Korean Journal of Nephrology 1996;15(4):558-566.

혈액투석 및 지속성 외래 복막 투석 환자의 혈청 Lipoprotein (a) 농도 : Apolipoprotein (a) 표현형에 따른 비교

서장원 , 유혜승 , 정영옥 , 유교상 , 박광재 , 김삼정 , 이상구

Abstract

Cardiovascular disease is one of the most impor- tant causes of death in patients on renal replacement therapy. Serum level of lipoprotein(a)[Lp(a)], an independent risk factor for atherosclerotic cardiovas- cular disease, is determined mainly by the gene locus in the general population, but is known to be elevated in patients with end-stage renal disease. This study was performed to evaluate the effect of dialysis modality on serum Lp(a) concentration. We measured fasting serum Lp(a) and apolipoprotein(a) [Apo(a)] phenotype in 82 continuous ambulatory peritoneal dialysis[CAPD] patients, 99 hemodialysis [HD] patients and 153 normal subjects. CAPD patients[median 62.7mg/dL, interquartile rangel; 28.2-90.3 mg/dL] had higher serum Lp(a) level than HD pati- ents[18.7mg/dL, 9.5-35.4mg/dL] or normal subjects [5.3mg/dL, 1.0-18.7mg/dL](p<0.0001). The Apo (a) phenotype of the whole subjects consisted mainly of S4, S4S5, S5 and S5S5 isoforms. For the S4, serum Lp(a) of CAPD patients [n=8; 64.9mg/dL, 37.6-90.7 mg/dL] was significantly higher than that of HD patients [n=15; 18.6mg/dL, 5.7-31.4mg/dLI or normal subjects[n=18; 3.0mg/dL, 1-17.1mg/dL](p<0.05). For the S4S5, serum Lp(a) of CAPD patients[n=15; 89.8 mg/dL, 83.9-113.6mg/dL] was significantly higher than that of HD patients [n=14; 27.9mg/dL, 14.5-38.9mg/ dL] or normal subjects [n=27; 11.4mg/dL, 3.6-25.9mg/ dL](p<0.005). For the S5, serum Lp(a) of CAPD patients[n=34; 35.5mg/dL, 13.3-63.6mg/dL] was signifi- cantly higher than that of HD patients[n=27; 12.1mg/ dL, 1.5-21.3mg/dL] or normal subjects[n=56; 2.9mg/ dL, 1-6.7mg/dL(p<0.001). For the SSS5, serum Lp(a) of CAPD patients[n=9; 69,0mg/dL, 47.9-88.4mg/dLJ was significantly higher than that of HD patients [n=17; 12.5mg/dL, 7.3-28.4 mg/dL) or normal subjects [n=23; 10.1mg/dL, 1.1-13.0 mg/dL](p<0.001). These findings indicate that serum Lp(a) is elevated in CAPD patients as compared with HD patients for all common Apo(a) phenotypes, suggesting that CAPD modality is associated with greater elevation of serum Lp(a) which may contribute to their frequent cardio- vascular mortality in CAPD patients.