慢性肾脏病3、4期患者脂代谢紊乱相关因素分析

Dyslipidemias and their risk factors in patients with chronic kidney disease stages 3 and 4

目的观察慢性肾脏病(CKD)3、4期患者脂质代谢紊乱情况,并分析其相关因素。方法选择CKD 3、4期患者126例作为CKD组,同期健康体检者100例作为对照组。记录2组的性别比(F∶M)、年龄(Age)、收缩压(SBP)、舒张压(DBP)、BMI。采用日立7170A自动分析仪测定血脂(TC、TG、HDL、LDL)、肾功能(Scr、BUN、UA)、空腹血糖(FPG)、血清白蛋白(A)、血清白蛋白与球蛋白比值(A/G)、C反应蛋白(CRP);采用免疫比浊法检测D-二聚体(DD),放射免疫法检测内皮素(ET);采用免疫比浊法检测尿白蛋白,碱性苦味酸法检测尿肌酐,并计算肾小球率过滤(eGFR)、尿白蛋白/肌酐比值(ACR)。采用多因素Logistic回归分析与脂代谢有关的独立危险因素。结果 CKD组TC、TG、HDL、LDL分别为(5.49±1.68)、(2.63±0.89)、(0.99±0.36)、(2.98±0.61)mmoL/L,对照组分别为(4.26±0.84)、(1.86±0.54)、(1.13±0.42)、(2.40±0.48)mmoL/L,P均<0.05。CKD组3期TG、HDL分别为(2.15±1.08)、(1.08±0.42)mmoL/L,4期分别为(2.77±1.10)、(0.81±0.38)mmoL/L,P均<0.05。Logistic回归分析显示,eGFR、CRP为TC升高的独立危险因素,ACR、A、eGFR、DD、CRP为TG升高的独立危险因素,Age、eGFR为HDL降低的独立危险因素,ACR、CRP为LDL升高的独立危险因素,P均<0.05。结论 CKD患者多有脂代谢紊乱,4期脂代谢紊乱比3期更严重;ACR、A、Age、eGFR、DD、CRP是CKD患者脂代谢紊乱的独立危险因素。

Objective To investigate the dyslipidemias in patients with chronic kidney diseases （CKD） stages 3 and 4 and to analyze the related risk factors. Methods We chose 126 patients with CKD3, 4 as the CKD group, at the same time 100 healthy people were taken as the control group. Recording sex ratio （F： M）, age （Age）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, body mass index （BMI） and determining serum creatinine （Scr）, urea nitrogen （BUN）, uric acid （UA）, fasting plasma glucose （FPG）, total cholesterol （TC）, triglyceride （TG）, high-density lipo- protein cholesterol （HDL） , low density lipoprotein cholesterol （LDL） , serum albumin（A） and globulin ratio （A/G）, c- reactive protein （CRP）. D-dimer （DD） was detected by immunoturbidimetry, endothelin （ET） by radioimmunoassay, u- rinary albumin by immunoturbidimetry and urine ereatinine by alkaline pierate method. Then the glomerular filtration （ eG- FR） rate and urinary albumin/ereatinine ratio （ACR） in the two groups were calculated. Multivariable Logistie regression analysis was used to analyze the independent risk factors associated with lipid metabolism. Results The levels of TC, TG, HDL, LDL in the CKD group were （5.49 ± 1.68 ） mmoL/L, （ 2.63 ± 0.89 ） retooL/L, （0.99 ±0.36） mmoL/L and （2.98 ± O. 61 ） mmoL/L, respectively, and were （4.26 ± 0.84） mmoL/L, （ 1.86 ± 0.54 ） mmoL/L, （ 1.13 ± O. 42） mmoL/ L and （2.40 ± 0.48 ）mmoL/L in the control group, respectively （all P 〈 0.05 ）. The levels of TG and HDL in CKD stage 3 were（2.15 ± 1.08 ）mmoL/L and（ 1.08 ± 0.42）retooL/L, respectively, and in CKD stage 4 were（2.77 ± 1.10）mmoL/L and （ 0.81 ± 0.38 ） mmoL/L, respectively （ all P 〈 0.05 ）. Logistic regressive analysis showed that eGFR and CRP were theindependent risk factors for high TC; ACR, A, eGFR, DD and CRP were the independent risk factors for high TG; age and eGFR were the independent risk factors for low HDL; and ACR, CRP were the independent risk factors for high HDL （all P 〈 0.05）. Conclusions Dyslipidemias are common in CKD patients, which are more serious in CKD stage 4 than stage 3. The main risk factors of dyslipidemias are ACR, A, age, eGFR, DD and CRP.