Korean Journal of Nephrology 1993;12(4):649-657.

투석 치료를 받고 있는 만성신부전증 환자의 Lipoprotein (a) 지질 대사 이상에 관한 연구

하성규 , 조한선 , 박움직이훈 , 만수연 , 이귀순 , 이병권 , 김흥수 , 이호영 , 한대석 , 정석호

Abstract

Lipoprotein (a)(Lp (a)) is a LDL-like particle with a glycoprotein called apolipoprotein (a) attached to its apolipoprotein B-100 through disulfide bond. Many case control studies have suggested that Lp (a) is strongly linked with atherogenesis and is an independent risk factor for coronary heart disease. This study was conducted to assess the seurm concentration of Lp (a) and its relationship between various biochemical parameters in 186 patients with chronic renal failure and 81 control subjects. Serum cholesterol levels were higher in CAPD patients and lower in hemodialysis patients than in control subjects (p<0.05, 206.±40.7 & 147.5±33.9 vs. 174. 3±51.0 mg/dl). Serum triglyceride levels were higher in predialysis and CAPD patients than in control subjects (p < 0.05, 150.8± 67.0 & 149.0± 78.7 vs. 115.2± 52.5 mg/dl). Serum HDL-cholesterol levels were significantly lower in predialysis, hemodialysis and CAPD patients than in control subjects (p<0.05, 34.8±8.1, 26.8±7.7 & 37.8±11. 2 vs. 44.8±11.5mg/dl, respectively). Serum LDL- cholesterol level was lower in hemodialysis patients than in control subjects (109.7±36.5 vs. 123.1±89.1 mg/ dl), but the other patients didnt show significant differences. Mean and median serum Lp (a) concentrations (in mg/dl) were significantly higher in predialysis, hemodialysis and CAPD patients than in control sub- jects (p<0.05, 37.2±28.5(34.5), 48.9±130.8(18.0), 21.3±29. 8(13.5) vs. 8.9±8.3(6.9) mg/dl respectively). The distribu- tion of Lp (a) concentrations revealed that 63.3% Of predialysis and 34.7% of hemodialysis patients had a Lp (a))30mg/dl compared with 3.7% of control subjects (p<0.05). Thirteen and one half percent of CAPD patients had a Lp (a)>30mg/dl compared to 3.7% for control subjects (p=0.0503). Correlation analysis were performed between Lp (a) and other variables. There were no significant correlations between Lp (a) concenttration and other variables in all groups except BUN in hemodialysis patients (p<0.05, r=0.3183). Serum Apo AI was significantly lower in predialysis, hemodialysis and CAPD patients than in control subjects (p <0.05, 146.9±41.0, 105.3±49.7, 153.6±40.5 vs. 172. 1±43.4 mg/dl, respectively). Serum Apo B was significantly higher in predialysis and lower in hemodialysis patients than in control subjects (p<0.05, 150.8±49.2, 102.0±32.8 vs. 119.8±31.5 mg/dl, respectively) and there were no significant differences between CAPD and control subjects. These resluts suggest that Lp (a) levels were increased in chronic renal failure patients and may increase the risk for coronary artery disease. And also, predialysis patients had a higher percentage of Lp (a) > 30 mg/dl compared with hemodialysis and CAPD patients. These findings suggest that the kidney plays a certain role in the removal of Lp (a). However, further siudies are needed to evaluate the role of kidney to remove serum LP (a).