血脂异常与狼疮性肾炎病情活动的相关性

Correlation between dyslipidemia and disease activity of lupus nephritis

目的探讨血脂异常与狼疮肾炎(lupus nephritis,LN)病情活动的相关性。方法回顾性分析2016年1月至2019年1月于武汉大学人民医院肾内科诊断为LN的患者472例,其中行肾穿刺活检术的患者212例,按照2∶1比例抽取健康体检者236例。根据LN患者狼疮活动度评分(systemic lupus erythematosus disease activity index,SLEDAI)、狼疮性肾炎病理类型、血脂水平[总胆固醇(total cholesterol,TC)、总三酰甘油(total glyceride,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)]进行分组,收集患者实验室检查指标,采用方差分析及相关性分析,探究LN患者血脂异常与LN病情活动度的相关性。结果①LN患者血脂平均水平(TC、TG、HDL-C、LDL-C)均高于健康体检者,其中TC、TG、HDL-C水平比较差异具有统计学意义(P<0.01);②LN血脂异常组患者TC、TG、LDL-C、SLEDAI、24 h尿总蛋白(24-hour urine total protein,24hUTP)、尿素氮(urea nitrogen,BUN)、尿酸(uric acid,UA)、D二聚体(D-Dimmer)、血沉水平高于血脂正常组,估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、HDL-C、血清白蛋白低于血脂正常组,差异具有统计学意义(P<0.05);③Ⅳ型、Ⅴ型、Ⅳ+Ⅴ型LN患者血脂异常发病率最高,各组之间TC(F=3.119,P=0.006)、LDL-C(F=2.237,P=0.041)水平比较,差异有统计学意义(P<0.05);④不同SLEDAI分组间LN患者TC(F=4.839,P=0.008)、TG(F=3.105,P=0.046)、LDL-C(F=4.605,P=0.010)水平差异有统计学意义(P<0.05),其中重度活动组LN患者TC、TG、LDL-C水平显著升高;⑤Logistics回归分析显示TC、TG升高,HDL-C降低是LN发生的危险因素;⑥Pearson相关分析显示LN患者体内TC、TG、HDL-C水平与SLEDAI呈正相关关系(r>0,P>0.05),HDL-C水平与SLEDAI呈负相关关系(r<0,P<0.05)。结论LN患者体内血脂水平与SLEDAI呈明显相关关系,早期监测LN患者血脂水平,对了解LN患者病情活动具有重要意义。

Objective To explore the correlation between dyslipidemia and lupus nephritis(LN).Methods From January 2016 to January 2019,472 LN patients were retrospectively analyzed.And 212 of them received renal biopsy and 236 healthy people were selected according to a ratio of 2:1.Based upon lupus activity score(SLEDAI),pathological type of LN and blood levels of total cholesterol(TC),total triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)were recorded.Analysis of variance and correlation were utilized for examining the correlation between dyslipidemia and disease activity of LN.Results The average levels of blood lipids(TC/TG/HDL-C/LDL-C)in LN patients were higher than those in healthy subjects and the differences in the levels of TC,TG and HDL-C were statistically significant(P<0.01);The levels of TC,TG,LDL-C,SLEDAI and 24-hour LDL-C were higher in LN dyslipidemia group.The incidence rate of total protein 24hUTP,urea nitrogen(BUN),uric acid(UA),D-dimmer and erythrocyte sedimentation rate(ESR)in urine were higher than those in normal lipid group.Estimated glomerular filtration rate(eGFR),LDL-C and albumin(Alb)were lower than those of normal lipid group(P<0.05).Significant differences existed in TC(F=4.839,P=0.008),TG(F=3.105,P=0.046)and LDL-C(F=4.605,P=0.046)among different SLEDAI groups.The levels of TC,TG and LDL-C were significantly higher in severe active group than those in control group(P<0.05).Logistic regression analysis showed that the elevation of TC/TG and the reduction of HDL-C were the risk factors of LN.Pearson’s correlation analysis indicated that the levels of TC,TG and LDL-C were positively correlated with SLEDAI(r>0,P>0.05)while the level of HDL-C negatively correlated with SLEDAI(r<0,P<0.05).Conclusion A significant correlation exists between blood lipid level and SLEDAI in LN patients.Early monitoring of blood lipid level is of great significance for tracking the disease activity of LN patients.