慢性腎臟病患者的血脂異常和治療

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812 482

ၡāāࢋ

statins statins

statins

ᙯᔣෟĈҕ਌ள૱ ( Dyslipidemia )

ၙّඪ᝙ঽ ( Chronic kidney disease ) Statins

͕ҕგ়ঽ ( Cardiovascular disease ) కϨԌ ( Proteinuria )

݈֏

ҋ 1952 ѐ੓Ă Keys ඈˠಶฟؕдБ஧˛࣎

฼ࢴ௫ၚͽ̈́਌۹ᛷפณमளޝ̂۞઼छ̚Ăአ ߤ੠ᖸВ 12,763 ࣎ 40 Ҍ 59 ໐۞շّ̝ҕ̚ᓙ׽

ዔ ( cholesterol ) ࣃͽ݄͕̈́াѪ˸۞ᙯܼĂВ੠

ᖸ˩ѐĂҲ૜ޘ਌కϨᓙ׽ዔ ( LDL-cholesterol ) ࣃߏϤᓁᓙ׽ዔଯზĂඕڍ൴னҲ૜ޘ਌కϨᓙ

׽ዔ׶݄͕াѪ˸ѣໂ̂࠹ᙯّ

¹

ĂЯ҃ڼᒚ੼

ᓙ׽ዔҕা˵јࠎࢫҲ͕ҕგ൴Ϡ̈́Ѫ˸த۞ࢦ

ࢋีϫĂ׎̚ͽ HMG-CoA ᔘࣧ ۞Ժט጗ ( H- MG-CoA reductase inhibitor Ă statins ) ۞൴ण౵צ ᓜԖᗁर۞ࢦϡĂ၁ᅫᓜԖᒚड़˵ѝ̏צזᗁጯ Чࠧ۞ۺؠĄ

ၙّඪ᝙ঽ ( chronic kidney disease Ă CKD ) ߏϫ݈έ៉˩̂ѪЯ۞ௐˣҜĂ׎Տ˩༱ˠ˾۞

Ѫ˸தϤϔ઼ 79 ѐ۞ 11.39 ుѐ˯̿Ҍϔ઼ 93

ѐ۞ 2 0 . 7 ĄӀϡ઼ᅫ়ঽ̶ᙷ΃ቅࡁտ൴ன઼

(2)

̰ᓜԖ˯ၙّඪΑਕ̙Б۞ঽˠᇴѐѐᆧΐĂ஽

ҖதϤϔ઼ 85 ѐ۞ 1.99% ుѐ˯̿Ҍϔ઼ 92 ѐ

۞ 9.83%

²

Ą႙႙ซणҌϐഇඪ਽ა ( end-stage re- nal disease Ă ESRD ) ҃ᅮࢋ౅ژڼᒚͽ̈́൴Ϡ͕

ҕგ়ঽߏၙّඪ᝙ঽঽଈ̙ሄ֍۞׌̂ᓜԖޢ ڍĄፂࡁտአߤĂၙّඪ᝙ঽଈ۰Ꭾଈҕ਌ள૱

( dyslipidemia ) ۞஽Җதͧܧඪ᝙ঽঽଈࠎ੼Ă Я҃ଯീၙّඪ᝙ঽঽଈޝΞਕЯѩ͕ҕგ়ঽ Ꭾঽத׶Ѫ˸தϺྵ੼ĂΩγϺѣࡁտ޽΍Ă੼

ҕ਌াٕҕ਌ள૱ົΐిඪ᝙ঽ۞ซҖ

³

Ą͌ᇴ

̈ݭࡁտពϯֹϡࢫҕ਌ᘽۏ statins ڼᒚޢĂΞ ͽࢫҲඪΑਕ̙Бଈ۰͕ҕგ়ঽПᐍّĂࢫҲ కϨԌĂͽ̈́ഴቤඪΑਕ̝ೋ̼Ąҭߏ statins ၆

ၙّඪ᝙ঽঽଈЧ͞ࢬ۞ᇆᜩ ( ࢫҲకϨԌĂഴ ቤඪΑਕೋ̼ĂࢫҲ͕ҕგ়ঽጱ࡭̝Ѫ˸ ) ݒ

৿ͻܜॡม̂ݭᓜԖࡁտĂᔘᅮࢋՀк࠹ᙯ̂ݭ ࡁտֽቁᄮ statins ߏӎਕѣड़гֹϡٺၙّඪ᝙

ঽ۞ঽଈĄ

ҕ਌ள૱၆ඪ᝙۞ᇆᜩ

ॲፂ௟ࡪ/ જۏƝˠវ̝ࡁտᇴፂពϯĂၙ

ّඪ᝙ঽ۞਌۹ள૱۞ቁΞΐࢦඪΑਕೋ̼Ă፟

טΞͽགྷ࿅ҕგள૱˵ΞਕѣۡତᇆᜩĄજۏࡁ տពϯ੼ᓙ׽ዔົΐిඪ᝙Αਕೋ̼Ĉග̟ҁဂ

੼਌ ( ӣ 3% ᓙ׽ዔ )฼ࢴĂົౄјඪක஧̰λጥ

௟ࡪ ( macrophage ) ۞ওማ̈́ڽڰ௟ࡪ ( foam cell )

۞ԛјĂ௣ಶౄјඪ̈஧ർ̼া ( glomeruloscle- rosis )

^{4, 5}

ĄдᓜԖࡁտ͞ࢬĂ Hovind ඈˠࡁտ̶

ژд 301 Ҝௐ˘ݭᎤԌঽঽˠĂ੼ᓙ׽ዔΞ࿰ീ

ᎤԌঽඪঽត۞ೋ̼

⁶

ćҭ˵ѣˠ޺̙Тຍ֍Ă ᄮࠎдௐ˘ݭᎤԌঽঽˠĂ҃ͅˬᅕϟڵ਌ ( triglyc- eride ) ̖׶ீغঽតྫྷඪঽត۞ត̼ซणͧྵѣ ᙯ

⁷

ćϤ RENAAL ( Reduction of Endpoints in NID- DM with the Angiotensin II Antagonist Losartan ) ࡁ տ۞ְޢ̶ژĂΞ࠻΍ᓁᓙ׽ዔĂҲ૜ޘ਌కϨ ᓙ׽ዔߏඪΑਕೋ̼Я৵̝˘

⁸

ĄΩ Muntner ඈ ˠࡁտ̶ژ 12,728 ࣎јˠĂ҉ᅕ⁇ ( creatinine ) д 1.8~2.0 mg/dL ͽ˭Ă੠ᖸ 3 ѐޢĂѣ 191 ࣎ˠ

҉ᅕ⁇چ੼ 0.4 mg/dL ͽ˯ĂдЧ჌ҕ਌̶ᙷᑭ ߤᇴࣃ̚Ă൴னͅࣆߏˬᅕϟڵ਌׶੼૜ޘ਌క Ϩᓙ׽ዔ ( HDL-cholesterol ) ۞ᇴࣃ׶ඪΑਕೋ̼

ྵѣᙯܼ

⁹

Ąᔵ൒Ч࣎ࡁտٙ଀ז۞ඕኢ̙֭˘

࡭ĂҭҌ͌˵ౌۺؠ˞ҕ਌ள૱ᑕྍ˵ߏ˘࣎ඪ Αਕೋ̼ٕߏඪঽតซण۞޽ᇾĂΩγଂனдᓜ Ԗ೼ֹ࿆ϡ۞ҕ਌̶ژᑭߤ࠻ֽĂ၆ඪ᝙ঽଈ҃

֏ĂΪ࠻Ҳ૜ޘ਌కϨᓙ׽ዔĂ΃ّܑΞਕ̙

֖Ă׎၁Ωѣкีͧྵ୎ܕ൴ன۞਌కϨ̶̄˵

జᙋ၁ߏ͕ҕგ়ঽ۞፾ϲЯ̄ ( ּтĈ lipopro- tein (a)Ă VLDL remnants Ă IDL ඈඈ )Ąּтд 1 9 9 8 ѐĂಶѣ੫၆ඪ᝙ঽଈ۞ࡁտ޽΍Ăܧ੼

૜ޘ਌కϨᓙ׽ዔ ( non-HDL cholesterol )Ă˵ಶ ߏҲ૜ޘ਌కϨᓙ׽ዔ + ໂҲ૜ޘ਌కϨᓙ׽ዔ ( LDL+VLDL ) ˵ధՀਕ΃ܑ఺ཏঽଈ۞͕ҕგ

়ঽПᐍّ

¹⁰

Ą

д̙Т۞ඪ᝙়ঽᄃඪ᝙Αਕ۞ଐڶ˭Ăҕ

਌ள૱۞ݭၗ˵ѣ׎̙ТĄඪঽা࣏ཏ ( Nephrotic syndrome ) ঽଈ̝੼ҕ਌া͹ࢋͽӣ੼ᓙ׽ዔ۞

਌కϨ ( cholesterol-rich lipoprotein B Ă LP-B ) ࠎ

͹Ă͹ࢋᄃք᝙Ъј࿅к۞ᓙ׽ዔѣᙯćၙّඪ

᝙ঽͽ̈́ତצ౅ژڼᒚঽଈ̝੼ҕ਌াͅࣆͽಱ ӣˬᅕϟڵ਌۞਌కϨ ( complex apoB-containing lipoproteins Ă LP-Bc ) ࠎ͹Ă͹ࢋᄃ਌۹̶ྋ

۞߿ّࢫҲ ( тĈ lipoprotein lipase, hepatic triglyceride lipase, lecithin-cholesterol acyltrans- ferase ) ̈́ˬᅕϟڵ਌۞ϠјᆧΐѣᙯĄၙّඪ᝙

ঽ۞਌۹ள૱ᄃ਍फ৵ܡԩ ( insulin resistance )

͔ٙ੓۞ҕ਌ள૱ݭၗྵࠎ࠹ҬĂ˵ಶߏͧྵઐ Шಱӣˬᅕϟڵ਌۞਌కϨࠎ͹Ă҃ிٙ׹ۢ਍

फ৵ܡԩٕߏᎤԌঽଈϒߏ͕ҕგ়ঽ۞੼Пᐍ ཏĂͧྵटٽౄјજਔඓېർ̼ ( atherosclerosis )Ă

҃ͅඪঽাޢཏ۞ঽଈ̙Ъ׀ᓜԖځព۞͕ҕგ

়ঽĄٙͽ̙გଂૄᖂࡁտٕߏଂᓜԖ៍ᕇ࠻

ֽĂඪঽা࣏ཏঽଈ۞ҕ਌ள૱၆ٺ͕ҕგ௡ᖐ

ͧྵ̙׍๋चਕ˧Ă҃ၙّඪ᝙ঽঽଈ۞ҕ਌ள

૱ݒϒߏ͕ҕგ়ঽࢦࢋ۞࡭ঽЯ৵Ą

дඪ᝙᜕ّܲᒚڱ ( renoprotective therapies )

̚

¹¹

Ăੵ˞ࢫҲҕᑅ ( ૟ќᒺᑅᄃනૺᑅଠטд 125~130/75~80 ୮ѼՑߗͽ˭ )ăֹϡҕგૺ˧

৵ Ժט጗ ( angiotensin converting enzyme in-

hibitor Ă ACEI )Ɲҕგૺ˧৵ II צጡ޻ԩ጗ ( an-

giotensin-II receptor antagonist Ă ARB )ăᎤԌঽ

ଈᚑॾଠטҕᎤ ( Ꭴ̼ҕҒ৵ HbA1C ጐΞਕଠט

(3)

Ҳٺ 6.5% ) ͽ̈́ዋޘ۞ҲకϨ฼ࢴ̝γĂֹϡࢫ ҕ਌ᘽۏֽଠט੼ҕ਌াٕԼචҕ਌ள૱Ă˵Ξ ਕߏ˘჌ࢦࢋڼᒚ͞ڱĄк჌ࢫҕ਌ᘽۏ̚Ă statins - HMG CoA ᔘࣧ ۞Ժט጗ -- ߏன̫౵ࢦ

ࢋ۞ڼᒚᘽۏĂιΞԺטք௟ࡪ۞ᓙ׽ዔЪјă ᆧΐք௟ࡪܑࢬ۞Ҳ૜ޘ਌కϨᓙ׽ዔତצጡᇴ ϫă̈́ഴ͌ք᝙ໂҲ૜ޘ਌కϨᓙ׽ዔ۞̶کĂ

ٙͽΞࢫҲҕ̚ᓁᓙ׽ዔ׶Ҳ૜ޘ਌కϨᓙ׽ዔ ड़ڍĂ˵Ξൾൾ೩̿੼૜ޘ਌కϨᓙ׽ዔ׶ࢫҲ ˬᅕϟڵ⟯

¹²

ĄѩγĂ statins ˵׍ѣк჌ࢫҕ਌

ͽγ̝үϡĂΒ߁Ĉԩ൴ۆүϡĂഴ͌ᎤԌঽ۞

າ൴ϠĂഴ͌Яࠎֹϡᙷ׽ዔ҃൴Ϡ۵੻ᐝᗼѪ

۞፟ົඈ

¹³

Ą

ࢫҕ਌ᘽۏ ( statins ) ၆కϨԌ۞ᇆᜩ

కϨԌ่̙ߏඪ᝙ۆ۞ܑᇈĂ҃ͷЯࠎకϨ Ԍົӛ͔Հк۞൴ۆ௟ࡪᄃ͔൴ᄦౄ௟ࡪγૄ

ኳకϨĂ൒ޢጱ࡭ඪ̈გมኳ௡ᖐۆাᄃញჯ

̼

¹⁴

Ăٙͽώ֗˵ߏਕૉ͔੓๋चඪ᝙۞Я̄Ă

౵ܕࡁտϺពϯకϨԌ۞΍னΞͽ࿰ീ͕ҕგ়

ঽ۞Ꭾଈத

¹⁵

Ąдତצ statins ᙷᘽۏ۞ڼᒚॡĂ ၆ԌకϨ۞າ൴Ϡٕߏ၆̏གྷѣԌకϨঽଈ۞ᇆ ᜩߏтңĂߏ͌ѣˠڦຍࠤҌࡁտ۞ᛉᗟĂזϫ

݈ࠎͤΪѣ˘ቔͽ Statins ֽڼᒚඪ᝙়ঽซण

ّ۞តள̶ّژ ( meta-analysis )Ăќᐂଂ1974 ѐז 2005 ѐВ 15 ቔдјˠ۞ᐌ፟၆໰ࡁտĂВ 1384 ҜঽˠĄ఺ֱࡁտϤ 10 ̙࣎Т۞઼छ൴ܑĂ̂

ొ̶дለ߷ĂΪѣ˘ቔд઼࡚Ą׎̚ 3 ቔᏴᐂ՟

ѣԌకϨ (Ŵ 30 mg/day ) ۞ঽˠĂ 6 ቔࠎ຋̈క ϨԌ ( microalbuminuira Ă 30-299 mg/day ) ଈ۰Ă Ω 6 ቔࠎᓜԖకϨԌ( clinical albuminuria ĂŸ 300 mg/day ) ঽˠćֹٙϡ۞ statins ̶Ҿࠎ sim- vastatin ( 5 ቔ )ă pravastatin ( 4 ቔ )ă fluvastatin ( 2 ቔ )ă cerivastatin ( 2 ቔ )ă lovastatin ( 1 ቔ )ă atorvastatin ( 1 ቔ )ĄՏ˘࣎ࡁտ۞πӮˠᇴࠎ 36 ˠ ( 18-864 ˠ )ĂπӮѐ᛬ 50 ໐ĂπӮ੠ᖸ 6 ࣎

͡ ( 3-46 ࣎͡ )Ăѣ 7 ቔТॡֹϡ ACEI/ARB Ąπ ӮֽᄲĂֹϡ statins ۞ঽଈΞࢫҲҲ૜ޘ਌కϨ ᓙ׽ዔ྿ז 26% ( 10-51% )Ă̶ژඕڍពϯдϒ

૱ԌకϨ௡۞ঽଈĂֹϡ statins ۞ԌకϨଵڴ۞

ΐᝋπӮम ( weighted mean difference ) ࢫҲ

2% Ă຋̈కϨԌ௡ࢫҲ 48% ĂᓜԖకϨԌ௡ࢫ Ҳ 47% Ăͽ˯ඕڍពϯ΍ statins ڼᒚ( ൑ኢ౵ܐ ϫ۞ࠎң ) ΞࢫҲకϨԌĂ͍׎д̏གྷѣᓜԖక ϨԌঽˠ֗˯ՀΞͽ࠻΍׎ࢫҲड़ڍ

¹⁶

Ąҭώቔ meta-analysis ٙৼˢ̶ژ۞ࡁտѣ׎ࢨטĂΒ߁

̂ొ̶ˠᇴ࿅͌ ( 15 ቔኢ͛̚ѣ 7 ቔٙࡁտঽˠ ᇴд 30 ˠͽ˭ )ă੠ᖸॡม࿅ൺ ( ѣ 9 ቔࡁտഇ มд̱࣎͡ͽ˭ )ăТॡֹϡ ACEI/ARB ( ᓜԖ˯

̏ۢਕࢫҲԌకϨ۞ᘽۏ ) ඈĂٙͽᔵ൒ଂ meta- analysis ࡁտ࠻ֹֽϡ statins ॡకϨԌົഴ͌Ă ҭߏϤٺ˯ࢗೀ࣎ࣧЯĂٙͽ̪ᖞ൑ڱ˭ඕኢᄮ ؠ statins ΞͽڼᒚకϨԌĄۡҌ̫̪͟՟ѣ̂ݭ ࡁտ੫၆ statins дၙّඪ᝙ঽˠ၆కϨԌ۞ڼᒚ үϡĂтڍࢋቁؠѩ˘ᛉᗟĂಶᅮࢋྵкˠᇴણ ᄃă֖ૉ۞੠ᖸॡมăᇾ໤̼۞Ъ׀ᘽۏă౵ࢦ

ࢋ۞ߏᅮࢋ૟కϨԌഴ͌඀ޘүࠎ͹ࢋࡁտϫᇾ ( ͽ˯ࡁտ׎၁ֹϡ statins ͹ࢋౌߏࠎ˞ڼᒚ੼ҕ

਌ͽ̈́ࢫҲ͕ҕგ়ঽĂకϨԌΪߏѨࢋ̶ژ )Ă

̖ਕૉֽৌϒаඍ఺࣎યᗟĄ

Ϥٺ statins ۞ᇃھֹϡĂܕѐֽ႙႙ѣಡӘ ڦຍזֹϡ statins ޢѣొ̶ࣧώ՟ѣకϨԌ۞ঽ ଈ҃ͅ൴ϠకϨԌ

¹⁷

Ċ̙࿅ଂЧ࣎ಡӘրЕΞͽ

࠻΍Ă̂࡭˯ֹϡ጗ณ෸੼ ( ּт rosuvastain ă simvastatin ă atorvastatin Տ͇ 40 ୮ҹͽ˯ )Ă͔

൴కϨԌ፟ົ෸੼Ą̙࿅̶ژ఺ֱԌ୵కϨኳΞ

ۢߏͽඪ̈გֽ໚కϨኳ ( ஧కϨ ) ࠎ͹Ăٙͽ

˵ధ၆ඪ᝙௡ᖐ۞๋चّ̙ࡶඪක஧ֽ໚కϨኳ ( ϨకϨ ) ۞ᚑࢦĂҭߏ఺̪ᅮࢋޢᜈ៍၅̖ਕ ቁؠĄ

ࢫҕ਌ᘽۏ ( statins ) ၆ၙّඪ᝙ঽ ଈඪΑਕ۞ᇆᜩ

˯ࢗᇾᗟ૲΍Ω˘࣎યᗟĂԧࣇ၆ၙّඪ᝙

ঽঽଈ఍͞ statins ॡĂזغԓ୕࠻ז statins ۞ֹ

ϡᇆᜩ˞ၙّඪ᝙ঽঽଈ۞̦ᆃតีĉ̙ΞᏕ֏

۞ְ၁ߏĂᓜԖᗁरдֹϡ statins ॡĂϫ۞˘ؠ

ౌᔘߏࢫҲ੼ᓙ׽ዔҕাͽ̈́ࢫҲ͕ҕგ়ঽ۞

൴ϠٕѪ˸Ăયᗟߏ࿅Νٙ൴ܑ۞ிк̂ݭࡁտ

̚ĂౌԯଈѣඪΑਕ̙Б۞ঽଈଵੵдγĂٙͽ

׎၁ Statins ϡдඪΑਕ̙Бঽଈ֗˯Ăߏ̙ߏ˵

тТܧඪ᝙ঽଈ˘ᇹĂΞͽѣड़ࢫҲ͕ҕგ়ঽ

(4)

۞Ꭾঽ̈́Ѫ˸ĉ఺યᗟ֭൑ڱଂ࿅Ν statins ࡁտ

̚଀זඕኢĄ Tonelli ඈˠ̶ژ Pravastatin Pooling Project ۞ˬቔ݈ᖀّᐌ፟ࡁտĂΒ߁ WOSCOPS ( West of Scotland Coronary Prevention Study )ă CARE ( Cholesterol And Recurrent Events )ă LIPID ( Long-term Intervention with Pravastatin in Ischemic Disease )ĂᓁВ 18,569 ࣎ঽˠĂ׎̚Β߁ 4491 Ҝ ௐˬഇၙّඪ᝙ঽ ( ඪක஧࿅ᕭதĈ 30-59.99 mL/min/1.73m

²

) ̈́ 12,333 Ҝௐ˟ഇၙّඪ᝙ঽ ( ඪක஧࿅ᕭதĈ 60-89.99 mL/min/1.73m

²

) ۞ঽˠĂ

ͧྵ pravastatin ྫྷщᇐ጗дၙّඪ᝙ঽঽଈĂ၆

͕҉ୟ๫ă࡭Ѫّᄃܧ࡭Ѫّ͕ҕგְІ۞ᇆ ᜩĄඕڍ൴ன pravastatin дௐ 12 ࣎͡ॡΞࢫҲҲ

૜ޘ਌కϨᓙ׽ዔ 47.9 Ų 24.1 mg/dL ĂࢫҲˬᅕ ϟڵ⟯ 17.3 Ų 56.3 mg/dL ̈́೩̿੼૜ޘ਌కϨᓙ

׽ዔ 2.3 Ų 6.0 mg/dL ćΩγ൴ன̙ኢߏдϒ૱ඪ

᝙Αਕٕௐ˟ഇăௐˬഇၙّඪ᝙ঽ۞ଈ۰Ăֹ

ϡ pravastatin ΞࢫҲ͕ҕგ়ঽ࠹ᙯ۞Ꭾঽதٕ

Ѫ˸த

^{1 8}

Ąॲፂ఺ˬี̂ݭࡁտඕڍ࠻ֽĂ̂࡭

Ξͽቁᄮ statins ϡдௐ˟ഇ׶ௐˬഇၙّඪ᝙ঽ

۞ঽଈॡĂࢫҲᓙ׽ዔͽ̈́ࢫҲ͕ҕგ়ঽ࠹ᙯ

۞ᎮঽதٕѪ˸த۞ड़ڍĂྫྷϡдඪΑਕϒ૱ঽ ଈ֗˯˘ᇹѣड़ć̙࿅ଂ఺ˬีࡁտ۞ඕڍĂ֭

൑ڱଯኢ΍ statins ၆ඪΑਕՀम۞ঽଈ ( ௐαഇ׶

ௐ̣ഇၙّඪ᝙ঽ ) ۞ᒚड़ߏӎ˵˘ᇹĂ఺̪ᅮ

ࢋ૟ֽ੫၆఺ཏপঅঽଈֽࡁտ̖ਕ଀ۢĄ ඪ᝙ࡊᗁरആၙّඪ᝙ঽঽଈ఍͞ statins Ă

ੵ˞҂ณ͕ҕგ়ঽͽγᔘপҾڦຍ၆ඪΑਕೋ

̼ซण۞ᇆᜩĄၙّඪ᝙ঽѝഇಶѣາౘ΃ᔁ۞

ள૱ត̼дซҖĂ఺ֱঽၗϠநன෪གྷϤ̙Т፟

טົΐిඪΑਕ਽ੜĂٙͽڼᒚ఺ֱ΃ᔁّள૱

ΞਕΞͽഴቤඪΑਕೋ̼

¹⁹

Ą Fried ඈˠд 2001 ѐ൴ܑௐ˘ቔͽ statins ϡдၙّඪ᝙ঽঽଈඪ᝙

ซण۞តள̶ّژĂВќᐂ 13 ቔ݈ᖀّࡁտĂ

̶ژࢫҕ਌ᘽۏ۞ֹϡ၆ඪΑਕ̝ೋ̼׶కϨԌ

̝ड़ڍĂࡁտ୉ཏ̂ౌ̶ࠎᅅޘҌ̚ޘඪ᝙ঽଈ ۰Ąඕڍពϯ΍ֹϡ statins ۞ঽଈĂд੠ᖸഇม ඪΑਕೋ̼ిޘൾѣؼቤĂ׎ඪක஧࿅ᕭத˭ࢫ

ిޘͧ၆໰௡πӮၙ 0.156 ml/min/month

²⁰

Ą఺࣎

ࡁտ۞ऴᕇߏѣ 12 ቔࡁտˠᇴд 40 ˠͽ˭Ă 8 ቔ੠ᖸഇมд˘ѐͽ̰Ă҃ͷ GFR តજ಼ޘ˵

ޝ̈ĂٙͽᓜԖຍཌྷᅮࢋГᑭ੅Ą

Ω˘ቔϤ S a n d h u ඈˠٺ 2 0 0 6 ѐ൴ܑͽ statins ڼᒚඪ᝙়ঽซण۞តள̶ّژĂќᐂଂ

1969 ѐז 2005 ѐВ 27 ቔͽјˠࠎ၆෪۞ᐌ፟၆

໰ࡁտĂВ 39,704 Ҝଈ۰Ă׎̚ѣ 21 ቔኢ͛྆ѣ

੃ᐂඪක஧࿅ᕭத˭ࢫిޘĂѣ 20 ቔኢ͛ѣࡔᐂ ԌకϨ˭ࢫ඀ޘĂҭБొ 27 ቔኢ͛ౌ̙ߏۡତࡁ տ statins ၆ඪΑਕ۞ᇆᜩ

²¹

Ą̶ژඕڍពϯ൑ኢ

ֹϡࣹ˘჌ statins Ă൑ኢϡдᎤԌঽඪঽតă੼

ҕᑅඪঽតٕߏඪක஧ඪۆ۞ঽଈĂඪක஧࿅ᕭ த࠰Ϗ྿ѣ௚ࢍຍཌྷ۞˭ࢫĄ఺ᔵ൒ߏ˘ቔტЪ 27 ቔኢ͛۞តள̶ّژĂ׎̚˵ѣ 7 ቔᛳٺྵ̂

ఢሀࡁտĂҭ׎ዶ 20 ቔ̪ᛳ̈ݭࡁտĂͷ׎ࡁտ

୉ཏ̂ొ̶ࠎᅅޘҌ̚ޘඪ᝙ঽଈ۰ ( πӮૄᖂ ඪක஧࿅ᕭதĈ 50-99 mL/min Ă˵ಶߏௐ˟ഇ׶

ௐˬഇၙّඪ᝙ঽ )Ă֭՟ѣଣ੅זࢦޘඪ᝙ঽଈ ۰ĂՀࢦᕇ۞ߏ఺ֱࡁտౌ̙ߏͽඪΑਕត̼ࠎ

͹ࢋࡁտࢦ͕ĂඪΑਕ۞̶ژд఺ֱࡁտ Ϊߏ Ѩࢋ̶ژีϫĂ҃ͷ̂ొ̶੠ᖸॡม͉ൺ ( 15 ቔ ኢ͛۞੠ᖸд˘ѐͽ˭ )Ąтڍࢋቁᄮ statins ۞ֹ

ϡ၆ඪΑਕត̼۞ᇆᜩĂ˘ؠᅮࢋྵкˠᇴણᄃă

֖ૉ۞੠ᖸॡมăЪ׀ᘽۏ ( ͍׎ߏ ACEI/ARB )

۞ᇾ໤̼ăΒ߁Հкࢦޘඪ᝙ঽଈ۰ă૟ഴቤඪ Αਕ̝ೋ̼үࠎ͹ࢋࡁտϫᇾĂ҃ܧѨࢋ̶ژĂ

̖ਕૉֽৌϒଣ੅ statins ၆ၙّඪ᝙ঽ۞ᒚड़Ą

ࢫҕ਌ᘽۏ( statins )၆౅ژঽˠ۞ᇆᜩ

ߊ൒੼ᓙ׽ዔҕাߏౄј͕ҕგ়ঽѪ˸۞

ࢦ̂Я̄Ă֤ᆃତצ౅ژঽଈ۞Ѫ˸ѣѺ̶̝α

˩ͽ˯ߏϤ͕ҕგ়ঽѪ˸఺˘ְ၁Ăߏӎ׶౅

ژঽଈᎮଈྵ੼۞ҕ਌ள૱ѣᙯĉтڍਕૉֹϡ statins јΑ۞૟ᓙ׽ዔள૱ᖼШϒ૱ҕ਌ᇴࣃĂ ߏ̙ߏ۞ቁಶਕѣड़ഴ͕͌ҕგ়ঽጱ࡭۞Ѫ

˸ĉॲፂ࿅Ν۞ፖᕝࢬࡁտ ( cross-sectional study )Ă Ѫ ˸ ۞ ౅ ژ ঽ ˠ ͅ ҃ ѣ ྵ Ҳ ۞ ˬ ᅕ ϟ ڵ ਌ ׶ apolipoprotein-B ̈́ྵ੼۞ apolipoprotein-A/

a p o l i p o p r o t e i n - B ּͧĂѪ˸தᄃҕ਌д౅ژ ঽˠӔ࠹ͅᙯܼĂ˵ಶߏѪ˸۰ѣྵҲ۞ᓙ׽

ዔ

²²

Ąٙͽ੼ҕ਌াٕҕ਌ள૱זغ၆౅ژঽˠ

ົ̙ົᆧΐ͕ҕგ়ঽ۞ПᐍّĂזغ౅ژঽˠ

۞ҕ਌ள૱ᅮ̙ᅮࢋڼᒚĉҌϫ݈ࠎͤĂ֭՟ѣ͉

(5)

кࡁտֽۡତଣ੅఺ีࢦࢋᓜԖኝᗟĄᓜԖᗁर ࢬ၆ѣඪ᝙Αਕᅪᘣঽଈ఍͞ statins ॡĂ૱ົፉ

͕൴Ϡᘽۏઘүϡ( ҉๋҇च̈́քΑਕள૱)Ąॲፂ Navaneethan ٙ൴ܑ۞˘ቔᐌ፟ᓜԖࡁտ۞ր௚ّ

̶ژĂ׎̚Βӣ̱ቔኢ͛Ăඕڍֹϡ atorvastatin

ٕ simvastatin ĂΞѣड़д౅ژঽˠࢫҲ׎ᓁᓙ׽

ዔ̈́Ҳ૜ޘ਌కϨᓙ׽ዔĂͷ׎ઘүϡ ( т҉҇

ঽតăք᝙ᅔ৵˯̿ඈ ) ֭՟ѣᆧΐĂٙͽᓜԖ ᗁर̂࡭൑ื͉࿅ፉᇎ statins д౅ژঽଈֹϡ۞

щБّĄҭߏд఺ೀቔᐌ፟ᓜԖࡁտ֭՟ѣଣ੅

ז၆͕ҕგ়ঽٕཝҕგ়ঽ۞࿰֨ड़ڍĂͷ࠰

ᛳٺ̈ݭᓜԖࡁտ

²³

Ąזϫ݈ࠎͤĂ઱˘൴ܑѣ ᙯ౅ژঽଈ statins ᒚड़۞̂ݭࡁտ͛ౢߏ Wanner ඈˠдᇇ઼ࡁտ 1,255 Ҝତצҕ୵౅ژ۞ௐ˟ݭ ᎤԌঽঽଈ ( 4D trials Ĉ Die Deutsche Diabetes Dialyse )Ă͹ࢋࡁտϫᇾߏ statins ਕӎѣड़ࢫҲᎤ Ԍঽҕ୵౅ژঽଈ۞͕ҕგ়ঽă࡭Ѫّᄃܧ࡭

Ѫّཝҕგ়ঽ׶ܧ࡭Ѫّ͕҉ୟ๫Ąڼᒚ௡д

˘ฟؕಶֹϡ atorvastatin Տ͇ 20 ୮ҹĂдࡁտฟ

ؕ ׌ ࣎ ͡ ̰ ಶ ਕ ૟ Ҳ ૜ ޘ ਌ క Ϩ ᓙ ׽ ዔ ࢫ Ҳ 40% Ă҃ͷдࡁտഇม˘ۡਕૉჯ޺఺࣎ड़ڍĄ

఺࣎ࡁտ۞ࣧؕଯീߏтڍֹϡ statins ѣड़ࢫҲ ҕ̚Ҳ૜ޘᓙ׽ዔĂಶᑕྍਕૉഴᅅ͕ҕგ়ঽ

۞ПᐍЯ̄Ăᚶ҃ਕૉഴ͕͌ҕგ়ঽ۞Ѫ˸Ą

̙࿅གྷ࿅πӮ̣ѐ۞੠ᖸޢĂ൴ᛇ atrovastatin ௡

ֹϡ̣ѐޢѣ 33.11% ൴Ϡ͕ҕგ়ঽٕѪ˸Ă҃

၆໰௡ѣ 38.67% ൴ϠĂ۞ቁ atrovastatin ഴ͌˞ֱ

ధ͕ҕგ়ঽયᗟć̙࿅Ăֹϡ atrovastatin ௡̣

ѐ̰ѣ 12.76% ൴ϠཝҕგঽតٕѪ˸Ă҃၆໰

௡ݒΪѣ 11% Ąଂ఺࣎ࡁտ࠻ֽĂҬͼ atrovas- tatin ၆͕ҕგ়ঽड़ᑕ̪дĂ̙࿅ഴऴధкĂ҃

̙ۢࠎңࣧЯĂͅࣆᆧΐ̚ࢲ፟ົ

²⁴

Ăٙͽ׌௡

ঽ ˠ д ̣ ѐ ̰ ۞ ᓁ Ѫ ˸ த ՟ ѣ ځ ព म Ҿ ( ڇ atrovastatin ௡ 48% ĂϏڇϡ௡ 50% )Ă֭ϏтТࣧ

ֽଯຐΞͽЯࠎഴ͕͌ҕგ়ঽѪ˸҃ࢫҲፋវ ঽଈѪ˸தĄ఺࣎ᅲצБ͵ࠧඪ᝙ጯࠧڦϫĂ૞

ܝΪஉᄏ౅ژঽଈ۞ࡁտඕኢ̂̂߄ጼ࿅Νᗁࠧ

̏གྷତצ۞ "statins ڼᒚΞͽځពԼචঽଈ࿰ޢ"

៍هĂᔵ൒֭Ϗଯᖙ఺࣎ໄه ( Яࠎ statins ڼᒚ

௡͕ҕგ়ঽѣᅅޘࢫҲ )Ăҭߏ̏གྷ౅ᜨ˘࣎

ᓜԖڼᒚੈिĈಶზߏ statins ఺ᇹૻ๕۞ᘽۏ˵

൑ڱஉ߁ٙѣঽଈཏĂᓜԖᗁरд఍͞Їңᘽۏ ॡ̪ᖞᅮࢋᖰຕޥ҂Ă֭ͷᐌॡෞҤڼᒚຫৈĄ

Ω˘ี˵ߏ૞ܝͽඪ᝙ঽଈࠎࡁտ͹ཏវ۞

ߏ CHORUS ( Cerivastatin in Heart Outcomes in Renal Disease Ĉ Understanding Survival ) ࡁտĂϤ Keane ඈˠҋ 2001 ѐฟؕ Cerivastatin д౅ژঽ ˠ۞͕ҕგ়ঽᒚड़Ă̙࿅ޝΞଓĂЯࠎ൴Ϡͧ࿰

ഇ੼۞ፖ৳҉໘ྋাѪ˸த̙҃଀̙ͤ̚ࡁտ

²⁵

ć ѩγࡻ઼۞ HARP ( Heart and Renal Protection ) ࡁ տ̶ژ simvastatin дˬ௡ၙّඪ᝙ঽ୉ཏ ( ౅ژ

݈ঽˠăඪொങঽˠă౅ژঽଈ ) ۞щБّ׶ᒚ ड़Ąдགྷ࿅˘ѐ۞ڼᒚޢĂ simvastatin ѣຍཌྷ۞

ࢫҲᓁᓙ׽ዔăҲ૜ޘ਌కϨᓙ׽ዔăˬᅕϟڵ

਌Ăҭд੼૜ޘ਌కϨᓙ׽ዔ݋՟ѣӔனѣຍཌྷ

۞ԼតĂ҃ઘүϡ͞ࢬ֭՟ѣᆧΐ

²⁶

ĄҌٺܜഇ ඕڍĂ͍׎Ѫ˸தă͕ҕგ়ঽ͞ࢬϤٺѩࡁտ ᔘдซҖ̚Ă̪υืඈޞĄ

ᔘѣ׌ቔ̪дซҖ̚۞̂ݭࡁտߏ SHARP ( Study of Heart and Renal Protection )Ăд 3,000 к Ҝ౅ژঽଈ̈́ 6,000 кҜࢦޘඪޘ਽აҭإϏ౅

ژ۞ঽˠĂࡁտ simavastatin Ъ׀າ˘΃۞ࢫҕ

਌ᘽۏ ezetimibe ၆͕ҕგ়ঽ۞ड़ڍ

²⁷

ć AU- RORA ( a study to evaluate the use of rosuvastatin in subjects on regular hemodialysis Ĉ an assessment of survival and CV events ) ݋ࡁտ rosuvastatin д 2,700 Ҝҕ୵౅ژঽଈ۞ᒚड़Ă͹ࢋࡁտϫᇾࠎ Ѫ˸த͕̈́ҕგ়ঽĂ࿰ࢍд 2008 ѐΞͽඕՁ ࡁտ

^{2 8}

Ąੵ˞݈ࢗ̏གྷ൴ܑ۞ 4D ࡁտͽγĂԧ ࣇҌ͌ᔘυืඈޞ HARP ă SHARP ྫྷ AURORA

۞ඕڍޢĂ̖ਕ၆ statins ߏӎਕѣड़гࢫҲ౅ژ ঽଈ۞͕ҕგѪ˸த˭ඕኢĄ

੺˯ঙனזᕧࢬ˯۞યᗟߏனдᓜԖᗁरࣇ ( ͍׎ߏඪ᝙ࡊᗁर ) ިᆃ఍ཉࢦޘඪ਽აͽ̈́

౅ژঽଈ۞੼ᓙ׽ዔҕাĉͧྵځം۞ၗޘߏ̙

ࢋΪ࠻ᓁᓙ׽ዔ׶Ҳ૜ޘᓙ׽ዔᇴፂֽՙؠ఍

͞ĂᔘᅮࢋෞҤ׎΁Я৵ГՙؠĂּтΞͽણ҂

ͧҲ૜ޘᓙ׽ዔՀѣ࿰ീड़˧۞ "ᓁᓙ׽ዔĈ੼

૜ޘᓙ׽ዔ" ( total cholesterol/HDL ) ۞ͧࣃߏӎ

̂ٺ 5.0 Ăٕߏߏӎ̏གྷజ෧ᕝѣ݄͕ঽඈЯ৵

ֽՙؠঽଈߏӎᅮࢋ఍͞ statins Ăضྻ۞ߏॲፂ

ࡁտ޽΍ֹϡѩᙷᘽۏ۞ઘүϡ֭Ϗᆧ੼Ăࡶߏ

(6)

Т ॡ ΐ ૻ ੼ ҕ ᑅ ۞ ଠ ט Ă ˵ ధ Ξ ͽ ᔖ Һ ֹ ϡ statins ܢ૲ᆧΐཝҕგঽត۞፟ົĄ

ҕ਌ڼᒚ۞Ϗֽ൴ण

ڼᒚҕ਌ள૱۞ᘽۏז statins ˯ξ̝ޢĂߏ

̙ߏಶז˞ႽᐝĉΪࢫҲҲ૜ޘ਌కϨᓙ׽ዔҬ ͼ̙֖ͽਕБࢬّ۞ഴ͕͌ҕგПᐍّĂ҃Ҭͼ ᓁᓙ׽ዔ/ ੼૜ޘ਌కϨᓙ׽ዔͧࣃΞਕྵਕ࿰

ീĂΩγҕ਌͞ࢬ۞ࡁտ˵ѝಶۢ྽ѣྵ੼۞੼

૜ޘᓙ׽ዔ۞ˠĂᎮଈ͕ҕგ়ঽ፟ົͧྵҲĂ

ٙͽ੼૜ޘᓙ׽ዔѝ̏జᄮࠎߏ᜕࣎ܲЯ̄ćٙ

ͽᆧΐ੼૜ޘ਌కϨᓙ׽ዔߏӎΞѣड़ࢫҲ͕ҕ გПᐍّ׸ĉѣ˘჌ٺ 1990 ѐ΃ฟؕࡁտ۞ᘽ ۏĂጯЩߏ torcetrapib Ă͹ࢋࠎ CETP ( cholesteryl- ester transfer protein ) Ժט጗Ă҃ҕል̚۞ CETP

ົ๊̼੼૜ޘ਌కϨᓙ׽ዔ˯۞ cholesteryl ester ᖼೱҌ׎΁਌కϨĂٙͽ CETP Ժט጗Ξͽ೩̿

੼૜ޘ਌కϨᓙ׽ዔ

²⁹

Ą Pfizer ̳Φ඾ீٺ ator- vastatin ่ࢫҲĶᗼķᓙ׽ዔ ( Ҳ૜ޘ਌కϨᓙ׽

ዔ )ĂϏਕᆧΐĶрķᓙ׽ዔ ( ੼૜ޘ਌కϨᓙ׽

ዔ )ĂࠎѩซҖТॡࢫҲҲ૜ޘ਌కϨᓙ׽ዔ̈́

ᆧΐ੼૜ޘ਌కϨᓙ׽ዔ۞̂ݭᓜԖࡁտĂ֭̏

൴ ण Ҍ ௐ 3 ล ߱ ۞ ᓜ Ԗ ၁ រ Ă ఺ ࡁ տ ߏ ੫ ၆ 15,000 ЩঽଈซҖາᘽ torcetrapib ᓜԖ၁រĂΗ ᇴঽଈֹϡ atorvastatin Ъ׀ֹϡ torcetrapib ĂΩ Ηᇴ่ಏ፾ֹϡ atorvastatin ćඕڍдࡁտ̖གྷ࿅

˘ѐνΠಶ൴ᛇĂڇϡ׌჌ᘽۏ۞఺௡ѣ 8 2 ˠ Ѫ˸Ă҃Ϊڇϡ atorvastatin ۞఺௡Ϊѣ 51 ˠѪ

˸ĂЯѩࡁտࢍထд 2006 ѐغͤ̚Ąд఺ௐ 3 ล

߱۞ᓜԖࡁտ൴னĂֹϡ atorvastatin ΐ˯ torce- trapib ۞ঽଈќᒺᑅ੼ٺಏ፾ֹϡ atorvastatin ۞ ঽଈĄᔵ൒ atorvastatin ΐ˯ torcetrapib ۞ڼᒚࠎ

̦ᆃεୀ۞ࣧЯ̙ߏޝځពĂҭޝΞਕ׶ torce- trapib ֹ଀ќᒺᑅ̿੼ѣᙯܼĄ఺࣎ࡁտᔵ൒՟

ਕтТ࿰ഇԆјෞҤТॡࢫҲҲ૜ޘ਌కϨᓙ׽

ዔ ̈́ ᆧ ΐ ੼ ૜ ޘ ਌ క Ϩ ᓙ ׽ ዔ ۞ ड़ ৈ Ă ҭ ੵ torcetrapib ͽγ۞׎΁ CETP Ժט጗֭՟ѣѩઘү ϡĂٙͽ఺࣎Հซ˘ՎԼචҕ਌ள૱ͽഴ͕͌ҕ გ়ঽѪ˸۞၆ඉ֭ϏεୀĂΪߏ၆ CETP Ժט

጗̪ᅮࢋՀк۞ࡁտ̖ਕ˭ඕኢĄ

ੵ˞ͽ˯ᘽۏ۞ฟ൴̝γĂΩ˘ڼᒚາݵ፟

݋ࠎ 2003 ѐٙ൴ன۞ PCSK9( Proprotein conver- tase subtilisin/kexin type 9 ) ૄЯ࠹ᙯࡎត

³⁰

ĄᓜԖ

˯̏གྷۢ྽ҋវពّ੼ᓙ׽ዔҕা( autosomal dominant hypercholesterolemia )׍ѣޝૻ۞᏷็ّ

ͷछ୉јࣶ૱֍ѝ൴ّ͕᝙ঽĂϫ݈̏ۢ࡭ঽૄ

Я͹ࢋѣҲ૜ޘ਌కϨᓙ׽ዔצጡă apolipopro- tein-B ඈૄЯ΍னតளĄ PCSK9 ૄЯҜٺௐ˘၆ ߖҒវൺᓖ ( 1p32 ) ˯ĂૄЯயۏߏ NARC-1 ( neural apoptosis regulated convertase )ĂүϡإϏ ԆБ୻຾Ăҭ̂ໄߏົᇆᜩҲ૜ޘ਌కϨᓙ׽ዔ צጡ۞̶ྋĂซ҃ᇆᜩҲ૜ޘ਌కϨᓙ׽ዔצጡ ᘦؠĂЯࠎҲ૜ޘ਌కϨᓙ׽ዔצጡώֽಶ࢑య ඕЪҕ୵̚Ҳ૜ޘ਌కϨᓙ׽ዔޢĂϤք௟ࡪ୻

ੵҲ૜ޘ਌కϨᓙ׽ዔĂٙͽ PCSK9 ૄЯࡎត ޢ౵௣ົᇆᜩҕ̚Ҳ૜ޘ਌కϨᓙ׽ዔ୻ੵćࡶ

PCSK9 ૄЯࡎតޢ൴ϠΑਕᆧૻ ( gain-of-func- tion ) үϡĂҲ૜ޘ਌కϨᓙ׽ዔצጡഴ͌Ăҕ̚

Ҳ૜ޘ਌కϨᓙ׽ዔົ޺ᜈઐ੼ćͅ࿅ֽᄲĂࡶ

PCSK9 ૄЯࡎតޢ൴ϠΑਕಉε ( loss-of - func- tion ) үϡĂҲ૜ޘ਌కϨᓙ׽ዔצጡಶົЯࠎഴ

͌୻ੵ҃ᆧΐ̶ο૜ޘĂٙͽҕ̚Ҳ૜ޘ਌కϨ ᓙ׽ዔ޺ᜈ୻ੵ҃ઐҲĄҋ 2003 ѐֽౙᜈϤБ

͵ࠧЧ઼ಡӘ̶ژ۞छ୉ঽּಶ׶˯ࢗଐڶӚ ЪĂಶߏ൴ϠΑਕᆧૻࡎត۞छ୉јࣶវ̰Ҳ૜

ޘ਌కϨᓙ׽ዔצጡౌޝ͌Ăҕ̚Ҳ૜ޘ਌కϨ ᓙ׽ዔౌޝ੼Ă౵ࢦࢋ۞ߏछ୉?ѣޝкѝ൴ّ

͕ҕგ়ঽѪ˸۞јࣶć̝ͅĂ൴ϠΑਕಉεࡎ ត۞छ୉јࣶវ̰ጾѣ੼ณҲ૜ޘ਌కϨᓙ׽ዔ צጡĂҕ̚Ҳ૜ޘ਌కϨᓙ׽ዔౌޝҲĂछ୉

ໂ͌൴Ϡ͕ҕგ়ঽѪ˸۞९ּĄϤͽ˯ྤफ़Ξ ͽ̂ᓙடീĂ఺࣎າ൴ன۞ૄЯΑਕޝΞਕߏ˭

˘࣎Ξͽࡁ൴ͽ೩ֻϏֽ੼ҕ਌াڼᒚ۞ϫᇾĄ

ඕኢ

ၙّඪঽଈ۰׎੼ҕ਌া̈́ҕ਌ள૱۞஽Җ த੼ĂТॡϺࠎ͕ҕგ়ঽ۞੼ПᐍཏĂ͕ҕგ

়ঽѪ˸ҫٙѣ౅ژঽଈѪ˸Ҍ͌Ѻ̶̝α˩ͽ

˯Ąܕ˟˩ѐֽĂ statins ࠎڼᒚҕ਌ள૱ă࿰֨

׶ڼᒚજਔർ̼ă͕ҕგ࠹ᙯ়ঽ̝ࢦࢋᘽۏĂ

҃Яࠎඪ᝙ঽঽଈ૱Ъ׀਌ኳள૱Ăٙͽ˵૱జ

఍͞ statins Ą statins ϡдඪ᝙ঽঽଈ۞щБّ̂

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࡭֭Ϗ׶׎΁ܧඪ᝙ঽঽଈѣځពमளĂ҃ͷֹ

ϡޢ၆ᅅ̚ޘඪΑਕள૱۞ঽଈĂ˘ᇹΞͽഴ͌

͕ҕგ়ঽ۞Ꭾঽ̈́Ѫ˸Ă̙࿅ statins ۞ֹϡ၆ ഴᅅకϨԌ֭൑ځពѣड़۞үϡĂ҃ͷ˵̙ቁؠ statins ૟ҕ਌ࢫҲޢਕؼቤඪΑਕೋ̼ĄۡҌϫ

݈ࠎͤĂ֭՟ѣ֖ૉѣड़۞ࡁտֽ͚޺ٕͅ၆ statins дࢦޘၙّඪ᝙ঽଈ۰ҕ਌ள૱۞ڼᒚड़

ৈĂ̙࿅д૟ֽೀѐ̰ᑕྍಶਕૉ࠻זೀี̂ݭ

݈ᖀّᓜԖࡁտඕڍĂΞቁ၁ෞҤ statins ߏӎਕ ࢫҲࢦޘၙّඪ᝙ঽࠤҌତצ౅ژ۞ঽଈ̝͕ҕ გᎮঽ̈́Ѫ˸தĄາ۞ڼᒚ̪ᔘдࡁտ̚ĂΒ߁ CETP Ժט጗րЕᘽۏͽ̈́ PCSK9 ૄЯΑਕአ༼

͞ࢬĂᑕߏ̫ޢᇴѐጯࠧͽ̈́ᘽࠧӅ˧۞ࢦ͕Ą

ણ҂͛ᚥ

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Dyslipidemia and Its Treatment in Patients with Renal Disorders

Szu-Chia Chen

¹

, Jer-Ming Chang

^1,2,3

, and Hung-Chun Chen

^2,3

Chronic kidney disease ( CKD ) is associated with dyslipidemia, which occurs as a consequence of nephrot- ic syndrome or renal insufficiency and are reflected in altered apolipoprotein profile as well as elevated plasma lipid levels. High cholesterol and triglyceride plasma levels have been reported to be independent risk factors for development of cardiovascular disease and renal progression. Statins are widely prescribed for the prevention of cardiovascular disease in the general population, and patients with kidney disease, including patients on dial- ysis. It has been shown that statin treatment reduces proteinuria and slows renal progression, although fewer and smaller trials exist. Therefore, long-term, large scaled clinical trials are needed to demonstrate the efficacy of statins on patients receiving renal replacement therapy. This review will focus on the impact of lipid disorder on renal diseases, and the effect of statins on proteinuria, on patients with CKD, and on dialysis patients. We al- so discuss treatment for dyslipidemia in patients with renal disorders based on up to date research. ( J Intern Med Taiwan 2008; 19: 128- 135 )

1

Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;

2

Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;

3

Department of Internal Medicine, Faculty of Renal Care, College of Medicine,

Kaohsiung Medical University, Kaohsiung, Taiwan