脂蛋白(a)与透析患者不良心血管结局：系统综述与荟萃分析。
完整摘要 · 中文译文
背景：接受维持性透析的患者心血管发病率和死亡率极高。脂蛋白(a) [Lp(a)] 在普通人群中被确定为心血管危险因素；然而，其在透析人群中的预后意义仍不明确。 方法：对评估维持性透析患者循环Lp(a)水平与不良心血管结局的观察性队列研究进行了系统评价和荟萃分析。检索了MEDLINE、Scopus、Web of Science和CENTRAL数据库，检索时间从建库至2026年5月5日。结局包括全因死亡率、心血管死亡率和主要不良心血管事件（MACE）。当至少两项研究报告了可比较的校正后风险比时，进行随机效应荟萃分析；基于极少研究的合并分析被视为探索性分析。 结果：共纳入15项报告，代表14个独立队列和6380例透析患者。其中9项研究仅评估血液透析人群，3项评估腹膜透析人群，2项评估混合透析队列。探索性荟萃分析显示，Lp(a)水平升高与全因死亡率（HR：1.58；95% CI：1.24-2.02）、心血管死亡率（HR：2.07；95% CI：1.22-3.50）和MACE（HR：1.56；95% CI：1.28-1.90）相关。MACE的证据确定性为低，死亡率结局的确定性为极低。 结论：现有证据表明，维持性透析患者高Lp(a)浓度与死亡率和不良心血管事件相关。然而，常规临床使用 用于心血管风险分层尚不能推荐，因为阈值、检测标准化、增量预测价值及治疗意义仍未明确。 试验注册：https://dx.doi.org/10.17504/protocols.io.dm6gp7491gzp/v1 。
完整摘要 · 英文原文
BACKGROUND: Patients receiving maintenance dialysis experience exceptionally high cardiovascular morbidity and mortality. Lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor in the general population; however, its prognostic significance in dialysis populations remains uncertain. METHODS: A systematic review and meta-analysis of observational cohort studies evaluating circulating Lp(a) levels and adverse cardiovascular outcomes in maintenance dialysis patients were conducted. MEDLINE, Scopus, Web of Science, and CENTRAL were searched from inception through May 5, 2026. The outcomes included all-cause mortality, cardiovascular mortality, and MACEs. Random-effects meta-analysis was performed when at least two studies reported comparable adjusted hazard ratios; pooled analyses based on very few studies were considered exploratory. RESULTS: Fifteen reports representing 14 unique cohorts and 6380 dialysis patients were included. Nine studies evaluated hemodialysis populations exclusively, three evaluated peritoneal dialysis populations, and two evaluated mixed dialysis cohorts. Exploratory meta-analyses revealed associations between elevated Lp(a) levels and all-cause mortality (HR: 1.58; 95% CI: 1.24-2.02), cardiovascular mortality (HR: 2.07; 95% CI: 1.22-3.50), and MACE (HR: 1.56; 95% CI: 1.28-1.90). Certainty was low for MACE and very low for mortality outcomes. CONCLUSIONS: Available evidence suggests an association between high Lp(a) concentrations and mortality and adverse cardiovascular events in maintenance dialysis patients. However, routine clinical use for cardiovascular risk stratification cannot yet be recommended because thresholds, assay standardization, incremental predictive value, and treatment implications remain unresolved. TRIAL REGISTRATION: https://dx.doi.org/10.17504/protocols.io.dm6gp7491gzp/v1 .