eGFR评价高血压合并冠心病患者肾功能与载脂蛋白A的关系  

Correlation between Apolipoprotein A and renal function in patients with hypertension and coronary heart disease by eGFR

作　　者：张振[1] 张建华[1] 徐岩[1] 

机构地区：[1]安徽医科大学第一附属医院心内科,安徽合肥230022

出　　处：《安徽医药》2016年第3期496-499,共4页Anhui Medical and Pharmaceutical Journal

基　　金：安徽省卫生厅医学科研课题(No 2010B005)

摘　　要：目的通过eGFR评价高血压合并冠心病患者肾功能与载脂蛋白A(apoA)的关系。方法纳入2011年3月—2012年12月入住安徽医科大学第一附属医院心内科行冠脉造影检查诊断为冠心病或临床诊断冠心病但因肾功能较差不能耐受冠脉造影检查(13例)的高血压患者共341例,使用简化MDRD公式计算各患者肾小球滤过率(eGFR),根据eGFR高低将其分为eGFR正常组291例(eGFR≥60 m L·min^(-1)·1.73 m-2)和eGFR下降组50例(eGFR<60 m L·min^(-1)·1.73m-2)。统计分析患者年龄、性别、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、LDL/HDL、载脂蛋白A(apoA),载脂蛋白B(apoB),apoA/apoB,白蛋白(ALB),脂蛋白a(lpa),血肌酐(SCr),糖尿病患者比例,吸烟比例,比较两组数据差异,并用Logistic回归分析上诉指标对eGFR下降的影响。结果 341例高血压合并冠心病患者中,平均年龄(65.04±10.62)岁,其中男性212例(62.1%)。eGFR下降组患者年龄,LDL/HDL、SCr、BUN、糖尿病比例、吸烟比例均高于eGFR正常组,apoA、apoA/apoB、HDL、ALB低于eGFR正常组,差异均有统计学意义(P<0.05)。Logistic回归分析显示患者BUN(OR=1.712,P<0.01),糖尿病比例(OR=5.100,P<0.01),吸烟比例(OR=5.004,P<0.01),apoA(OR=0.127,P<0.01)为影响eGFR下降的独立因素,其中apoA的相关性最强。结论 apoA与高血压合并冠心病患者eGFR下降强相关,为独立的保护因素。Objective To evaluate the correlation between Apolipoprotein A and renal function in patients with hypertension and coro-nary heart disease by eGFR.Methods A total of 341 patients with hypertension,who were admitted to The First Affiliated Hospital of Anhui Medical University and diagnosed with coronary heart disease by angiography,were enrolled in this study.The patients whose eGFR was no less than 60 mL·min^-1 ·1.73 m^-2 were in normal eGFR group （n =291 ）,and those whose eGFR was less than 60 mL·min^-1 ·1.73 m^-2 were in decreased eGFR group（n =50）.Such factors as age,gender,total cholesterol（TC）,tri-glyceride（TG）,low density lipoprotein（LDL）,high density lipoprotein（HDL）,LDL /HDL,Apolipoprotein A,Apolipoprotein B, Apolipoprotein A /Apolipoprotein B,albumin（ALB）,Lipoprotein a （lpa）,serum creatinine （SCr）,the proportion of patients with diabetes,smoking were compared.Multivariate logistic regression analysis was performed to estimate the relationship of above factors and eGFR.Results In 341cases with hypertension and coronary heart disease,patients had an average age of （65.04 ＆#177;10.62）, among whom there were 212 cases （62.1%）of men and 129 cases （37.9%）of women.Compared with normal eGFR group,the age,SCr,BUN,LDL /HDL,apoA /apoB,the proportions of the diabetes,smoking were higher while apoA,apoA /apoB,HDL, ALB were lower in decreased eGFR group.The differences had statistical significance （P 〈0.05 ）.Logistic regression analysis showed that BUN （OR =1.712,P 〈0.01）,diabetes （OR =5.100,P 〈0.01 ）,the smoking history （OR =5.004,P 〈0.01 ）, apoA （OR =0.127,P 〈0.01）were the independent factors influencing the decrease in eGFR,among which apoA was most closely correlated.Conclusions apoA,as an independent protective factor,is strongly related to the decrease of eGFR in patients with coro-nary heart disease and hypertension.

关 键 词：冠状动脉粥样硬化性心脏病 高血压病 载脂蛋白A 肾小球滤过率 

分 类 号：R544.1[医药卫生—心血管疾病] R541.4[医药卫生—内科学]