臨牀透析 Vol.14 No.11(2-3)


特集名 腎不全における高脂血症の病態と治療
題名 高脂血症の治療 (3) リポ蛋白の質的改善をめざした薬物療法
発刊年月 1998年 09月
著者 坂頭 美智子 和歌山県立医科大学第三内科
著者 湯川 進 和歌山県立医科大学第三内科
【 要旨 】 慢性腎不全におけるリポ蛋白の質的異常のおもなものは，酸化LDLなど変性LDLへと変化することにある．変性LDLはその代謝機構から動脈硬化の発症・進展に重要な位置を占めている．実際，測定では血液透析患者の血清過酸化脂質(MDA)は高値であり，LDL中のMDAは高値である．抗酸化剤であるビタミンEの服用により，透析患者のLDL中MDAは低下傾向を示し，マクロファージにおける患者LDLの代謝亢進も改善された．長期服用では，大動脈石灰化の進展度は服用群で有意に低値であった．これらよりビタミンEは慢性腎不全の脂質代謝異常に対する第一選択薬と考えている．今後は，LDLの酸化防止作用の確認されているプロブコール，ビタミンC，βカロチンなど他の抗酸化剤についても腎不全病態における効果の検討が必要である．
Theme Pathophysiology and Treatment of Deranged Lipid Metabolism in Chronic Renal Failure
Title Therapy to improve the qualitative abnormalities of lipoproteins in chronic renal failure
Author Michiko Sakagashira The Third Department of Internal Medicine, Wakayama Medical College
Author Susumu Yukawa The Third Department of Internal Medicine, Wakayama Medical College
[ Summary ] In chronic renal failure, the main qualitative abnormality of lipoproteins is the change to modified low-density lipoproteins(modified LDL), such as oxidized LDL. It is important that modified LDL be related to the progress of atherosclerosis and its relationship to the patient's metabolic system.
In fact, serum malondialdehyde (MDA) concentrations (MDA/TBARS) were significantly higher in hemodialysis patients than in control groups, and MDA concentrations in LDL were significantly higher in hemodialysis patients. After the treatment with an antioxidant, vitamin E (alpha-Tocopherol;alpha-Toc), the level of MDA in LDL tended to decrease, and abnormalities in LDL metabolism in macrophages improved. In the long term treatment of alpha-Toc, the level of the calcification of the aorta in hemodialysis patients was significantly lower than in untreated patients.
Therefore we consider vitamin E as the medication of first choice, to improve lipid abnormalities in chronic renal failure. Further studies are needed to investigate the effects of probucol, vitamin C,and beta-carotene in chronic renal failure.
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