维持性血液透析患者血脂危险因素分析

Risk factors of serum lipid in patients undergoing maintenance hemodialysis

目的分析维持性血液透析(Maintenance hemodialysis,MHD)患者影响血脂的因素。方法 43例MHD患者常规血液透析前抽取空腹静脉血行实验室检查,分析血脂与年龄、民族、性别、血透龄和血透频率的相关性,P<0.05的变量选为控制变量进行血脂与实验室指标的偏相关分析;偏相关分析结果为P<0.05的变量进行血脂与实验室指标的多元回归线性分析。结果单因素相关分析显示仅性别及血透龄和血脂(脂蛋白a除外)的相关性有统计学意义(P<0.05)。偏相关分析结果示血常规、胆红素、血浆蛋白、果糖胺、透析前血肌酐、二氧化碳结合力、血钾和血钙均与血脂相关(P<0.05)。多元线性回归分析显示血钙和果糖胺升高是总胆固醇、低密度脂蛋白胆固醇及载脂蛋白B升高的危险因素;血常规中性粒细胞百分比降低是甘油三酯升高、高密度脂蛋白胆固醇降低的危险因素,白细胞计数低是脂蛋白a升高的危险因素;血浆总蛋白降低及血透龄是高密度脂蛋白胆固醇及载脂蛋白A1降低的危险因素(P<0.05)。结论高血钙、高果糖胺、低血浆总蛋白、血透龄长、血白细胞计数低及中性粒细胞百分比降低是MHD患者影响血脂的危险因素。

Objective To explore the risk factors of serum lipid in patients undergoing maintenance hemodi-alysis （MHD）. Methods Blood simple of 43 MHD patients were obtained for laboratory tests before routine hemodi-alysis. The correlation between serum lipid and clinical characteristics including age, gender, ethnicity, dialysis vin-tage and dialysis frequency was analyzed. Pearson and spearman correlation were used to assess the relationship be-tween serum lipid and clinical characteristics and variables were treated as control variables in partial correlation anal-ysis when P〈0.05. Partial correlation was used to assess the relationship between serum lipid and laboratory parame-ters. Multivariable linear regression was used to assess the association of serum lipid and some laboratory parameters which were significantly related to serum lipid in partial correlation. Results Only gender and dialysis vintage were significantly related to serum lipid （but not lipoprotein （a）） in univariate correlation analysis. Blood component, biliru-bin, plasma protein, fructosamine, pred-dialysis serum creatinine, CO2cp, serum potassium and calcium were signifi-cantly related to serum lipid in partial correlation analysis. Multivariable linear regression showed that increased se-rum calcium and fructosamine were risk factors of higher total cholesterol （βequal to 0.434, 0.403, respectively）, high-er low density lipoprotein cholesterol （βequal to 0.397, 0.395, respectively） and higher apolipiprotein B （βequal to 0.25, 0.307, respectively）. Meanwhile, Lower neutrophil percentage was risk factor of higher triglyceride （β=-0.357） and lower high density lipoprotein cholesterol （HDL-c） （β=0.358） and white blood cell counts decrease was risk factor of higher lipoprotein（a） （β=-0.406）. Additionally, total protein decrease and longer dialysis vintage were risk factors of lower HDL-c （βequal to 0.367,-0.378, respectively） and apolipoprotein A1 （βequal to 0.272,-0.343, respectively）, P〈0.05. Conclusion Higher serum calcium, higher fructosamine, lower plasma total protein, longer dialysis vintage, lower white blood cell counts and neutrophil percentage may act as risk factors of lipid profile in MHD patients.