维持性血液透析患者脂质代谢紊乱及相关因素

目的 分析维持性血液透析(MHD)患者血清脂质水平及其相关影响因素。方法 测定77例MHD患者血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白(Apo)A1、ApoB、ApoA1／ApoB及脂蛋白a[Lp(a)]水平，与50例正常人进行对照研究。结果 MHD患者脂质代谢异常，表现TC、TG、LDL、ApoB和Lp(a)显著增高，HDL、ApoA1、ApoA1／ApoB显著降低。相关性分析表明，TC、LDL与尿素清除指数(Kt／V)负相关；TC与标准蛋白分解率(nPCR)负相关；HDL、ApoA1与nPCR正相关。Lp(a)与TC和LDL正相关，与血清白蛋白负相关。心、脑血管事件的发生与血中Lp(a)、TC和LDL明显增高及低白蛋白血症密切相关。结论 MHD患者存在明显脂质代谢紊乱，且与透析不充分和蛋白营养不良有关，并随维持性透析时间的延长而加重。脂质代谢紊乱和蛋白营养不良可能是心、脑血管事件发生的危险因素。

Dyslipoproteinemia and Related Factors Analysis in Maintenance of Hemodialysis

Objective To analyse serum lipids and their related factors in maintenance hemodialysis(MHD). Methods 77 cases of MHD were enrolled to be measured total cholesterol(TC), triglyceride(TG), high|dense lipoprotein cholesterol(HDL), low|dense lipoprotein cholesterol(LDL), apolipoprotein(Apo)A-1, ApoB, ApoA-1/ApoB and lipoprotein(a) and other biochemical parameters. Results The patients of MHD exhibited dyslipoproteinemia which showed significantly higher TC, TG, LDL, ApoB and Lp(a) and lower HDL, ApoA-1, ApoA-1/ApoB compared with the normal controls. By correlation analysis, TC and LDL were negatively correlated with Kt/V, TC was negatively correlated with nPCR, HDL and ApoA-1 were positively correlated with nPCR. Lp(a) was positively correlated with TC and LDL, negatively correlated with serum albumin. Lp(a) had no correlations with Kt/V and nPCR. The plasma Lp(a), TC and LDL were increased and the plasma albumin decreased in patients with more cardiac and/or cerebral vascular events than in patients without them. Conclusion The patients on MHD exhibit significant disturbance of lipid metabolism,which is associated with inadequate hemodialysis and protein malnutrition. The dyslipoproteinemia and protein malnutrition may be the risk factors for occurrence of cardial and/or cerebral vascular events.