局部枸橼酸抗凝对血液透析患者脂质代谢的影响

目的：探讨应用局部枸橼酸抗凝（RCA）对血液透析患者脂质代谢的影响。方法：采用为期2年的长期开放，随机对照的方法，选择40例尿毒症患者，随机分成普通肝素（UFH）组（18例）及局部枸橼酸抗凝（RCA）组（22例），在治疗前，治疗后6个月及12个月检测血脂，脂蛋白，载脂蛋白水平及脂酶活性。结果：（1）两治疗组透析前血甘油三酯（TG），低密度脂蛋白胆固醇（LDL－c)，极低密度脂蛋白胆固醇（VLDL－c）,脂蛋白（Lp)(a)和载脂蛋白B（apo-B)水平均升高，而高密度脂蛋白胆固醇（HDL－c)，载脂蛋白AL（apo-AL)水平及卵磷脂胆固醇酰基转移酶（LCAT），脂蛋白脂酶（LPL）活性较对照组低（P＜0．05）。（2）LMWH组随透析时间延，LPL，LCAT逐渐升高，TG逐渐降低，而VLDL－c,LDL-c与治疗前相比无显著变化，但与UFH组相比显著降低，结论：长期使用RCA代替普通肝素抗凝，不加重尿毒症血液透析患者脂质代谢障碍，并能部分缓解已存在的脂质代谢异常。

Long-term Effect of Regional Citrate Anticoagulation on Lipid Parameters in Hemodialysis Patients

Objective:To investigate the effect of regional citvate anticoagulation on lipid parameters in hemodialysis patients.Methods:The trial was double blind open controlled and randomized for two years.40 pre dialysis patients were divided into two groups:UFH(unfractionated heparin)group ( n =18) and RCA(Regional citrate anticdagulation)group ( n =22),UFH or Fragmin according to individual dosage was infused to patients of two groups respectively.The levels of serum lipids,lipoprotein apolipoprotein and activity of lipase were measured at months 0 6 and 12 of trial.Results:Significant increase in serum concentrations of TG,LDL,CLDL,Lp(a) and apo B were observed.The serum concentrations of HDL,apo Al and activity of LCAT or LDL were decreased in both groups before hemodialysis.As dialysis time went by,in RCA group activities of plasma LPL and LCAT elevated,TG concentration decreased,VLDL and LDL were not significantly different compared with that of pre dialysis,but were staistically different in contrast to UFH group.Conclusion:The long term use of RCA instead of conventional heparin for anticoagulation during dialysis has beneficial effects on the lipid profile especially in patients with dyslipidemia.