and transferrin saturation(r=-0.350,P<0.001 and r=-0.312,P=0.001),respectively,and negatively correlated with hemoglobin and plasma albumin levels(r=-0.188,P=0.041;r=-0.243,P=0.008).The mean systolic blood pressure after dialysis was positively correlated with Lp(a)(=0.208,P=0.025).Logistic regression analysis showed that the increase of Lp(a),ferritin,neutrophils and the decrease of urea rate(URR)were independent risk factors for new cardiovascular events in MHD patients.Each 1 unit increase in Lp(a),ferritin level,and neutrophil ratio was associated with a 1.074,1.004,and 1.221 fold increase in the risk of cardiovascular events,respectively,while each 1 unit increase in dialysis sufficiency URR decreased the risk of cardiovascular events by 0.854 fold.Conclusion Lp(a)is an independent risk factor for cardiovascular events in MHD patients.