载脂蛋白A在高密度脂蛋白中所占比例与维持型腹膜透析患者腹膜溶质转运速率关系的研究

Investigation of the Relationship between the Proportion of Apolipoprotein A in High Den-sity Lipoprotein and the Rate of Peritoneal Solute Transport in Patients on Maintenance Dialysis

摘要: 目的：分析载脂蛋白A (APOA)在高密度脂蛋白(HDL)中所占比例与维持性腹膜透析患者腹膜溶质转运速率(PSTR)相关性。方法：回顾性地选择2013年2月至2022年1月山东第一医科大学附属省立医院收治并行腹膜透析置管术的腹膜透析患者108例为研究对象，根据患者腹膜透析腹膜平衡实验D/P分为高转运组和低转运组，比较两组患者血脂水平、D/D0及超滤情况。对其中52例腹膜透析时间 > 24月的患者，比较患者透析3月与透析24月时D/P值、D/D0值、超滤量及血脂水平的变化，计算ΔAPOA、ΔAPOB、ΔAPOA/HDL、ΔAPOB/HDL值，分析各项数值变化与患者ΔD/P、ΔD/D0、超滤量变化的相关性。结果：低转运组与高转运组患者血清HDL、LDL、APOB、APOA、APOB/HDL、APOA/APOB、超滤水平比较差异无统计学意义(均p > 0.05)，而高转运组患者D/D0及血清APOA/HDL水平低于低转运组，差异有统计学意义(p < 0.01)。进一步根据透析龄分析发现，在透析3月和透析12月时，低转运组血清APOA、APOA/HDL水平及超滤量均高于高转运组患者。自身前后结果对比显示，患者透析3月时血清APOA、APOA/HDL水平及超滤量均高于透析24月时，且患者透析3月与透析24月时ΔAPOA/HDL值与ΔD/P值呈负相关(r = −0.77, p < 0.01)，与ΔD/D0值呈正相关(r = 0.35, p < 0.05)，即APOA在HDL中所占比例低，患者D/P值高，D/D0值低，腹膜溶质转运率增加。结论：维持性腹膜透析患者血清APOA在HDL中所占比例与患者的腹膜溶质转运速率具有相关性，提示APOA是PD病人腹膜转运功能的保护性因素。

Abstract: Objective: To analyze the correlation between the proportion of Apolipoprotein A (APOA) in High-Density Lipoprotein (HDL) and the peritoneal solute transport rate (PSTR) in maintenance peritoneal dialysis patients. Methodology: A retrospective study was conducted on 108 patients on peritoneal dialysis catheterization admitted to a provincial hospital affiliated with Shandong First Medical University between February 2013 and January 2022. According to the peritoneal balance experiment D/P of patients with peritoneal dialysis, they were divided into high transport group and low transport group, and compare the blood lipid level, D/D0 and ultrafiltration of the two groups. For 52 patients with peritoneal dialysis time > 24 months, compare the changes of D/P val-ue, D/D0 value, ultrafiltration volume and blood lipid level between 3 months and 24 months of di-alysis, calculate ΔAPOA, ΔAPOB, ΔAPOA/HDL, ΔAPOB/HDL values, and analyze the correlation be-tween the changes of various values and the changes of ΔD/P, ΔD/D0, and ultrafiltration volume. Result: There was no significant difference in the levels of serum HDL, LDL, APOB, APOA, APOB/HDL, APOA/APOB and ultrafiltration between the low transport group and the high transport group (all p > 0.05), while the levels of D/D0 and serum APOA/HDL in the high transport group were lower than those in the low transport group (p < 0.01). Further analysis of dialysis age showed that the serum APOA, APOA/HDL and ultrafiltration volume levels in the low transport group were higher than those in the high transport group at 3 months and 12 months of dialysis. The comparison of the results before and after results showed that the levels of serum APOA, APOA/HDL and ultrafil-tration volume at 3 months of dialysis were higher than those at 24 months of dialysis, and the ΔAPOA/HDL values at 3 months and 24 months of dialysis were negatively correlated with ΔD/P values (r = −0.77, p < 0.01), and positively correlated with ΔD/D0 values (r = 0.35, p < 0.05), that is, the proportion of APOA in HDL was low, the patients’ D/P values were high, the D/D0 values were low, and the peritoneal solute transport rate increased. Conclusion: The proportion of serum APOA in HDL of maintenance peritoneal dialysis patients is correlated with the peritoneal solute transport rate of patients, suggesting that APOA is a protective factor of peritoneal transport function in PD patients.