雖然終末期腎臟疾?。‥SRD）患者常伴脂質(zhì)代謝異常已廣為人知,，但膽固醇與腎功能不全的聯(lián)系卻并不清楚。我們進(jìn)行了一項(xiàng)前瞻性隊(duì)列研究,，共有4483例健康者參加了此項(xiàng)名為“醫(yī)生健康研究”（PHR）并分別在1982年與1996年抽取血樣,。主要觀測值：肌酐值升高，定義為1.5mg/dl(133µmol/L),；肌酐清除率下降,，定義為55ml/min。膽固醇參數(shù)包括總膽固醇（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,。我們使用Logistic回歸處理年齡及多變量較正優(yōu)勢比，評(píng)價(jià)風(fēng)險(xiǎn)因素,。14年后,，134（3%）人肌酐值上升，224人（5.4%）肌酐清除率下降,。肌酐多變量相關(guān)風(fēng)險(xiǎn)：總膽固醇240mg/dl為1.77（95%置信區(qū)間(CI)為1.10-2.86）,，HDL小于40mg/dl為2.16（95%CI為1.42-3.27）；TG/HDL比值（6.8）最高四分位數(shù)是2.34（95%CI為1.34-4.07）,，non-HDLC（196.1）最高四分位數(shù)為2.16（95%CI為1.22-3.80）,。膽固醇參數(shù)與肌酐清除率下降聯(lián)系較小但卻相似。TG上升,、Non-HDLC上升,、 TG/HDLC增加 ,、TG上升,、LHDL下降與肌酐小于1.5mg/dl病人發(fā)生腎功能不全風(fēng)險(xiǎn)呈現(xiàn)顯著相關(guān)。
（水平有限 歡迎指正 風(fēng)雪來 譯）
J Am Soc Nephrol 14:2084-2091, 2003
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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: [email protected]
