慢性腎臟病患的血脂肪異常－治療的新進展

Recent Advance in the Treatment of Dyslipidemia in Chronic Kidney Disease Patients

陳泓源(Hung-Yuan Chen) ； 蔡敦仁(Tun-Jun Tsai)

《內科學誌》 17卷5期 (2006/10) Pp. 195-203

https://doi.org/10.6314/JIMT.2006.17(5).01

摘要

血脂肪異常(dyslipidemia)在慢性腎臟病患中相當常見，根據ATP Ⅲ(Adult Treatment Panel Ⅲ)的定義，約有三分之二的病患有此疾病。它們的特徵是以異常的apo-脂蛋白(apolipoprotein)組成和濃度為主；在這些異常的組成中，最主要的表現為高密度脂蛋白(HDL)的數量減少與三酸甘油脂(triglyceride)、非常低密度脂蛋白(VLDL)、中間密度脂蛋白(IDL)及小緊緻型低密度脂蛋白(small dense LDL)的數量增加。原因可能肇因於肝臟對VLDL的生成增加、HDL的形成減少及代謝排除的異常。慢性腎臟病患的血脂肪異常，是促成心血管疾病的重要因素之一，也可能與腎臟功能惡化有密切相關。所以積極的對腎臟病患進行血脂肪異常的治療，會大幅降低腎臟病患總體及心血管疾病死亡率。美國國家腎臟基金會K/DOQI在2003年建議以HMG-CoA還原酶抑制劑，作為治療慢性腎臟病患血脂肪異常的首選藥品，並提出治療的率則及流程。本文並統計臺大醫院於民國九十三年二月至十月期間，在本院接受現則性血液及腹膜透析的尿毒病患血脂肪異常情況的臨床觀察與經驗，使大家對慢性腎臟病患的血脂肪異常有更清楚的認識，將來能為腎臟病患提供更好的治療。

關鍵字

血脂肪異常 ； 慢性腎臟病 ； HMG-CoA還原酶抑制劑

並列摘要

Dyslipidemia is a common problem in chronic kidney disease CKD patients. According to the definitions of dyslipidmia published in ATP Ⅲ Adult Treatment Panel Ⅲ, there are more than two-third CKD patients have this problem. The characteristics of dyslipidemia in CKD patients are low serum HDL and elevated serum triglyceride, VLDL and small dense LDL which are different from those in general population. The dyslipidemia may be induced by increased hepatic synthesis of VLDL lipoprotein, decreased HDL synthesis and the abnormality in lipoprotein metabolism caused by altered enzymatic activity. Dyslipidemia in CKD patients has been known to be a major risk factor of their cardiovascular disease, and may contribute to progressive renal dysfunction. Consequently, the K/DOQI proposed a therapeutic guideline for dyslipidemia in CKD patients and recommended the HMG-CoA reductase inhibitor as the drug of choice for them. We also presented a retrospective cohort of dialysis patients with dyslipidemia during 9 months period gave some clinical examples for trouble-shooting and sharing experience.

並列關鍵字

Dyslipidemia ； Chronic kidney disease ； HMG-CoA reductase inhibitor