糖尿病肾病患者血脂异常与尿蛋白关系

Relationship Between Dyslipidemia and Proteinuria in Patients with Diabetic Nephropathy

探讨糖尿病肾病(DN)患者血脂异常与尿蛋白关系.选取122例住院的DN患者,年龄(62.26±12.67)岁,女性49例,男性73例,测定血脂代谢各指标,同时留取24h尿蛋白定量(24h pro),依据蛋白尿定量分为肾病和非肾病综合征组,比较两组相关血脂指标,并行相关性分析比较.肾病综合征组患者的TC(总胆固醇)、NHDL、Lpa和Apo-B水平均显著高于非肾病综合征组(P<0.05);TC、NHDL、Apo-B和Apo-E均分别与24h尿蛋白定量和糖化血红蛋白(HbA1C)相关(P<0.01),Lpa与24h尿蛋白定量及肾小球滤过率(eGFR)相关,LDL-C及TG仅与HbA1C相关(P<0.01),Apo-A1仅与24hpro相关(P<0.05);各血脂指标依据四分位法分组,TC、NHDL-C、TG、Apo-A1、Apo-B、Lpa及Apo-E随着数值升高,组内24h尿蛋白定量(≥3.5g)百分比例增高(P<0.05),而LDL-C及HDL-C组内比较无统计学差异(P>0.05).DN患者随着24h蛋白尿增多,血脂异常更为显著,尤其在肾病综合征患者以TC、NHDL、Lpa及Apo-B升高为主,而血脂异常进一步加重肾脏病进展,有效控制血脂有望改善肾脏病预后.

The relationship between 24 h urine protein excretion with dyslipidemia in diabetic nephropathy （DN） patients was evaluated. A total of 122 DN patients （49 females and 73 males） with an average age of （62.26±12.67） were included in this study. 24-hour urine were collected for 24 hprotein（24hpro） meas urement and blood samples were taken as lipid parammeters. According to 24 h pro assays, subjects were divided into nephrotic group and non-nephrotic group. Lipid profiles and correlation analysis were corn pared between the two groups. It is found that the levels of total cholesterol（TC）, non high density lipo- protein （NHDL）, lipoprotein （a） [Lp（a）], and apolipoprotein B （ApoB） were much higher in nephrotic- group compared with non-nephrotic one （P〈0.05）. In correlation analysis, TC, NHDL, Apo-B and Apo- E were found to be related to 24 h urine protein and HbA1C （P〈0.01） respectively and Lpa was related to 24 h pro and eGFR. LDL-C and TG were independently associated with HbA1C （P〈0.01） while Apo-A1 was only associated with 24 h pro （P〈0.05）. In each group classified according to quartiles of lipid pro- file, it is found that the proportion of patients with 〉3.5 g/24 h urine protein excretion grew progressive- ly with the increase in TC, NHDL-C, TG, Apo-A1, Apo-B,Lpa and Apo-E （P^0.05） while LDL-C and HDL-C had no statistical differences （P^0.05）. Conclusion. In patients with diabetic nephropathy, an obvious dyslipidemia was observed with increase of 24 h urine protein excretion, especially in those with nephrotic syndrome who mainly present with the an elevation in TC, NHDL, Lpa and Apo-B. Since dys- lipidemia could aggravate the progress of kidney disease, an effective control of lipid profile is likely to im- prove the prognosis.