终末期肾衰竭透析患者血清RLP-C检测的临床意义

摘要

Objective To detect the concentration of serum remnant lipoprotein cholesterol(RLP-C)in continuous ambulatory peritoneal dialysis(CAPD)and maintenance hemodialysis(MHD)patients,and investigate its clinical significance.Methods Immunomagnetic separation method was used to measure the serum RLP-C concentrations in 30 healthy subjects and 29 patients with CAPD,28 patients with MHD hefore dialysis,dialysis for 1 month,6 months and 12rnmonths.The levels of triglyceride(TG),total cholesterol(TC),high density lipoprotein-cholesterol(HDL-C)and low density lipoprotein-cholesterol(LDL-C)were determined.The levels of lipoprotein(a)[Lp(a)],apolipoprotein A1(apoA1)and apolipoprotein B(apo B)were determined,and the very low density lipoprotein-cholesterol(VLDL-C)was calculated according to the formula:VLDL-C=TC-(HDL-C+LDL-C).The correlation of RLP-C concentration with hemodialysis for 12 months and other lipid indices was analyzed.Results The serum concentrations of RLP-C in CAPD patients before dialysis,dialysis for l month,6 months and 12 months were 0.26±0.12,0.33±0.14,0.41±0.15 and (0.49±0.14)mmol/L,and the serum concentrations of RLP-C in MHD patients were 0.22±0.15,0.31±0.14,0.40rn±0.16 and(0.49±0.17)mmol/L,which were significantly higher than those in controls [(0.19±0.12)mmol/L J (P<0.05).The concentration of RLP-C with TG and VLDL-C had positive correlation for dialysis 12 months(r=0.72 and 0.64,P<0.01),and the concentration with TC,LDL-C,HDL-C,apo A1,apo B and Lp(a)had no significant correlation(r=0.14,0.20,-0.20,-0.21,0.21 and 0.18,P>0.05).Conclusions RLP-C can be used as a dialysis reference indicator for the prevention and treatment of cardiovascular and cerebrovascular complications.%目的 检测连续性不卧床腹膜透析(CAPD)和维持性血液透析(MHD)患者血清脂蛋白残粒胆固醇(RLP-C)水平,并探讨其临床意义.方法 采用免疫分离法分别测定29例CAPD患者、28例MHD患者透析前和透析1、6、12个月以及30名正常对照者血清RLP-C水平,同时测定甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(apo A1)、载脂蛋白B(apo B)和脂蛋白(a)[Lp(a)],极低密度脂蛋白胆固醇(VLDL-C)按VLDL-C＝TC-(HDL-C+LDL-C)计算,并分析透析12个月RLP-C与其他血脂指标的相关性.结果 CAPD患者透析前及透析1、6和12个月血清RLP-C水平分别为0.26±0.12、0.33±0.14、0.41±0.15、(0.49±0.14)mmol/L,MHD患者分别为0.22±0.15、0.31±0.14、0.40±0.16、(0.49±0.17)mmol/L,均明显高于正常对照组 [(0.19±0.12)mmol/L](P<0.05).患者透析12个月血清RLP-C与TG、VLDL-C呈正相关(r值分别为0.72、0.64,P均<0.01),与TC、LDL-C、HDL-C、apo A1、apo B和Lp(a)无明显相关性(r值分别为0.14、0.20、-0.20、-0.21、0.21、0.18,P均>0.05).结论 RLP-C可作为透析患者预防和治疗心脑血管并发症的参考指标.