發(fā)布時(shí)間：2018-10-19 18:25

【摘要】：目的：研究慢性腎臟病(chronic kidney disease,CKD)中血脂代謝指標(biāo)變化與腎臟疾病進(jìn)展的相關(guān)性,旨在為CKD患者臨床合理調(diào)控血脂代謝提供研究數(shù)據(jù)。方法：采集2014年7月至2015年2月在解放軍總醫(yī)院腎臟病科住院并同意參加本研究的患者446例,所有患者均記錄一般臨床資料,包括患者基本情況和簡(jiǎn)要病史及是否包括患有原發(fā)性高脂血癥及原發(fā)性高脂血癥家族史；一般指標(biāo)(身高、體重、血壓)、檢測(cè)血常規(guī)、血生化：含血糖、尿酸、肌酐、尿素、血脂多項(xiàng)指標(biāo)：總膽固醇(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、甲狀旁腺激素(parathyroid hormone, PTH)、血清胱抑素(Cystatin C)、同型半胱氨酸、尿常規(guī)、24h尿蛋白定量、尿微量白蛋白/肌酐等指標(biāo),部分患者行腎臟穿刺活檢術(shù),建立EXCEL數(shù)據(jù)庫(kù)。計(jì)算身高體重指數(shù)(body mass index,BMI)、用EPI公示估算腎小球?yàn)V過(guò)率(estimated glomerular filtration rate,eGFR),根據(jù)2007年K/DOGI指南進(jìn)行CKD分期,完善臨床數(shù)據(jù)庫(kù)。第一部分：分析CKD患者血脂代謝指標(biāo)與腎臟病臨床指標(biāo)的相關(guān)性。從446例登記患者中選擇符合納排標(biāo)準(zhǔn)的患者221人,計(jì)算eGFR,將患者分為A組(eGFR≥60 ml/min·1.73m2)、B組(eGFR為30-60 ml/min · 1.73m2)和C組(eGFR30ml/min · 1.73m2),比較各組血脂指標(biāo)的差異,觀察血脂指標(biāo)與腎功能指標(biāo)等相關(guān)性,應(yīng)用多元逐步回歸分析研究CKD患者血脂指標(biāo)與腎臟疾病進(jìn)展的相關(guān)因素。第二部分：分析IgA腎病(IgA nephropathy, IgAN)患者血脂代謝指標(biāo)與腎臟進(jìn)展指標(biāo)的相關(guān)性。入選符合納排標(biāo)準(zhǔn)IgAN患者110例,計(jì)算eGFR,研究分組同第一部分,比較各組血脂指標(biāo)差異,觀察血脂指標(biāo)與腎功能指標(biāo)、蛋白尿等相關(guān)性,應(yīng)用多元逐步回歸分析研究IgA腎病患者血脂指標(biāo)變化與腎臟疾病進(jìn)展的相關(guān)因素。結(jié)果：1、第一部分研究發(fā)現(xiàn),TC水平C組B組A組(P0.05),TC隨著eGFR的降低，，逐漸升高；TC、TG和LDL的升高和HDL的降低均與肌酐的升高相關(guān),高TC和高LDL水平與尿蛋白程度相關(guān)。2、第二部分研究發(fā)現(xiàn),TC水平從eGFR60ml/min·1.73m2開始顯著升高,TC水平與肌酐及蛋白尿呈正相關(guān),TG升高與肌酐水平正相關(guān),高LDL與尿蛋白呈正相關(guān)。結(jié)論：本研究主要探討CKD中血脂代謝指標(biāo)變化與腎臟疾病進(jìn)展的相關(guān)性。結(jié)果表明CKD患者的TC水平隨著eGFR的降低逐漸升高：TC、TG和LDL的升高和HDL的降低均與肌酐水平呈正相關(guān)。IgAN患者TG升高與肌酐水平正相關(guān),高LDL與尿蛋白呈正相關(guān)。提示血脂代謝變化與CKD的進(jìn)展有關(guān),需要引起臨床醫(yī)師關(guān)注并進(jìn)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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