不同类型血脂异常对IgA肾病临床及病理特征的影响  

Impact of different types of dyslipidemia on clinical and pathological characteristics of IgA nephropathy

作　　者：彭熙[1] 李晓华[1] 马云华[1] 吴悦[1] 农凤伟 廖蕴华[1] 

机构地区：[1]广西医科大学第一附属医院肾内科,南宁530021

出　　处：《中华肾病研究电子杂志》2016年第5期214-217,共4页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：国家自然科学基金地区科学基金项目(81360111);广西科学研究与技术开发计划项目(1598011-6)

摘　　要：目的探讨不同类型血脂异常对IgA肾病临床及病理特征的影响。方法共纳入283例原发性IgA肾病患者,收集临床资料及病理资料进行回顾性分析。将患者分为:高胆固醇(HTC)组48例(TC≥6.22 mmol/L,TG<1.7 mmol/L);高甘油三脂(H-TG)组48例(TG≥2.26 mmol/L,TC<5.18 mmol/L);低高密度脂蛋白(L-HDL)组34例(HDL-C<1.04 mmol/L,TC<5.18 mmol/L,TG<1.7 mmol/L],同时收集IgAN血脂正常者(153例,TG<1.7 mmol/L、TC<5.18 mmol/L、HDL-C>1.04 mmol/L)作为对照组。对各组患者的一般情况、临床指标及病理分型(牛津分型)进行比较,并采用逐步回归分析方法进行多重线性回归分析探讨影响患者肾小球滤过率(e GFR)的因素。结果 H-TC组24 h尿蛋白量高于血脂正常组(Z=-2.979,P=0.003),血清白蛋白低于血脂正常组(t=2.606,P<0.001)。H-TG组,身体质量指数(BMI)、血清尿酸高于血脂正常组(t=3.982,t=5.056;P<0.001),e GFR低于血脂正常组(t=2.011,P=0.045)。L-HDL组BMI高于血脂正常组(t=2.946,P=0.004),e GFR低于血脂正常组(t=2.498,P=0.013),肾小管萎缩/间质纤维化程度高于血脂正常组(χ~2=8.284,P<0.017)。回归方程结果显示年龄、收缩压、尿酸与e GFR呈负相关关系(P<0.05),血清TC与e GFR亦呈负相关关系(95%CI:-5.228^-0.312,t=-2.220,P=0.027)。血清HDL与e GFR呈正相关关系(95%CI:1.469~7.468,t=2.935,P=0.004),该模型经检验有统计学意义(F=11.838,P<0.001)。结论 H-TC、H-TG、L-HDL血症均可能加重IgA肾病的临床损害,且L-HDL血症者肾小管间质受损更严重。降低血清TC,提高血清HDL可能有助于IgA肾病患者改善预后。Objective To investigate the impact of different types of dyslipidemia on clinical and pathological characteristics of IgA nephropathy （IgAN）. Methods A total of 283 patients with primary IgAN were enrolled. The clinical and pathological data of all the patients were recorded and retrospectively analyzed. The patients were divided into normal blood lipid group, hypercholesterolemia （H-TC）group, hypertriglyceridemia （H-TG） group, and low high density lipoprotein （L-HDL） group. The general information, and clinical and pathological features of IgAN were compared. And stepwise regression analysis method for multiple linear regression analysis was used to investigate the influence factors of estimated glomerular filtration rate （eGFR） of the patients. Results Compared with the normal blood lipid group, the H-TC group had higher 24-hour urinary protein excretion （ Z = - 2. 979, P = 0. 003 ） and lower plasma albumin （t = 2. 606, P 〈 0. 001 ）. The H-TG group also had higher body mass index （BMI）（ t = -3. 982, P 〈 0. 001 ） , higher serum uric acid （ t = 3. 982,t = 5. 056, P 〈0. 001 ） , and lower eGFR （ t = 2.011, P = 0. 045 ） than the normal blood lipid group. The L- HDL group had higher BMI （ t = - 2. 946, P = 0. 004 ）, lower eGFR （ t = 2. 498, P = 0. 013 ）, and more serious renal tubular atrophy/interstitial fibrosis than the normal blood lipid group （X2 = 8. 284, P 〈 0. 017）. The regression equation results indicated that the age, systolic blood pressure, uric acid （ P 〈 0.05）, and serum TC （95% CI： ~ 5. 228 to - 0. 312, t = - 2. 220, P = 0.027） were negatively associated with eGFR. The serum HDL was positively correlated with eGFR （95% CI： 1. 469 to 7. 468, t = 2. 935, P = 0. 004）. The model was statistically significant （F = 11. 838, P 〈 0.001 ）. Conclusions Hypercholesterolemia, hypertriglyceridemia, and low high density lipoprotein all could do harm to the clinical outcomes of IgAN patients. The renal tubulointerstitial damage

关 键 词：IGA肾病 高胆固醇血症 高甘油三酯血症 低高密度脂蛋白血症 

分 类 号：R692.31[医药卫生—泌尿科学]