2型糖尿病肾病患者肾血流阻力指数与血清脂蛋白a对肾功能进展的预测

Prediction of Renal Function Progression in Patients with Type 2 Diabetic Kidney Disease by Renal Blood Flow Resistance Index and Lipoprotein a

目的研究双肾血流阻力指数(RI)、血清脂蛋白a[Lp(a)]和2型糖尿病肾病(diabetic kidney disease,DKD)肾功能损害程度三者之间的关系,探讨RI联合Lp(a)在评估糖尿病肾病肾功能进展及预后的价值.方法使用Logistic回归分析2型DN患者中eGFR下降的相关危险因素.采用RI分为两组,比较RI升高组、正常组之间的人口学指标、检验指标及双肾多普勒彩超结果的差异,使用Pearson相关分析RI与各指标之间的相关性,采用Logistic回归分析RI升高的相关危险因素,比较RI升高组、Lp(a)升高组与RI合并Lp(a)升高组的差异,采用生存分析研究RI并Lp(a)升高对2型DKD预后的影响.结果2型DKD患者中eGFR下降的相关危险因素分析提示糖尿病病程、24h尿蛋白定量、RI的升高是2型DKD患者eGFR下降的独立危险因素.RI正常组与RI升高组各项临床参数比较提示RI与DKD之间有密切关系,且发现RI与Lp(a)之间有密切关系.RI与各临床参数的相关性分析进一步证实了RI与Lp(a)和eGFR之间都有显著的相关性,RI升高的相关危险因素分析提示Lp(a)、年龄、血肌酐的升高是RI升高的独立危险因素,RI并Lp(a)升高组与其余各组间临床参数比较提示RI并Lp(a)升高组相较于其他组在eGFR、右肾体积、尿d1微球蛋白水平较低,尿β2微球蛋白水平较高,差异有统计学意义(P<0.05).RI并Lp(a)升高对DN患者肾功能预后的影响生存分析提示RI合并Lp(a)升高的患者组肾脏生存率显著低于非双升组[RI或Lp(a)未升高组],差异有统计学意义(P<0.05).结论Lp(a)可以独立预测RI升高,RI可以独立预测2型糖尿病肾病肾功能进展,RI联合Lp(a)的检测可作为糖尿病肾病进展的标志物,肾功能下降早期行降脂蛋白a治疗的临床意义更大.

Objective To research the relations between the renal blood flow resistance index(RI),serum lipoprotein a[Lp(a)]and type 2 diabetic kidney disease kidney damage.To explore the value of RI combined with Lp(a)in the evaluation of renal function progression and prognosis of diabetic nephropathy.Methods Logistic regression was used to analyze the risk factors related to eGFR decline in type 2 DKD patients.The RI group was divided into two groups,and the differences in the demographic indexes,examination indexes and doppler ultrasound results between the RI elevated group and the normal group were compared.Pearson correlation analysis was used to analyze the correlation between RI and each indicator.Logistic regression was used to analyze the related risk factors of RI increase.The differences between the RI elevated group,Lp(a)elevated group and the RI combined Lp(a)elevated group were compared.Survival analysis was used to study the effect of elevated RI and Lp(a)on the prognosis of DN.Results The analysis of related risk factors for eGFR decline in type 2 DKD patients suggests that the course of diabetes mellitus,24-hour urine protein quantification,and RI increase are independent risk factors for eGFR decline in type 2 DKD patients.The comparison of clinical parameters between the normal RI group and the elevated RI group suggested that there was a close relationship between RI and DKD,and RI was found to be closely related to Lp(a).Correlation analysis between RI and various clinical parameters further confirmed that RI was significantly correlated with Lp(a)and eGFR.The analysis of related risk factors for RI elevation suggests that Lp(a),age,and serum creatinine elevation are independent risk factors for RI elevation.The comparison of clinical parameters between the RI and Lp(a)elevated group and the other groups indicated that the elevated RI and Lp(a)raised group had lower eGFR,right kidney volume,higher urinary 1 microglobulin level and higher urinary 2 microglobulin level than the other groups,and the difference was statistically significant(P<0.05).The influence of RI with Lp(a)increase on renal function prognosis of DKD patients survival analysis suggests that renal survival rate of patients with RI with Lp(a)increase was significantly lower than that of non-double-rise group[RI or Lp(a)not increased group],and the difference is statistically significant(P V.0.05).Conclusion Lp(a)can independently predict the elevation of RI,and RI can independently predict the progression of renal function in type 2 diabetic kidney disease.The detection of RI combined with Lp(a)can be used as a marker for the progression of diabetic kidney disease.The clinical significance of lowering lipoprotein a in the early stage of renal function decline is greater.