臨牀透析 Vol.17 No.10(2-5)


特集名 透析患者における心・血管系合併症と対策
題名 透析者における心・血管系合併症 (5) 動脈硬化と脂質代謝異常
発刊年月 2001年 09月
著者 木村 圭吾 和歌山県立医科大学第三内科
著者 宗 正敏 和歌山県立医科大学第三内科
【 要旨 】 血液透析患者の合併症のなかで動脈硬化症に起因する心・血管系合併症があり,透析患者の死因の第1位を占めている.われわれは腹部大動脈の石灰化を腹部CTを用いて大動脈石灰化面積指数として測定し,動脈硬化の指標とした.非糖尿病透析患者103例で重回帰分析を用いた検討では,年齢,収縮期血圧,血清カルシウム・リン積,血清Lp(a)が統計学的に有意に関与していた.血液透析患者の血清脂質でもっとも特徴的な変化は,高トリグリセリド血症と低HDLコレステロール血症である.また,血清Lp(a)も高値を示す.血液透析患者の主要な合併症である心・血管合併症を引き起こす動脈硬化の危険因子としての脂質代謝異常を改善させることは重要であり,とくに高血圧や糖尿病などの合併症をもった血液透析患者ではより重要となる.また,血液透析患者の脂質代謝異常では単に脂質の量的異常だけでなく,今後は酸化LDLの増加などの質的変化から動脈硬化進展につながることも考慮に入れた検討が必要であると考えられる.
Theme Management of Cardio-vascular Complication in Hemodialysis Patient
Title Arteriosclerosis and disorder of lipid metabolism
Author Keigo Kimura Third Department of Internal Medicine, Wakayama Medical College
Author Masatoshi Mune Third Department of Internal Medicine, Wakayama Medical College
[ Summary ] There are cardio-vascular complications for hemodialysis patients, which are due to arteriosclerosis. This is the number one cause of death for dialysis patients. We measured the calcification of an abdominal aorta, using CT scanning, to produce a calcification index. From this, we produced an arteriosclerosis index. For examinations, using multiple regression analysis for non-diabetes mellitus dialysis patients, there were one hundred and three cases, in which we examined factors, including age, systolic blood pressure, serum calcium, phosphorus by products, and serum Lp(a), which were considered to be statistically significant. The most characteristic change in the serum lipid levels of hemodialysis patients is a prevalence of high triglyceride blood disease and low HDL cholesterol blood disease. Serum Lp(a) is also found in high levels. It is important that disorders, related to lipid metabolism are seen as risk factors for arteriosclerosis, causing heart and vascular complications, which are major complications for hemodialysis patients. These complications must be improved, especially since it has become clear that they are important in the care of hemodialysis patients, with complications, such as hypertension or diabetes mellitus. Presently available antihyperlipidemic medications, as well as dialyzers and related treatments, including anticoagulants, in which calcium-phosphorus dysbolism is a particular factor, must be improved, in order to treat disorders of lipid metabolism in hemodialysis patients.
It is necessary to carry out examinations, in terms of quantitative abnormalities of lipids, but also in terms of the connection with the progress of arteriosclerosis and increases in levels of LDL. In the future, consideration must be given to disorders of lipid metabolism in hemodialysis patient.
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