지속성 외래 복막투석 환자의 혈중 lipoprotein(a)와 허혈성 심질환의 상관관계에 관한 연구

Abstract

Atherosclerotic vascular disease is a leading csuse of morbidity and mortality in ESRD patients under- going maintenance dialysis. Although deranged lipo- protein metabolism is considered as a cardiovascular risk factor in these patients, it is not clear which ab- normality is indeed atherogenic. Some epidemiologic studies revealed that increased lipoprotein (a) [Lp (a)] concentration is an independent risk factor for development of coronary heart disease. In this study, we examined the concentration of Lp(a) of 88 CAPD patient (male.:'female 55:33, mean age 46.6 years) in our center and compared the Lp(a) level between patients with and without ischemic heart disease (IHD) to see whether a high Lp(a) could be a marker of atherogenic risk in CAPD patients. We also analyzed factors which affect Lp(a) concentra- tion with a particular emphasis on the role of nutri- tional status and dialysis adequacy. Mean Lp(a) in our CAPD patients was 37.7±27.3 mg/dl. Mean concentration of cholesterol and triglyc- eride was 202±39 mg/dl, 152±107 mg/dl, respectively. Forteen patients with IHD had a signifi- cantly higher median value of Lp(a) than those without it (72.8 vs. 39.8 mg/dl, p<0.05). In IHD group, TC/HDL cholesterol ratio was significantly in- creased (6.2±2.5 vs. 4.9±1.6, p<0.05) with a sig- nificant decrease of insulin like growth factor 1 (IGF 1) (82.7±36.6 vs. 179.6±69.3 mg/dl, p<0. 05). Calculated arm muscle area (CAMA) and total body muscle (TBM) were also significantly decreased in IHD patients. NPCR was decreased in pa- tients with IHD (0.70±0.31 vs. 0.92±0.32 g/kg/day, p<0.05). According to the stepwise multiple regres- sion analysis, Lp(a) and IGF 1 were the significant risk factors of IHD. Thirty two (36.3%) out of 88 patients had Lp(a) concentration above 30 mg/dl. In these high Lp(a) patients group, LBM and TBM were decreased with the increased TC/HDL ratio. There was no significant correlation between Lp(a) and age, duration of CAPD, Iean body mass, percent body fat, total cholesterol, triglyceride and albumin. In conclusion, high level of Lp(a) may contribute to the increased risk for ischemic heart disease in CAPD patients, and there may be a relationship between the presence of ischemic heart disease, the in- crease Lp(a) Ievel and nutritional status of patients. Further study are needed to confirm these relation- ship and to clarify the effects of intensification of dialysis and lipid lowering agents.