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題 名 | Low Molecular Weight Heparin in Diabetic and Nondiabetic Hypercholesterolemic Patients Receiving Long-Term Hemodialysis=應用低分子量肝素於接受長期血液透析之糖尿病性及非糖尿病性高血膽固醇病人 |
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作 者 | 呂至剛; 劉宏祥; 吳繡春; 楊五常; 黃東波; 吳肖琪; | 書刊名 | 臺灣醫學會雜誌 |
卷 期 | 97:1 1998.01[民87.01] |
頁 次 | 頁49-54 |
分類號 | 415.816 |
關鍵詞 | 低分子量肝素; 血液透析; 糖尿病性; 非糖尿病性高血膽固醇病人; Low molecular weight heparin; Cholesterol; Apolipoprotein; Hemodialysis; Lipoprotein(a); Anti-factor Xa activity; |
語 文 | 英文(English) |
英文摘要 | Dyslipidemia is a major factor associated with cardiovascular disease, which is the leading cause of death in hemodialysis patients. Low molecular weight heparin (LMWH) is superior to conventional unfractionated heparin in treating hyperlipidemia in nondiabetic long-term hemodialysis patients and has fewer sideeffects. Only a few reports have addressed the influence of LMWH on serum lipids in diabetic patients, although dyslipidemia is common among this population. We investigated the effect of LMWH on serum lipids in 12 nondiabetic and eight diabetic hypercholesterolemic patients receiving long-term hemodialysis Patients had been receiving hemodialysis with unfractionated heparin for a minimum of 6 months before beginning the study. Continuous LMWH infusion during hemodialysis was administered to all patients for 2 months, followed by unfractionated heparin administration for 2 months. During LMWH treatment, plasma anti-factor Xa activity increased from 0.06 ± 0.04 IU/mL before dialysis to 0.49 ± 0.25 IU/mL after 3 hours. Serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and apolipoprotein B (Apo B) in both nondiabetic and diabetic patient groups and lipoprotein (a) (Lp(a)) in patients with higher initial values (≧ 15 mg/mL) decreased significantly after LMWH treatment (TC from 6.38 ± 1.14 to 5.07 ± 1.09 mmol/L, LDL-C from 3.08 ± 0.93 to 2.15 ± 0.88 mmol/L, Apo B from 100 ± 18 to 78 ± 18 mg/dL, all p<0.01;Lp(a) from 41.8 ± 34.5 to 28.5 ± 22.8, p<0.05). They rebounded to pre-LMWH levels after the 2 months on unfractionated heparin (TC 5.72 ± 1.11 mmol/L, LDL-C 2.97 ± 1.01 mmol/L, Apo B 98 ± 20 mg/dL, Lp(a) 38.1 ± 29.0 mg/dL). We conclude that continuous infusion of LMWH during dialysis reduces serum total cholesterol, low-density lipoprotein-cholesterol, and apolipoprotein B concentrations in both diabetic and nondiabetic hypercholesterolemic hemodialysis patients, and does not increase the risk of bleeding compared with unfractionated heparin. |
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