Cholesterol Metabolism in CKD.
Cholesterol Metabolism in CKD.
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CKD中的胆固醇代谢。
DOI：
10.1053/j.ajkd.2015.06.028
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Mattana J
中科院分区：
文献类型：
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作者：
Reiss AB;Voloshyna I;De Leon J;Miyawaki N;Mattana J
慢性肾脏病（CKD）患者发生冠状动脉疾病的风险很大。传统的心血管疾病（CVD）危险因素，如高血压和高脂血症，不能充分解释CKD患者CVD的高患病率。CVD和CKD都是炎症状态，炎症会对脂质平衡产生不利影响。CKD中的血脂异常的特征在于甘油三酯和高密度脂蛋白升高，其降低且功能障碍。这种功能失调的高密度脂蛋白成为促炎性物质，并失去其促进胆固醇从细胞（包括动脉壁中脂质超载的巨噬细胞）流出的动脉粥样硬化保护能力。甘油三酯升高主要由清除缺陷引起。低密度脂蛋白胆固醇水平与慢性肾脏病患者冠状动脉风险之间的弱相关性导致了他汀类药物治疗有效性的争议。本综述研究了CKD中胆固醇转运的中断，提出了尿毒症环境对血管脂质蓄积影响的临床和临床前证据。探讨了预防和治疗策略。
Patients with chronic kidney disease (CKD) have a substantial risk of developing coronary artery disease. Traditional cardiovascular disease (CVD) risk factors such as hypertension and hyperlipidemia do not adequately explain the high prevalence of CVD in CKD. Both CVD and CKD are inflammatory states and inflammation adversely impacts lipid balance. Dyslipidemia in CKD is characterized by elevated triglycerides and high density lipoprotein that is both decreased and dysfunctional. This dysfunctional high density lipoprotein becomes pro-inflammatory and loses its atheroprotective ability to promote cholesterol efflux from cells, including lipid-overloaded macrophages in the arterial wall. Elevated triglycerides result primarily from defective clearance. The weak association between low density lipoprotein cholesterol level and coronary risk in CKD has led to controversy over the usefulness of statin therapy. This review examines disrupted cholesterol transport in CKD, presenting both clinical and pre-clinical evidence of the impact of the uremic environment on vascular lipid accumulation. Preventative and treatment strategies are explored.