虽然终末期肾脏疾病(ESRD)患者常伴脂质代谢异常已广为人知,但胆固醇与肾功能不全的联系却并不清楚。我们进行了一项前瞻性队列研究,共有4483例健康者参加了此项名为“医生健康研究”(PHR)并分别在1982年与1996年抽取血样。主要观测值:肌酐值升高,定义为1.5mg/dl(133µmol/L);肌酐清除率下降,定义为55ml/min。胆固醇参数包括总胆固醇(TC)(<200, 200~239, 240mg/dl)、HDL(<40或40mg/dl)非高密度脂蛋白(non-HDL)及TC/HDL比值。我们使用Logistic回归处理年龄及多变量较正优势比,评价风险因素。14年后,134(3%)人肌酐值上升,224人(5.4%)肌酐清除率下降。肌酐多变量相关风险:总胆固醇240mg/dl为1.77(95%置信区间(CI)为1.10-2.86),HDL小于40mg/dl为2.16(95%CI为1.42-3.27);TG/HDL比值(6.8)最高四分位数是2.34(95%CI为1.34-4.07),non-HDLC(196.1)最高四分位数为2.16(95%CI为1.22-3.80)。胆固醇参数与肌酐清除率下降联系较小但却相似。TG上升、Non-HDLC上升、 TG/HDLC增加 、TG上升、LHDL下降与肌酐小于1.5mg/dl病人发生肾功能不全风险呈现显著相关。
(水平有限 欢迎指正 风雪来 译)
J Am Soc Nephrol 14:2084-2091, 2003
点击浏览该文件
Cholesterol and the Risk of Renal Dysfunction in Apparently Healthy Men
ABSTRACT. Despite extensive knowledge about abnormal lipid patterns in patients with end-stage renal disease, the association between cholesterol and the development of renal dysfunction is unclear. We evaluated this association in a prospective cohort study among 4,483 initially healthy men participating in the Physicians’ Health Study who provided blood samples in 1982 and 1996. Main outcome measures were elevated creatinine, defined as 1.5 mg/dl (133 µmol/L), and reduced estimated creatinine clearance, defined as 55 ml/min. Cholesterol parameters included total cholesterol (<200, 200 to 239, and 240 mg/dl), HDL (<40 or 40 mg/dl), total non-HDL cholesterol, and the ratio of total cholesterol to HDL. We used logistic regression to calculate age- and multivariable adjusted odds ratios as a measure for the relative risk. After 14 yr, 134 men (3.0%) had elevated creatinine and 244 (5.4%) had reduced creatinine clearance. The multivariable relative risk for elevated creatinine was 1.77 (95% confidence interval [CI], 1.10 to 2.86) for total cholesterol 240 mg/dl, 2.16 (95% CI, 1.42 to 3.27) for HDL <40 mg/dl, 2.34 (95% CI, 1.34 to 4.07) for the highest quartile of total cholesterol/HDL ratio (6.8), and 2.16 (95% CI, 1.22 to 3.80) for the highest quartile of non-HDL cholesterol (196.1). Similar although smaller associations were observed between cholesterol parameters and reduced creatinine clearance. Elevated total cholesterol, high non-HDL cholesterol, a high ratio of total cholesterol/HDL, and low HDL in particular were significantly associated with an increased risk of developing renal dysfunction in men with an initial creatinine <1.5 mg/dl. E-mail: tkurth@rics.bwh.harvard.edu