血脂代谢指标在慢性肾脏病进展的相关意义研究

发布时间：2018-10-19 18:25

【摘要】：目的：研究慢性肾脏病(chronic kidney disease,CKD)中血脂代谢指标变化与肾脏疾病进展的相关性,旨在为CKD患者临床合理调控血脂代谢提供研究数据。方法：采集2014年7月至2015年2月在解放军总医院肾脏病科住院并同意参加本研究的患者446例,所有患者均记录一般临床资料,包括患者基本情况和简要病史及是否包括患有原发性高脂血症及原发性高脂血症家族史；一般指标(身高、体重、血压)、检测血常规、血生化：含血糖、尿酸、肌酐、尿素、血脂多项指标：总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、高低密度脂蛋白(high density lipoprote in, HDL)、低密度脂蛋白(low density lipoprotein, LDL)等、甲状旁腺激素(parathyroid hormone, PTH)、血清胱抑素(Cystatin C)、同型半胱氨酸、尿常规、24h尿蛋白定量、尿微量白蛋白/肌酐等指标,部分患者行肾脏穿刺活检术,建立EXCEL数据库。计算身高体重指数(body mass index,BMI)、用EPI公示估算肾小球滤过率(estimated glomerular filtration rate,eGFR),根据2007年K/DOGI指南进行CKD分期,完善临床数据库。第一部分：分析CKD患者血脂代谢指标与肾脏病临床指标的相关性。从446例登记患者中选择符合纳排标准的患者221人,计算eGFR,将患者分为A组(eGFR≥60 ml/min·1.73m2)、B组(eGFR为30-60 ml/min · 1.73m2)和C组(eGFR30ml/min · 1.73m2),比较各组血脂指标的差异,观察血脂指标与肾功能指标等相关性,应用多元逐步回归分析研究CKD患者血脂指标与肾脏疾病进展的相关因素。第二部分：分析IgA肾病(IgA nephropathy, IgAN)患者血脂代谢指标与肾脏进展指标的相关性。入选符合纳排标准IgAN患者110例,计算eGFR,研究分组同第一部分,比较各组血脂指标差异,观察血脂指标与肾功能指标、蛋白尿等相关性,应用多元逐步回归分析研究IgA肾病患者血脂指标变化与肾脏疾病进展的相关因素。结果：1、第一部分研究发现,TC水平C组B组A组(P0.05),TC随着eGFR的降低，，逐渐升高；TC、TG和LDL的升高和HDL的降低均与肌酐的升高相关,高TC和高LDL水平与尿蛋白程度相关。2、第二部分研究发现,TC水平从eGFR60ml/min·1.73m2开始显著升高,TC水平与肌酐及蛋白尿呈正相关,TG升高与肌酐水平正相关,高LDL与尿蛋白呈正相关。结论：本研究主要探讨CKD中血脂代谢指标变化与肾脏疾病进展的相关性。结果表明CKD患者的TC水平随着eGFR的降低逐渐升高：TC、TG和LDL的升高和HDL的降低均与肌酐水平呈正相关。IgAN患者TG升高与肌酐水平正相关,高LDL与尿蛋白呈正相关。提示血脂代谢变化与CKD的进展有关,需要引起临床医师关注并进一步研究。
[Abstract]:Objective: to study the correlation between the changes of lipid metabolism and the progression of renal disease in chronic kidney disease (chronic kidney disease,CKD), in order to provide data for clinical rational regulation of blood lipid metabolism in patients with chronic kidney disease (CKD). Methods: from July 2014 to February 2015, 446 patients who were admitted to the Department of Nephrology of PLA General Hospital and agreed to participate in the study were collected. Including the patient's basic condition and brief medical history and whether to include the family history of primary hyperlipidemia and primary hyperlipidemia; general indicators (height, weight, blood pressure), blood routine examination, blood biochemistry: blood sugar, uric acid, creatinine, urea, Serum lipid: total cholesterol (total cholesterol, TC), triglyceride (triglyceride, TG), low density lipoprotein (high density lipoprote in, HDL), low density lipoprotein (low density lipoprotein, LDL) et al; serum cystatin (Cystatin C), homocysteine of parathyroid hormone (parathyroid hormone, PTH),; urine routine; 24h urinary protein quantification; Urinary microalbumin / creatinine index, some patients underwent renal biopsy to establish EXCEL database. The body mass index (body mass index,BMI) and glomerular filtration rate (estimated glomerular filtration rate,eGFR) were estimated by EPI. According to the K/DOGI guidelines in 2007, CKD staging was carried out to improve the clinical database. Part one: analyze the correlation between blood lipid metabolism index and renal disease clinical index in CKD patients. 221 patients were selected from 446 registered patients. The patients were divided into group A (eGFR 鈮

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