低分子肝素对血液透析患者脂质代谢影响的临床研究
作者：袁伟杰 湛冯岚 张小瑛 苏红 程杰 张国兆
单位：200433上海，第二军医大学附属长海医院肾内科
关键词：血液透析；低分子肝素；脂质
中华肾脏病杂志000304摘 要：目的探讨长期应用低分子肝素抗凝对尿毒症血液透析患者脂质代谢的影响。方法采用为期1年的长期开放、随机对照的方法，选择35例无明显出血倾向的尿毒症患者，随机分成普通肝素(UFH)组(13例)及低分子肝素(LMWH)组(22例)，于透前分别按个体剂量给予普通肝素及低分子肝素钠动脉血路端注射，并在治疗前、治疗后6月及12月检测血脂、脂蛋白、载脂蛋白水平及脂酶活性。结果(1)两治疗组透析前血甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-c)、极低密度脂蛋白胆固醇(VLDL-c)、脂蛋白(Lp)(a)和载脂蛋白B(apo-B)水平均升高，而高密度脂蛋白胆固醇(HDL-c)、载脂蛋白A1(apo-A1)水平及卵磷脂胆固醇酰基转移酶(LCAT)、脂蛋白脂酶(LPL)活性较对照组低(P<0.05)。(2)LMWH组随透析时间延长，LPL、LCAT逐渐升高，TG逐渐降低，而VLDL-c、LDL-c与治疗前相比无明显变化，但与UFH组相比显著降低。结论长期使用LMWH代替普通肝素抗凝，不加重尿毒症血液透析患者脂质代谢障碍，并能部分缓解已存在的脂质代谢异常。
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Long-term effect of low molecular weight heparin on lipid parameters in hemodialysis patients
YUAN Weijie,ZHAN Fenglan,ZHANG Xiaoying
(Department of Nephrology, Changha?Hospital, Second Military Medical University, Shanghai 200433, China)
Abstract：Objective To investigate the effect of low molecular weight heparin on lipid parameters in hemodialysis patients. Methods The trial was double blind, open, controlled and randomized for one year. 35 pre-dialysis patients were divided into two groups: UFH(unfractionated heparin) group(n=13) and LMWH(low molecular weight heparin ) group(n=22), UFH or Fragmin according to individual dosage was infused to patients of two groups respectively. The level of serum lipid , lipoprotein , apolipoprotein and activity of lipase were measured at months 0, 6 and 12 of trial. Results Significant increases in serum concentrations of TG, LDL, VLDL, Lp(a) and apo-B were observed, whereas serum concentrations of HDL, apo-A1 and activity of plasma LCAT or LDL were decreased in both groups before hemodialysis. As dialysis time went by, in LMWH group, activities of plasma LPL and LCAT elevated; TG concentration decreased; VLDL and LDL were not significantly different compared with that of pre-dialysis, but were statistically different in contrast to UFH group. Conclusion The long-term use of LMWH instead of conventional heparin for anticoagulation during dialysis has beneficial effects on the lipid profile, especialy in patients with dyslipidemia.
, 百拇医药
Keywords：Hemodialysis; Low molecular weight heparin; Lipid
参考文献：
[1]Verzola A, Perini L, Gatto S, et al. Causes and risks of hyperlipidemia during dialysis and after renal transplantation. Recenti Prog Med, 1998, 89: 590-597.
[2]Arnadottir M, Kurkus J, Nilsson EP. Different types of heparin in hemodialysis: long term effects on post-heparin lipases. Scand J Clin Lab Invest, 1994, 54: 515-521
, http://www.100md.com
[3]Schrader J. Andersson LO. Armstrong VW. et al. Lipolytic effects of heparins and low molecular weight heparin and their importance in hemodialysis. Semin Thromb Hernost, 1990, 16 Suppl: 41-43.
[4]Bergvist D. low molecular weight heparins. J Intern Med, 1996, 240: 63-72.
[5]Durrington PN. Secondary. hyperlipidaemia. Br Med Bull, 1990, 46: 1005-1013.
[6]Sparks DL, Frank PG, Neville TA. Effect of the surface lipid composition of reconstituted LPA-I on apolipoprotein A-I structure and lecithin: cholesterol acyltransferase activity. Biochim Biophys Acta, 1998, 16: 160-172.
, 百拇医药
[7]Kwiterovich PJ. The antiatherogenic role of high-density lipoprotein cholesterol. Am J Cardiol,1998, 82(9A): 13-21
[8]Clee SM. Zhang H. Bissada N, et al. Relatinnship between lipoprotein lipase and high density lipoprotein cholesterol in mice: modulation by cholesteryl ester transfer protein and dietary status. J Lipid Res, 1997, 38: 2079-2089
[9]Cressman MD, Heyka RJ, Paganini EP, et al. Lipoprotein(a) is an independent risk factor of cardiovascular disease in hemodialysis patients. Circulation, 1992, 86, 475-482
[10]Kronenberg F, Konig P, Neyer U, et al. Muhicenter study of lipoprotein(a) and apo(a) phenotypes in patients with end-stage renal disease treated by hemodialysis or continuous ambulatory peritoneal dialysis. J Am Soc Nephrol, 1995, 6: 110-120.
收稿日期：1999-07-28, http://www.100md.com
单位：200433上海，第二军医大学附属长海医院肾内科
关键词：血液透析；低分子肝素；脂质
中华肾脏病杂志000304摘 要：目的探讨长期应用低分子肝素抗凝对尿毒症血液透析患者脂质代谢的影响。方法采用为期1年的长期开放、随机对照的方法，选择35例无明显出血倾向的尿毒症患者，随机分成普通肝素(UFH)组(13例)及低分子肝素(LMWH)组(22例)，于透前分别按个体剂量给予普通肝素及低分子肝素钠动脉血路端注射，并在治疗前、治疗后6月及12月检测血脂、脂蛋白、载脂蛋白水平及脂酶活性。结果(1)两治疗组透析前血甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-c)、极低密度脂蛋白胆固醇(VLDL-c)、脂蛋白(Lp)(a)和载脂蛋白B(apo-B)水平均升高，而高密度脂蛋白胆固醇(HDL-c)、载脂蛋白A1(apo-A1)水平及卵磷脂胆固醇酰基转移酶(LCAT)、脂蛋白脂酶(LPL)活性较对照组低(P<0.05)。(2)LMWH组随透析时间延长，LPL、LCAT逐渐升高，TG逐渐降低，而VLDL-c、LDL-c与治疗前相比无明显变化，但与UFH组相比显著降低。结论长期使用LMWH代替普通肝素抗凝，不加重尿毒症血液透析患者脂质代谢障碍，并能部分缓解已存在的脂质代谢异常。
, http://www.100md.com
Long-term effect of low molecular weight heparin on lipid parameters in hemodialysis patients
YUAN Weijie,ZHAN Fenglan,ZHANG Xiaoying
(Department of Nephrology, Changha?Hospital, Second Military Medical University, Shanghai 200433, China)
Abstract：Objective To investigate the effect of low molecular weight heparin on lipid parameters in hemodialysis patients. Methods The trial was double blind, open, controlled and randomized for one year. 35 pre-dialysis patients were divided into two groups: UFH(unfractionated heparin) group(n=13) and LMWH(low molecular weight heparin ) group(n=22), UFH or Fragmin according to individual dosage was infused to patients of two groups respectively. The level of serum lipid , lipoprotein , apolipoprotein and activity of lipase were measured at months 0, 6 and 12 of trial. Results Significant increases in serum concentrations of TG, LDL, VLDL, Lp(a) and apo-B were observed, whereas serum concentrations of HDL, apo-A1 and activity of plasma LCAT or LDL were decreased in both groups before hemodialysis. As dialysis time went by, in LMWH group, activities of plasma LPL and LCAT elevated; TG concentration decreased; VLDL and LDL were not significantly different compared with that of pre-dialysis, but were statistically different in contrast to UFH group. Conclusion The long-term use of LMWH instead of conventional heparin for anticoagulation during dialysis has beneficial effects on the lipid profile, especialy in patients with dyslipidemia.
, 百拇医药
Keywords：Hemodialysis; Low molecular weight heparin; Lipid
参考文献：
[1]Verzola A, Perini L, Gatto S, et al. Causes and risks of hyperlipidemia during dialysis and after renal transplantation. Recenti Prog Med, 1998, 89: 590-597.
[2]Arnadottir M, Kurkus J, Nilsson EP. Different types of heparin in hemodialysis: long term effects on post-heparin lipases. Scand J Clin Lab Invest, 1994, 54: 515-521
, http://www.100md.com
[3]Schrader J. Andersson LO. Armstrong VW. et al. Lipolytic effects of heparins and low molecular weight heparin and their importance in hemodialysis. Semin Thromb Hernost, 1990, 16 Suppl: 41-43.
[4]Bergvist D. low molecular weight heparins. J Intern Med, 1996, 240: 63-72.
[5]Durrington PN. Secondary. hyperlipidaemia. Br Med Bull, 1990, 46: 1005-1013.
[6]Sparks DL, Frank PG, Neville TA. Effect of the surface lipid composition of reconstituted LPA-I on apolipoprotein A-I structure and lecithin: cholesterol acyltransferase activity. Biochim Biophys Acta, 1998, 16: 160-172.
, 百拇医药
[7]Kwiterovich PJ. The antiatherogenic role of high-density lipoprotein cholesterol. Am J Cardiol,1998, 82(9A): 13-21
[8]Clee SM. Zhang H. Bissada N, et al. Relatinnship between lipoprotein lipase and high density lipoprotein cholesterol in mice: modulation by cholesteryl ester transfer protein and dietary status. J Lipid Res, 1997, 38: 2079-2089
[9]Cressman MD, Heyka RJ, Paganini EP, et al. Lipoprotein(a) is an independent risk factor of cardiovascular disease in hemodialysis patients. Circulation, 1992, 86, 475-482
[10]Kronenberg F, Konig P, Neyer U, et al. Muhicenter study of lipoprotein(a) and apo(a) phenotypes in patients with end-stage renal disease treated by hemodialysis or continuous ambulatory peritoneal dialysis. J Am Soc Nephrol, 1995, 6: 110-120.
收稿日期：1999-07-28, http://www.100md.com