臨牀透析 Vol.14 No.11(1-3)


特集名 腎不全における高脂血症の病態と治療
題名 高脂血症の病態 (3) CAPD患者におけるリポ蛋白代謝
発刊年月 1998年 09月
著者 蔵田 英明 東京慈恵会医科大学内科学講座第3
著者 清水 佳苗 東京慈恵会医科大学内科学講座第3
著者 宇都宮 一典 東京慈恵会医科大学内科学講座第3
著者 中山 昌明 東京慈恵会医科大学内科学講座第2
著者 久保 仁 東京慈恵会医科大学内科学講座第2
著者 田嶼 尚子 東京慈恵会医科大学内科学講座第3
著者 川口 良人 東京慈恵会医科大学内科学講座第2
【 要旨 】 CAPDの脂質代謝の特徴は,尿毒症性リポ蛋白代謝異常に加え,透析液中グルコースの腹膜からの持続的吸収が増悪因子となり,HDL-Cの減少とLDL-CおよびVLDL-Cの増加,そしてIII型,IV型の電気泳動パターンを示す高TG血症が特徴的とされる.自験例では,CAPD開始前後で,LDL-Cは有意に増加したが,HDL-C,VLDL-C,TGは増加傾向にあったが有意ではなく,症例個々の脂質代謝予備能による可能性が示唆された.また,臨床的に高脂血症を呈さない例でもレムナントリポ蛋白中のTG含量が相対的に増加する可能性もあり,動脈硬化進展との関連を詳細に検討する必要が今後の課題である.
Theme Pathophysiology and Treatment of Deranged Lipid Metabolism in Chronic Renal Failure
Title Clinical features of hyperlipidemia -- Lipoprotein metabolism in the patients treated with CAPD
Author Hideaki Kurata Department of Internal Medicine III, The Jikei University School of Medicine
Author Kanae Shimizu Department of Internal Medicine III, The Jikei University School of Medicine
Author Kazunori Utsunomiya Department of Internal Medicine III, The Jikei University School of Medicine
Author Masaaki Nakayama Department of Internal Medicine II, The Jikei University School of Medicine
Author Hitoshi Kubo Department of Internal Medicine III, The Jikei University School of Medicine
Author Naoko Tajima Department of Internal Medicine II, The Jikei University School of Medicine
Author Yoshindo Kawaguchi Department of Internal Medicine II, The Jikei University School of Medicine
[ Summary ] Plasma lipoprotein profiles in uremic patients treated with CAPD are characterized by decreases in HDL-C levels, and increases in LDL-C, VLDL-C and TG levels especially with type III and IV hyperlipoproteinemia. This dyslipoproteinemia is considered to be caused by the continuous loading of glucose in the dialisate through the peritoneum. However, in our study, there were no significant changes in levels of plasma HDL-C, VLDL-C or TG before or after six months of receiving CAPD treatments. This data suggests that dyslipoproteinemia in CAPD patients depends not only on the glucose loading but also their genetic history. On the other hand, dyslipoproteinemia including an increase in remnant TG levels, may be found in the CAPD patients without hyperlipidemia. So, we need further evaluation of the relationship between the increase in remnant TG levels and atherogenesis in CAPD patients.
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