特发性膜性肾病患者血清维生素D结合蛋白检测及临床意义
发布时间：2018-06-24 20:54
本文选题：特发性膜性肾病 + 维生素D结合蛋白 ； 参考：《广西医科大学》2017年硕士论文
【摘要】：目的:探讨特发性膜性肾病(IMN)患者的血清维生素D结合蛋白(VDBP)的水平的影响因素以及VDBP与IMN临床预后的相关性。方法:以2013年6月-2015年8月在广西医科大学第一附属医院肾内科行肾活检病理诊断为膜性肾病,临床排除继发因素,确诊为特发性膜性肾病的患者58例为IMN组,同时选取性别、年龄与病例组相仿的健康体检者21例作为对照组。测定两组的血清VDBP,及IMN组患者25(OH)D水平,并根据VDBP及白蛋白计算出功能性25(OH)D水平。收集IMN组临床资料、生化指标、病理资料及治疗方案以及随访12个月的临床资料。比较两组的生化指标差异,并通过相关分析及多元线性回归分析,了解血清VDBP的影响因素。根据随访12个月时的缓解情况分为缓解组和未缓解组,比较两组间的基线血清25(OH)D水平及功能性25(OH)D水平。结果:1.纳入的58例IMN患者基本情况:男性35例(60.3%),女性23例(39.6%),平均年龄48.45±14.63岁,平均估计肾小球滤过率(eGFR)为75.22±21.26ml/(min1.73m2)。其中表现为肾病综合征29例(50.0%),合并高血压12例(20.7%)。血清25(OH)D≤37nmol/L的患者50例(86.2%),血清25(OH)D≤75nmol/L且血清25(OH)D37nmol/L的患者8例(13.8%)。2.分组比较:IMN组与对照组比较,IMN组的血红蛋白、eGFR降低,白细胞计数、尿酸、总胆固醇、甘油三脂、低密度脂蛋白胆固醇升高,两组间差异有统计学意义(P0.05)。IMN组和健康对照组的VDBP水平分别为1018.23(611.09,1329.66)μg/ml和643.17(357.50,1078.17)μg/ml,IMN组高于对照组(Z=-2.097,P=0.036)。3.IMN患者血清VDBP水平相关因素的分析:VDBP水平与红细胞计数(r=0.265,P=0.044)、总胆固醇(r=0.342,P=0.009)呈正相关,与eGFR(r=-0.281,P=0.032)呈负相关。4.多元线性回归分析显示,eGFR是IMN患者血清VDBP水平的影响因素之一(?=-0.364,P=0.023)。5.随访结果:随访12个月时,58例IMN缓解26例(其中完全缓解11例,部分缓解15例),未缓解32例。缓解组基线血清25(OH)D水平高于未缓解组(Z=-1.979,P=0.048),缓解组基线功能性25(OH)D水平高于(Z=-2.314,P=0.021),两组间差异有统计学意义。结论:IMN患者的血清VDBP水平较正常人群升高;eGFR是IMN患者血清VDBP水平的影响因素之一;IMN患者基线血清25(OH)D水平及功能性25(OH)D可能与疾病缓解相关。
[Abstract]:Objective: to investigate the relationship between serum vitamin D binding protein (VDBP) and clinical prognosis of idiopathic membranous nephropathy (IMN). Methods: from June 2013 to August 2015, 58 patients with idiopathic membranous nephropathy were diagnosed as membranous nephropathy by renal biopsy from June 2013 to August 2015 in the Department of Renal Medicine, first affiliated Hospital of Guangxi Medical University. 58 patients with idiopathic membranous nephropathy were selected as IMN group. 21 healthy persons of the same age as the case group served as the control group. Serum VDBP and 25 (OH) D levels were measured in both groups and functional 25 (OH) D levels were calculated according to VDBP and albumin. The clinical data, biochemical index, pathological data and treatment plan of IMN group were collected and followed up for 12 months. The biochemical indexes of the two groups were compared, and the influencing factors of serum VDBP were analyzed by correlation analysis and multiple linear regression analysis. The baseline serum 25 (OH) D level and the functional 25 (OH) D level were compared between the remission group and the non-remission group. The result is 1: 1. The basic conditions of 58 IMNs included: 35 males (60.3%) and 23 females (39.6%) with an average age of 48.45 卤14.63 years. The mean estimated glomerular filtration rate (eGFR) was 75.22 卤21.26ml/ (min?1.73m2). There were 29 cases (50.0%) with nephrotic syndrome and 12 cases (20.7%) with hypertension. There were 50 (86.2%) patients with 25 (OH) D 鈮，
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