载脂蛋白B在糖尿病肾脏疾病患者进展到肾脏替代治疗中的预测价值

Predictive value of apolipoprotein B in the risk of progression to renal replacement therapy in diabetic kidney diseases patients

目的分析载脂蛋白B(apolipoprotein B,ApoB)在慢性肾脏病(chronic kidney diseases,CKD)3~5期的糖尿病肾脏疾病(diabetic kidney disease,DKD)患者进展到肾脏替代治疗(RRT)中的预测价值.方法回顾性收集2011年1月到2014年11月在中山大学附属第三医院肾内科住院并随诊、临床资料详细完整的CKD 3~5期的DKD患者.按CKD-EPI公式计算估算肾小球滤过率(eGFR).随访2年,按是否进入肾脏替代治疗分为未进入RRT组和RRT组.采用Cox回归分析分析DKD进展到RRT的影响因素;通过绘制受试者工作特征曲线(ROC)分析ApoB对随访2年内DKD患者进入RRT的预测价值.通过建立多个Cox模型,逐步校正影响因素,分析ApoB升高对DKD患者进展到RRT的影响.结果共纳入病例258例,其中男性156例,女性102例,年龄(66.13±11.88)岁(27~91岁);CKD 3~5期患者分别为181、50、27例;未进入RRT组165例,RRT组93例.两组间比较发现,血红蛋白、红细胞压积、血磷、ApoB、血肌酐、尿素氮、血清胱抑素、eGFR及血管紧张素转换酶抑制剂、利尿剂、β受体阻滞剂使用比例方面差异有统计学意义(均P<0.05).多因素Cox回归分析结果显示,ApoB是DKD患者2年内进入肾脏替代治疗的独立预测因素(HR=2.203,95%CI 1.352~3.589,P=0.002).随访2年内,ApoB预测DKD进展到RRT的ROC曲线下面积为0.641(C-index=0.749,P<0.01).经校正混杂因素后,Cox回归分析结果显示,ApoB每升高1 mmol/L,CKD 3~5期DKD患者进展到RRT的风险增加1.038倍(HR=2.038,95%CI 1.312~3.168,P=0.002).结论ApoB是CKD 3~5期DKD患者进展到RRT的独立预测因素;ApoB每增加1 mmol/L,CKD 3~5期DKD患者进展到RRT的风险增加1.038倍.

Objective To analyze the predictive value of apolipoprotein B(ApoB)in the risk of progression to renal replacement therapy(RRT)in diabetic kidney disease(DKD)patients with chronic kidney disease(CKD)stage 3-5.Methods The data of DKD patients with CKD stage 3-5 who were hospitalized and followed up with detailed clinical data from January 2011 to November 2014 in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively collected.Estimated glomerular filtration rate(eGFR)was calculated according to the CKD-EPI formula.After 2 years of follow-up,the patients were divided into RRT group and non-RRT group according to whether they had entered renal replacement therapy.Cox regression analysis was used to analyze the influencing factors of DKD progression to RRT.The predicted value of ApoB in the risk of progression to renal replacement therapy(RRT)of DKD patients within 2 years of follow-up was analyzed by plotting the receiver operating characteristic curve(ROC).By establishing multiple Cox models,the effect of ApoB elevation on the progression of DKD patients to RRT was analyzed after adjusting for the influencing factors gradually.Results A total of 258 cases were included in this study,including 156 males and 102 females.They were(66.13±11.88)years old(27-91 years old).CKD 3-5 patients were 181 cases,50 cases and 27 cases respectively.There were 165 cases in the non-RRT group and 93 cases in the RRT group.There were statistically significant difference in hemoglobin,hematocrit,blood phosphorus,ApoB,serum creatinine,urea nitrogen,serum cystatin C,eGFR and in the proportion of using angiotensin converting enzyme inhibitor,diuretic,βblockers between the two groups(all P<0.05).Multivariate Cox regression analysis showed that ApoB was an independent predictor of progression to RRT in patients with DKD within 2 years(HR=2.203,95%CI 1.352-3.589,P=0.002).The area under the ROC curve of ApoB for DKD progression to RRT within 2 years of follow-up was 0.641(C-index=0.749,P<0.01).After adjusting for confounding factors,Cox regression analysis showed that for every 1 mmol/L increase in ApoB,the risk of RRT increased by 1.038 times in DKD patients with CKD stage 3-5(HR=2.038,95%CI 1.312-3.168,P=0.002).Conclusions ApoB is an independent predictor of progression to RRT with CKD stage 3-5 diabetic kidney disease(DKD).For every 1 mmol/L increase in ApoB,the risk of progression to RRT in patients with CKD 3-5 DKD increases by 1.038 times.