Липопротеин(а) и заболевания почек

Липопротеин(а) [Лп(а)] представляет собой подкласс липопротеинов, состоящий из богатой холестерином частицы липопротеина низкой плотности (ЛПНП) с одной молекулой аполипопротеина В100, ковалентно связанной дисульфидным мостиком с уникальным гидрофильным высокогликозилированным белком, называемым аполипротеином a [апо(а)]. К настоящему времени имеется достаточно данных, чтобы рассматривать повышение уровня Лп(a) как причинный и независимый фактор риска сердечно-сосудистых заболеваний (ССЗ) и кальцинирующего стеноза аортального клапана (КСАК). Содержание Лп(a) в плазме крови может колебаться в широком диапазоне, что преимущественно определяется генетическими факторами. Повышение уровня Лп(a) затрагивает до 30 % населения во всем мире, однако данной категории липидных расстройств в настоящее время не уделяется должного внимания. Определение уровня Лп(a) не входит в стандартный липидный профиль, поэтому значительное количество лиц с гиперлипопротеи-немией (а), которые потенциально могли бы получить пользу от лечения, остается недиагносцированными. Определенные ограничения по-прежнему связаны с отсутствием стандартизированного метода измерения концентрации Лп(a) и консенсуса в отношении оптимальных его уровней в плазме крови. Несмотря на наличие ограниченных, но статистически значимых данных, свидетельствующих о благотворном влиянии его снижения на клинические исходы, нет единства представлений об оптимальных мерах нормализации уровня Лп(a) в плазме крови. Содержание Лп(a) в сыворотке крови отражает баланс между его синтезом, происходящим в печени, и катаболизмом, в котором, по мнению ряда авторов, значимую роль играют почки. Увеличение содержания Лп(a) отмечается уже на ранних стадиях хронической болезни почек (ХБП), а пациенты с нефротическим синдром имеют четырехкратное повышение Лп(a) по сравнению со здоровыми лицами. Тем не менее, до конца остается не ясным, в какой степени повышенные уровни Лп(a) будут влиять на сердечно-сосудистый риск у больных с нефропатиями. В данной статье представлены основные сведения относительно взаимосвязи между содержанием Лп(a), нарушениями функции почек и повышенным риском неблагоприятных кардиоваскулярных событий.

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