REZUMAT
Introducere: Pacientii hemodializati cronic au un risc foarte crescut pentru ateroscleroza, care a fost caracterizata ca o boala inflamatorie. La subiectii umani, proteina C reactiva (PCR) este un reactant major de faza acuta, foarte sensibil. Ipoteza de lucru a acestui studiu este ca activarea raspunsului de faza acuta este responsabila pentru statusul proaterogen al pacientilor hemodializati. Material si metode: La 170 de pacienti hemodializati si la 50 de subiecti sanatosi (grupul de control) am determinat lipoproteina (a) [Lp(a)], lipidele, lipoproteinele si albumina serica, precum si legatura acestora cu PCR, ca marker sensibil al unui raspuns de faza acuta. Rezultate: PCR serica a fost peste 10 mg/L la 69 (40,6%) din cei 170 de pacienti hemodializati cronic si a fost semnificativ mai mare la pacientii hemodializati comparativ cu grupul de control (44,62 mg/L vs. 8,75 mg/L, p <0,01). Lp(a) si trigliceridele serice au semnificativ mai mari la pacientii hemodializati comparativ cu grupul de control (31,37 mg/dL vs. 19,69 mg/dL, p<0,01, si respectiv 2,76 mmol/L vs. 1,32 mmol/L, p<0.01). Colesterolul total si LDL-C serice nu au fost diferite fata de grupul de control. HDL-C seric si albumina serica au fost semnificativ mai mici la pacientii hemodializati fata de grupul de control (1,14 mmol/L vs. 1,35 mmol/L, p< 0,01, respectively 34,92 g/L vs. 39,67 g/L, p<0,01). Pacientii care au avut PCR crescuta au avut o Lp(a) semnificativ mai mare comparativ cu cei cu PCR in limite normale (35,39 mg/L vs. 28,6 mg/L, p<0,01). HDL-C seric si albumina serica au fost semnificativ mai mici la pacientii cu PCR reactiva crescuta decat la cei cu PCR in limite normale (0,91 mmol/L vs. 1,29 mmol/L, p<0,01, si respectiv 33,56 g/L vs. 35,86 g/L, p< 0,01). Concentratia PCR a corelat pozitiv cu Lp(a) (R = 0,58, p < 0,01) si negativ cu HDL-C si cu albumina serica (R = -0,88, p<0,01 si, respectiv, R = - 0,87, p< 0,01) la subiectii cu PCR crescuta, dar nu si la grupul de control si la cei cu CRP scazuta. Concentratia Lp(a) a corelat negativ cu albumina serica (R = -0,57, p< 0,01) la pacientii hemodializati cronic cu PCR crescuta, dar nu si la grupul de control si la pacientii cu PCR normala. Concluzii: Conform acestor rezultate, un numar considerabil de pacienti hemodializati prezinta un raspuns de faza acuta activat care este in stransa relatie cu un risc mult crescut de ateromatoza. PCR s-a corelat semnificativ cu lipidele plasmatice si cu albumina, care au fost dovediti ca predictori ai mortalitatii cardiovasculare la pacientii hemodializati.

ABSTRACT
Background: Patients on chronic hemodialysis have one of the highest risks for atherosclerosis, which has been characterized as an inflammatory disease. C-reactive protein (CRP) is a sensitive major acute phase reactant in humans. We therefore hypothesize that an activated acute phase response is responsible for the atherogenic condition in hemodialysis patients. Material and methods: In 170 hemodialysis patients and in 50 healthy controls lipoprotein (a) [Lp(a)], lipids, lipoproteins and serum albumin were determined in relation CRP, as a sensitive marker of an acute phase response. Results: Serum CRP was found to be elevated more than 10 mg/L in 69 (40.6%) from the 170 patients on chronic hemodialysis. Serum concentration of CRP was significantly higher in hemodialysis patients than in control group (44.62 mg/L vs. 8.75 mg/L, p < 0.01). Lp(a) and triglycerides serum levels were significantly higher in hemodialysis patients than in control group (31.37 mg/dl vs. 19.69 mg/dl, p < 0.01, and respectively 2.76 mmol/L vs. 1.32 mmol/L, p < 0.01). Total cholesterol and low density lipoprotein cholesterol (LDL-C) serum levels in hemodialysis patients are similar to those found in the control group. Serum levels of high density lipoprotein cholesterol (HDL-C) and serum albumin were significantly lower in hemodialysis patients than in control group (1.14 mmol/L vs. 1.35 mmol/L, p < 0.01, respectively 34.92 g/L vs. 39.67 g/L, p < 0.01). Patients with elevated CRP had significantly higher levels of Lp(a) compared with patients with CRP in normal range (35.39 mg/L vs. 28.6 mg/L, p < 0.01). Serum levels of HDL-C and serum albumin were significantly lower in patients with elevated CRP than in patients with values in normal range (0.91 mmol/L vs. 1.29 mmol/L, p<0.01, and 33.56 g/L vs. 35.86 g/L, p < 0.01, respectively). CRP levels correlated positively with Lp(a) (R = 0.58, p < 0.01) and negatively with HDL-C and serum albumin (R = -0.88, p < 0.01, and R = -0.87, p < 0.01, respectively) in patients with elevated CRP, but not in the control group and patients with low CRP. The Lp(a) levels correlated negatively with serum albumin (R = -0.57, p < 0.01) in hemodialysis patients with elevated CRP but not in the controls and in patients with low CRP. Conclusion: According to the results, a considerable number of hemodialysis patients exhibit an activated acute phase response which is closely related to high levels of atherogenic vascular risk. We found significant correlations of CRP with plasma lipids and albumin which have been proven as predictors of cardiovascular mortality in hemodialysis patients.