Korean Journal of Nephrology 1995;14(1):78-87.

혈액투석중인 만성신부전증 환자에서 혈중 지질 및 Lipoprotein (a)의 심혈관계 합병증 유무에 따른 상관계에 관한 고찰

조한선 , 이귀래 , 한창완 , 김성환 , 이명희

Abstract

Cardiovascular disease is one of the most comon cause of death in patients undergoing hemodi- alysis. Long standing hypertension, volume over- load, anemia and hyperliprlipidemia lead to dys- function of heart in these patients. Recently, lipo- protein(a) (Lp(a) ) reported as a major risk factor of ischemic heart disease and peripheral vascular disease. So we reviewed hyperlipidemic feature and serum Lp(a) concentrations of patients undergo- ing hemodialysis to evalualuate their functional and structural features of heart and the effects of hyperlipidemia and Lp(a) to the heart. The results are as followings'. 1) Serum Lp(a) concentrations are significantly higher in patients undergoing hemodialysis with 26.5±18.6 mg/dl than normal control subjects with 10.9±5.2 mg/dl (median value.' 22.05 mg/dl ' vs 10 mg/dl, p<0.01). 2) Serum Lp(a) concentrations are significantly higher in patients with ischemic heart disease with 36.0±18.5 mg/dl than other patients with 14.9± 10.6 mg/dl (median value. 37 mg/dl vs 9.75 mg/ dl, p<0.01) and show positive correlations with thickness of posterior wall of left ventricle and ejection fraction (r=0.61, r=0.49). Serum triglyc- eride concentrations show positive correlations with ejection fraction (r=0.52), serum cholesterol concentrations show positive correlatior with thickness of posterior wall of left ventricle and ejection fraction (r = 0.50, r = 0.48) and apolipo- protein A I concentrations show negative correla- tions with internal dimension of left atrium during diastole(r = 0.54) 3) Serum Lp(a) concentrations are significantly higher in patients with occlusion of arteriovenous fistula with 39.9±17.1 mg/dl than other patients with 21.5±16.8 mg/dl (median value'. 37.5 mg/dl vs 15 mg/dl, p<0.01) and show positive correla- tions with thickenss of posterior wall of left ventri- cle and ejection fraction (r=0.51, r=0.65) and negative correlations with internal dimension of left atrium during diastole(r= 0.67). Triglyceride and cholesterol correlate positively with ejection fraction (r=0.49, r=0.65), and LDL cholesterol shows positive correlations with thickness of pos- terior wall of left ventricle and ejection fraction (r =0.57, r=0.70). 4) Serum Lp(a) concentrations are significantly higher in patients with arrhythmia with 30.2±20.2 mg/dl than other patients with 17.9±10.0 mg/dl (median value'. 33 mg/dl vs 15.8 mg/dl, p<0.01), serum cholesterol (172.3±67.5 mg/dl vs 130.3± 22.3 mg/dl, p<0.01) and LDL cholesterol(79.5± 34.6 mg/dl vs 59.1±17.6 mg/dl, p<0.05) concen- trations are higher in patients with arrhythmia than other patients. Concentrations of triglyceride and cholesterol show positive correlation ehection fraction (r =0.48, r = 0.70) in patients with arr- hythmia. From above results, we suggest that hyperli- pidemia may acclerate the cardiovascular disease and Lp(a) may influence to the development of cardiovascular complications and survival of arteriovenous fistula in the patients undergoing hemodialysis.