血清小而密低密度脂蛋白胆固醇与维持性血液透析患者颈动脉内膜中层厚度的相关性分析

Correlation analysis of serum small and dense low-density lipoprotein cholesterol and carotid intima-media thickness in maintenance hemodialysis patients

目的探讨血清小而密低密度脂蛋白胆固醇(small and dense low-density lipoprotein cholesterol,sdLDL-C)与维持性血液透析(maintenance hemodialysis,MHD)患者颈动脉内膜中层厚度(intimamedia thickness,IMT)的相关性。方法选取2016年1月至2019年12月在大连市中心医院血液净化中心行维持性血液透析治疗的终末期肾脏病(end-stage renal disease,ESRD)患者作为研究对象,包括IMT正常血液透析组(36例)和IMT异常血液透析组(104例),以及同期健康体检者(30例)作为健康对照组。收集所有研究对象的基本资料、实验室检测指标和颈动脉超声检查结果,分析包括血清sdLDL-C在内的多项指标在不同IMT分组中的水平差异及相关性。结果血液透析组中血尿素氮(BUN)、肌酐(CR)、sdLDL-C等指标比较差异存在统计学意义(P<0.05);有序多因素Logistic回归分析结果显示,sdLDL(OR=4.787,95%CI 1.704~13.464,P=0.003)和透析时间(OR=1.033,95%CI 1.001~1.057,P=0.045)是IMT的独立相关因素;并且血清sdLDL-C与血液透析患者的颈动脉内膜中层厚度IMT呈显著正相关(内膜增厚组r=0.611,P<0.01,斑块形成组r=0.576,P<0.01)。结论sdLDL-C是维持性血液透析患者颈动脉狭窄的独立危险因子。

Objective To investigate the correlation between serum small and dense low-density lipoprotein cholesterol(sdLDL-C)and carotid intima-media thickness(intimamedia thickness,IMT)in patients with maintenance hemodialysis(MHD).Methods Patients with end-stage renal disease(ESRD)who underwent maintenance hemodialysis in the blood purification center of our hospital from January 2016 to December 2019 were selected as the research subjects,including the normal IMT hemodialysis group(36 cases)and the abnormal IMT hemodialysis group(104 cases),and healthy persons for medical examines(30 cases)during the same period served as the healthy control group.The basic data,laboratory test indicators and carotid ultrasound examination results of all the research subjects were collected,and the level differences and correlations of multiple indicators including serum sdLDL-C among different IMT groups were analyzed.Results There was a statistically significant difference in the comparison of blood urea(UREA),creatinine(CR),sdLDL-C and other indicators in the hemodialysis groups(P<0.05).Order logistic regression analysis showed that sdLDL(OR=4.787,95%CI 1.704~13.464,P=0.003)and dialysis time(OR=1.033,95%CI 1.001~1.057,P=0.045)were independent risk factors of IMT in MHD patients.Serum sdLDL-C and IMT were significantly positively correlated(intimal thickening group,r=0.611,P<0.01);plaque formation group,r=0.576,P<0.01).Conclusions SdLDL-C can be used as an independent risk factor for carotid artery stenosis in maintenance hemodialysis patients.