慢性肾脏病患者血脂变化特征及与氧化应激相关性研究

Study on the changes of blood lipid in patients with chronic kidney disease and its correlation with oxidative stress

目的 探讨慢性肾脏病(chronic kidney disease,CKD)患者血脂变化特点及对氧化、炎症指标的影响,为CKD患者血脂干预及抗氧化治疗提供依据。方法 选取2017年7月-2019年4月本院收治的CKD非透析患者269例作为研究对象,统计患者性别、年龄,并测定血红蛋白(hemoglobin,Hb)、血清白蛋白(albumin,Alb)、血肌酐(Serum creatinine,Scr)、胱抑素C(cystatin C,CYS-C)、尿酸(uric acid,UA)、超氧化物歧化酶(superoxide dismutase,SOD)及C反应蛋白(c-reactive protein,CRP)水平,血脂异常为实验组(145例),血脂正常为对照组(124例),两组内根据肾小球滤过率分1~2期、3~4期和5期,分别进行上述指标比较;以145例实验组患者为观察对象,根据血脂参数将其分5组,分别为高甘油三酯(HTG)组、低高密度脂蛋白(LHDL)组、混合型高脂血症(CH)组、混合型高脂血症(CH)+低高密度脂蛋白(LHDL)组及高甘油三酯(HTG)+低高密度脂蛋白(LHDL)组,进行上述指标比较;运用Pearson相关性分析判断相关性。结果 实验组与对照组比较:CKD1~2期差异均无统计学意义(P>0.05); CKD3~4期CRP水平比较差异有统计学意义,CKD5期SOD、CRP水平比较,差异有统计学意义(P<0.05),其余比较差异均无统计学意义(P>0.05); CKD合并高脂血症以TG升高、HDL降低为主要特点,单纯低HDL血症随病程进展明显增多;不同血脂特点组之间ALb、UA、CRP水平比较,差异无统计学意义(P>0.05);低HDL组Hb水平<CH组、高TG组,SOD水平<CH组,Scr、CYS-C水平>CH组、高TG组、高TG+低HDL组,差异有统计学意义(P<0.05); Hb水平与HDL、LDL、TC水平成正相关(P<0.05); CYS-C水平与HDL、LDL、TC水平成负相关(P<0.05); Scr水平与HDL、TG水平成负相关(P<0.05); SOD水平与HDL水平成正相关(P<0.01); CRP水平与LDL水平成负相关(P<0.05)。结论 CKD血脂特点主要表现为TG升高、HDL降低,随病程进展,HDL水平下降显著。HDL与SOD、Hb水平成正相关,与CYS-C、Scr水平成负相关,其水平变化与肾功能状态密切相关。

Objective To investigate the characteristics of blood lipid changes in patients with chronic renal disease(CKD)and their effects on oxidation and inflammation indexes,in order to provide evidence for lipid intervention and antioxidant therapy for CKD patients.Methods 269 cases of non-dialysis CKD patients in our hospital were selected,and gender and age of patients were counted,the level of hemoglobin(Hb),albumin(Alb),serum creatinine(Scr),cystatin C(CYS-C),uric acid(UA),superoxide dismutase(SOD)and c-reactive protein(CRP)were measured,patients with dyslipidemia were in the experimental group and those with normal blood lipid were in the control group.According to the glomerular filtration rate,the two groups were divided into stage 1~2,stage 3~4 and stage 5,and the above indexes were compared respectively,P<0.05 was considered statistically significant.A total of 145 patients in the experimental group were observed and divided into hypertriglyceridemia(HTG)group,low level of High-density lipoprotein cholesterol(LHDL)group,combined hyperlipidemia group(CH),CH with LHDL group and HTG with LHDL group according to lipid parameters,and the above indicators were compared,P<0.05 was considered statistically significant.Pearson correlation analysis was used to determine the correlation.Results Comparison between experimental group and control group showed that:there was no significant difference in CKD of stage 1~2(P>0.05),there was significant difference in CRP level in CKD of stage 3~4,there was significant difference in SOD and CRP level in stage CKD5(P<0.05),the other differences were not statistically significant.CKD complicated with hyperlipidemia was characterized by increased TG and decreased HDL,while single LHDL increased significantly with disease progression;There was no significant difference in ALb,UA and CRP levels among the 5 groups(P>0.05).Hb level in LHDL group was lower than CH group and HTG group;SOD level in LHDL group was lower than that in CH group;Scr and CYS-C levels in LHDL group were lower than HTG group,CH group and HTG with LHDL group(P<0.05).Pearson correlation analysis results show that Hb level was positively correlated with HDL,LDL and TC levels(P<0.05).CYS-C level was negatively correlated with HDL,LDL and TC levels(P<0.05).Scr level was negatively correlated with HDL and TG levels(P<0.05).SOD level was positively correlated with HDL level(P<0.01).CRP level was negatively correlated with LDL level(P<0.05).Conclusions The characteristics of lipid metabolism in CKD patients were mainly characterized by increase of TG and decrease of HDL,and the HDL decreased significantly with the progress of disease course.HDL is positively correlated with SOD,Hb levels,and negatively correlated with CYS-C and Scr levels,and its level change is closely related to renal function.