臨牀透析 Vol.16 No.7(6)


特集名 透析患者の長期予後とリスクファクター
題名 脂質 -- 透析患者における脂質代謝異常と長期予後
発刊年月 2000年 06月
著者 大久保 景子 東京慈恵会医科大学腎臓高血圧内科
著者 横山 啓太郎 東京慈恵会医科大学腎臓高血圧内科
【 要旨 】 長期透析患者における動脈硬化に起因する心血管合併症の発生頻度はきわめて高く,その生命予後は不良である.脂質代謝異常は,透析患者においても動脈硬化のリスクファクターであり,ひいては長期透析患者の予後を左右する重要なリスクファクターのーつである.透析患者の脂質代謝異常の特徴は,血清トリグリセライド(TG)の上昇とHDL(high-density lipoprotein)コレステロールの低下である.さらにVLDL(very low-density lipoprotein)とIDL(intermediate-density lipoprotein)に代表されるレムナントリポ蛋白の増加が透析患者における催動脈硬化性リポ蛋白として重要である.いままでに高TG血症,低HDL血症,高IDL血症と透析患者の動脈硬化との関連が報告されているが,これら脂質代謝異常と透析患者における長期予後との関連性や,抗脂血剤投与による治療効果についての検討は少なく,透析患者における血中脂質のadequacyとcritical levelのconsensusは得られていない.今後,透析患者における大規模なintervention trialが必要である.
Theme Risk Factors and Outcome on Long-term Dialysis
Title Lipid abnormalities and long-term survival in dialysis patients
Author Keiko Okubo Division of Nephrology and Hypertension, Jikei University of Medicine
Author Keitaro Yokoyama Division of Nephrology and Hypertension, Jikei University of Medicine
[ Summary ] Atherosclerotic cardiovascular disease frequently occurs in uremic patients receiving long-term dialysis and it is the leading cause of death in those patients. The mechanisms for the advance of atherosclerosis in dialysis patients are numerous. However, plasma lipid abnormalities have been identified as significant risk factors for cardiovascular disease and long-term survival in such patients. The prominent characteristics of lipid abnormalities in dialysis patients are an increase in serum triglyceride levels and a decrease in HDL-cholesterol. VLDL and IDL, which are more atherogenic, increase in such patients. It has previously been reported that hypertriglyceridemia, low HDL-cholesterol and elevated IDL are independent risk factors for atherosclerosis. Howeyer, there have been no clinical trials to determine the relationship between lipid abnormalities and long-term survival rates, or the relationship between lipid-lowering agents and long-term survival in dialysis patients. As yet, there is no consensus on adequately defining the critical levels of lipids in dialysis patients. Additional intervention trials are needed to better define the relationship between lipid abnormalities and atherosclerosis, for the long-term survival of dialysis patients.
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