Lipoprotein abnormalities associated with mild impairment of kidney function in the multi-ethnic study of atherosclerosis
Lipoprotein abnormalities associated with mild impairment of kidney function in the multi-ethnic study of atherosclerosis
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DOI：
10.2215/cjn.03390807
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发表时间：
2008-01-01
影响因子：
9.8
通讯作者：
Kestenbaum, Bryan
中科院分区：
文献类型：
--
作者：
de Boer, Ian H.;Astor, Brad C.;Kestenbaum, Bryan
背景和目的：肾功能受损与心血管疾病的风险增加相关，并可能随着时间的推移而进展为终末期肾脏疾病。脂蛋白代谢异常被认为是这些并发症的可能原因，但脂蛋白在肾脏疾病的早期阶段尚未被描述。设计、设置、参与者和测量：在以社区为基础的动脉粥样硬化多种族研究中，这项研究检查了血清胱抑素C与常规血脂测量和详细的核磁共振脂蛋白测量的横断面相关性。结果：调整了年龄、性别、种族/民族、糖尿病、空腹血糖受损、血压、吸烟、药物、体重指数和蛋白尿，较高的胱抑素C浓度与逐渐不利的脂质和脂蛋白浓度相关，包括较高的甘油三酯浓度(+22 mg/dl，与胱抑素C的五分之一相比)和较低的高密度脂蛋白胆固醇浓度(-7 mg/dl)，但与用常规方法测量的低密度脂蛋白胆固醇无关。当使用核磁共振对低密度脂蛋白颗粒亚类进行更详细的检查时，较大的胱抑素C与致动脉粥样硬化的小颗粒低密度脂蛋白颗粒(+6nmol/L)和中密度脂蛋白颗粒(+6nmol/L)的浓度增加以及平均低密度脂蛋白颗粒尺寸的减小相关。结论：脂蛋白异常存在，肾脏损害的程度比以前认为的轻，用传统的血脂测量方法可能无法识别低密度脂蛋白颗粒分布的异常。这些异常可能导致肾脏疾病进展和/或心血管疾病。
Background and objectives: Impaired kidney function is associated with increased risk for cardiovascular disease and may progress over time to end-stage renal disease. Abnormal lipoprotein metabolism has been implicated as a possible cause of these complications, but lipoproteins have not been described at the earliest stages of kidney disease.Design, setting, participants, & measurements: This study examined cross-sectional associations of serum cystatin C with conventional lipid measurements and detailed nuclear magnetic resonance lipoprotein measurements in the community-based Multi-Ethnic Study of Atherosclerosis. A total of 5109 participants with estimated glomerular filtration rate >= 60 ml/min per 1.73 m(2) were included in analyses.Results: Adjusting for age, gender, race/ethnicity, diabetes, impaired fasting glucose, BP, smoking, medications, body mass index, and albuminuria, greater cystatin C concentrations were associated with progressively unfavorable lipid and lipoprotein concentrations, including greater triglyceride concentration (+22 mg/dl, comparing fifth versus first quintiles of cystatin C) and lesser high-density lipoprotein cholesterol concentration (-7 mg/dl) but not with low-density lipoprotein cholesterol measured using conventional methods. When low-density lipoprotein particle subclasses were examined in more detail using nuclear magnetic resonance, greater cystatin C was associated with greater concentrations of atherogenic small low-density lipoprotein particles (+63 nmol/L) and intermediate-density lipoprotein particles (+6 nmol/L) and with a decrease in mean low-density lipoprotein particle size.Conclusions: Lipoprotein abnormalities are present with milder degrees of renal impairment than previously recognized, and abnormalities in low-density lipoprotein particle distribution may not be appreciated using conventional lipid measurements. These abnormalities may contribute to kidney disease progression and/or cardiovascular disease.