他汀类药物治疗原发肾病综合征致肝损害的临床特点分析

Liver damage in patients with primary nephrotic syndrome caused by statins therapy: Clinical characteristics

目的探讨他汀类药物治疗原发性肾病综合征发生肝损害患者的临床特点。方法选取2014-01至2019-01重庆医科大学附属第一医院肾内科88例住院期间使用他汀类药物的成人原发肾病综合征患者,按照发生肝损害与否分为A组(n=31,肝损害组)与B组(n=57,无肝损害组),比较两组患者入院时的临床特点。结果88例患者中主要病理类型为:肾小球轻微病变(minimal change disease,MCD)26例(29.5%),膜性肾病(membranous nephropathy,MN)21例(23.9%),免疫球蛋白A(immunoglobulin A)肾病17例(19.3%)。两组患者年龄、性别、血清白蛋白(albumin,Alb)、血尿酸(serum uric acid,SUA)、肾脏病理及是否联合使用激素比较,差异均有统计学意义(P<0.05);两组患者体重指数(body mass index,BMI)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、24 h尿蛋白定量、合并疾病(高血压、糖尿病、感染、急性肾损伤)比较,差异均无统计学意义(P>0.05)。结论原发性肾病综合征使用他汀类药物治疗时,男性、较低血清白蛋白、高血尿酸、联合使用激素以及MCD患者发生肝损害的可能性更大;临床中需掌握患者基本情况及临床特点,并根据患者情况调整用药,以期避免肝损害的发生。

Objective To investigate the clinical characteristics of liver damage in patients with primary nephrotic syndrome caused by the statins therapy.Methods 88 adults with primary nephrotic syndrome(PNS)treated with statins in the nephrology department of the First Affiliated Hospital of Chongqing Medical University from January 2014 to January 2019 were divided into two groups according to whether liver damage occurred or not.Group A(n=31)were those with liver damage,and group B(n=57)were those with no liver damage.The clinical features of 88 adults at the time of admission were compared between the two groups.Results The most common pathological types of 88 patients were minimal change disease(MCD),membranous nephropathy(MN)and immunoglobulin A(IgA)nephropathy,accounting for 29.5%,23.9%,19.3%,respectively.There were differences in age,gender,albumin(Alb),serum uric acid(SUA),renal pathology and whether hormone was combined between group A and group B(P<0.05);there was no significant difference in body mass index(BMI),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),24-hour proteinuria and combined disease(hypertension,diabetes,infection,acute kidney injury)between the two groups(P>0.05).Conclusions Patients with PNS who are male,with lower serum albumin,high serum uric acid,combined with hormone and MCD are susceptible to liver damage when using statins.It is necessary to observe the basic condition and clinical characteristics of patients,and to adjust the medication according to the patient's condition,aimingto avoid the occurrence of liver damage.