高密度脂蛋白与C反应蛋白比值对非透析慢性肾脏病进展的预测作用

Predictive Effect of High Density Lipoprotein to C-reactive Protein Ratio on Progression of Chronic Kidney Disease in Non-Dialysis Patient

【目的】探讨高密度脂蛋白(HDL)与C反应蛋白(CRP)比值(HDL/CRP)对非透析慢性肾脏病(CKD)患者肾功能恶化的预测作用。【方法】纳入2015年至2019年就诊于中山大学附属第三医院(天河院区、岭南院区),有至少2次随访数据的非透析慢性肾脏病患者。通过电子病案系统录入患者基线人口特点及生化检查结果。根据Ln(HDL/CRP)四分位间距分组,正态分布连续性变量通过one-way ANOVA方差分析、非正态连续性变量通过Kruskal-Wallis秩和检验、分类变量通过卡方分析对患者人口数据、生化指标进行组间对比。并通过相关性分析、单因素和多因素线性回归分析、Cox生存分析,探讨HDL/CRP与基线eGFR、肾功能恶化事件的关系。【结果】共获得9142名CKD患者资料,最终纳入439例患者。其中慢性肾小球肾炎患者100例(22.8%)、糖尿病肾病患者145例(33%)、高血压肾病患者40例(9.1%)、其他病因患者154例(35.1%)。根据Ln(HDL/CRP)四分位分组,Quartile 4组肾功能恶化发生率低于其他三组(11%vs.21.1%~21.8%),基线eGFR水平最高。从Quartile 1~4组,患者年龄和糖化血红蛋白水平逐渐降低、APOA1水平逐渐升高。慢性心力衰竭患病率、BMI、血红蛋白、白蛋白、TC、LDL、TG、APOB100水平四组间存在差异性。通过相关性分析发现Ln(HDL/CRP)与基线eGFR正相关(r=0.162,P=0.001)。以肾功能恶化作为终点事件,通过多因素Cox回归分析,校正多种因素后,Ln(HDL/CRP)能进入最终方程[HR=0.79,95%CI(0.69,0.91),P=0.001]。【结论】HDL/CRP能反应慢性肾脏病严重程度,对慢性肾脏病进展有预测作用。

【Objective】To investigate the predictive effect of high density lipoprotein(HDL)to C-reactive protein(CRP)ratio(HDL/CRP)on the progression of chronic kidney disease(CKD)in non-dialysis patients.【Methods】Non-di⁃alysis chronic kidney disease patients with at least two sets of follow-up data from the Third Affiliated Hospital of Sun Yatsen University(Tian-he and Ling-nan districts)from 2015 to 2019 were enrolled.The baseline demographic characteris⁃tics and biochemical examination results were collected from the electronic medical record system.The patients were grouped according to the quantile of Ln(HDL/CRP).The demographic and biochemical data were compared among groups by one-way ANOVA for normal distribution continuous variables,Kruskal-Wallis rank-sum test for non-normal distribu⁃tion continuous variables,and Chi-square analysis for categorical variables.The relationship between HDL/CRP and base⁃line eGFR was investigated by correlation analysis,univariate and multivariate linear regression analysis.The Cox survival analysis were used to investigate the predictive effect of Ln(HDL/CRP)on renal deterioration events.【Results】Totally 9142 patients with CKD were enrolled,and 439 patients were included in the end.There were 100 patients(22.8%)with chronic glomerulonephritis,145 patients(33%)with diabetic nephropathy,40 patients(9.1%)with hypertensive ne⁃phropathy,and 154 patients(35.1%)with other causes.According to Ln(HDL/CRP)quartile,group Quartile4 had a low⁃er incidence of renal deterioration than the other three groups(11%vs.21.1%to 21.8%)and had the highest baseline eG⁃FR level.From Quartile1 to quartile 4 groups,age,Hba1c and APOA1 levels decreased gradually.The prevalence of chronic heart failure,BMI,hemoglobin,albumin,TC,LDL,TG,APOB100 levels were different among groups.Through correlation analysis,Ln(HDL/CRP)were positively correlated with baseline eGFR(r=0.162,P=0.001).After adjusting for a variety of factors by Cox regression analysis,Ln(HDL/CRP)could be included in the final equation when defined de⁃terioration of renal function as end point[HR=0.79,95%CI(0.69,0.91),P=0.001].【Conclusion】HDL/CRP can reflect the severity of chronic kidney disease,and the ratio of HDL and CRP can predict the progression of chronic kidney disease in non-dialysis patient.