發(fā)布時間：2018-06-24 20:54

  本文選題：特發(fā)性膜性腎病 + 維生素D結(jié)合蛋白　； 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討特發(fā)性膜性腎病(IMN)患者的血清維生素D結(jié)合蛋白(VDBP)的水平的影響因素以及VDBP與IMN臨床預后的相關(guān)性。方法:以2013年6月-2015年8月在廣西醫(yī)科大學第一附屬醫(yī)院腎內(nèi)科行腎活檢病理診斷為膜性腎病,臨床排除繼發(fā)因素,確診為特發(fā)性膜性腎病的患者58例為IMN組,同時選取性別、年齡與病例組相仿的健康體檢者21例作為對照組。測定兩組的血清VDBP,及IMN組患者25(OH)D水平,并根據(jù)VDBP及白蛋白計算出功能性25(OH)D水平。收集IMN組臨床資料、生化指標、病理資料及治療方案以及隨訪12個月的臨床資料。比較兩組的生化指標差異,并通過相關(guān)分析及多元線性回歸分析,了解血清VDBP的影響因素。根據(jù)隨訪12個月時的緩解情況分為緩解組和未緩解組,比較兩組間的基線血清25(OH)D水平及功能性25(OH)D水平。結(jié)果:1.納入的58例IMN患者基本情況:男性35例(60.3%),女性23例(39.6%),平均年齡48.45±14.63歲,平均估計腎小球濾過率(eGFR)為75.22±21.26ml/(min1.73m2)。其中表現(xiàn)為腎病綜合征29例(50.0%),合并高血壓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.分組比較:IMN組與對照組比較,IMN組的血紅蛋白、eGFR降低,白細胞計數(shù)、尿酸、總膽固醇、甘油三脂、低密度脂蛋白膽固醇升高,兩組間差異有統(tǒng)計學意義(P0.05)。IMN組和健康對照組的VDBP水平分別為1018.23(611.09,1329.66)μg/ml和643.17(357.50,1078.17)μg/ml,IMN組高于對照組(Z=-2.097,P=0.036)。3.IMN患者血清VDBP水平相關(guān)因素的分析:VDBP水平與紅細胞計數(shù)(r=0.265,P=0.044)、總膽固醇(r=0.342,P=0.009)呈正相關(guān),與eGFR(r=-0.281,P=0.032)呈負相關(guān)。4.多元線性回歸分析顯示,eGFR是IMN患者血清VDBP水平的影響因素之一(?=-0.364,P=0.023)。5.隨訪結(jié)果:隨訪12個月時,58例IMN緩解26例(其中完全緩解11例,部分緩解15例),未緩解32例。緩解組基線血清25(OH)D水平高于未緩解組(Z=-1.979,P=0.048),緩解組基線功能性25(OH)D水平高于(Z=-2.314,P=0.021),兩組間差異有統(tǒng)計學意義。結(jié)論:IMN患者的血清VDBP水平較正常人群升高;eGFR是IMN患者血清VDBP水平的影響因素之一;IMN患者基線血清25(OH)D水平及功能性25(OH)D可能與疾病緩解相關(guān)。
[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 鹵14.63 years. The mean estimated glomerular filtration rate (eGFR) was 75.22 鹵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，

本文編號：2062907