原发性胆汁性胆管炎血脂异常患者的临床特点分析  

Clinical features of dyslipidemia in patients with primary biliary cholangitis

作　　者：邵体红[1] 田然[1] 孙金磊 张硕[1] 曹逸涵 陈志磊 王立[1] 张奉春[1] Shao Tihong;Tian Ran;Sun Jinlei;Zhang Shuo;Cao Yihan;Chen Zhilei;Wang Li;Zhang Fengchun(Department of Rheumatology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences ＆ Pecking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科,100730

出　　处：《中华全科医师杂志》2018年第8期617-620,共4页Chinese Journal of General Practitioners

基　　金：国家自然科学基金青年项目（81501414）;首发科研专项青年项目（首发2016-4-40111）

摘　　要：目的了解原发性胆汁性胆管炎（PBC）患者的血脂异常特点。方法回顾性分析2010—2016年北京协和医院136例住院及门诊PBC患者的病例资料，根据患者血脂水平分为血脂异常组和血脂正常组，分析比较两组患者的血脂异常特点。结果136例PBC患者中，血脂异常者100例，占74%。其中，61%（59/96）患者TC升高，58%（48/83）患者LDL-C升高，47%（46/97）患者TG升高，26%（21/82）患者HDL-C降低。血脂异常组患者瘙痒发生率高于血脂正常组[26%（26/100）比8%（3/36），χ2＝4.93, P＝0.032]，血脂异常组患者与血脂正常组相比，血清总胆红素[17.3（12.2，28.2） μmol/L比14.5（9.4，21.1） μmol/L，Z＝2.25，P＝0.024]、直接胆红素[5.5（3.4，12.4） μmol/L比4.4（2.9，7.1） μmol/L, Z＝2.00，P＝0.045]、谷氨酰转肽酶[193.0（64.3，454.8） U/L比105.5 （53.5，179.5）U/L，Z＝2.02，P＝0.043]及碱性磷酸酶水平[183 （86，351）U/L比135（85，188） U/L, Z＝1.98，P＝0.048]均更高，差异均有统计学意义。相关分析结果显示，血脂异常组ALT水平与TG、TC水平呈正相关（r＝0.248、0.272，P＝0.015、0.008），白蛋白与LDL-C（r＝0.335，P＝0.002），直接胆红素与HDL-C（r＝0.252, P＝0.022），碱性磷酸酶、谷氨酰转肽酶与TC（r＝0.313、0.346，P＝0.002、0.001），谷氨酰转肽酶与LDL-C（r＝0.251，P＝0.022）呈正相关。结论PBC患者血脂异常以TC和LDL-C升高为主，合并血脂异常的PBC患者肝脏损害更重。ObjectiveTo analyze the clinical features of dyslipidemia in patients with primary biliary cholangitis （PBC）.MethodsThe clinical and laboratory data of 136 PBC patients in Peking Union Medical College Hospital from 2010 to 2016 were retrospectively analyzed.The liver function was compared between patients with normal and abnormal blood lipids.ResultsAmong 136 PBC patients, 100（74%）had abnormal serum lipids. The incidence of increased cholesterol, low-density lipoprotein and triglyceride was 61%（59/96）, 58%（48/83） and 47%（46/97）, respectively; while that of reduced HDL-C was 26%（21/82）. The incidences of pruritus [26%（26/100） vs. 8%（3/36）, χ2=4.93, P=0.032], serum total bilirubin （TBIL） [17.3（12.2, 28.2） μmol/L vs. 14.5 （9.4, 21.1） μmol/L, Z=2.25, P=0.024], direct bilirubin （DBIL）[5. 5 （3.4, 12.4） μmol/L vs. 4.4（2.9, 7.1） μmol/L, Z=2.00, P=0.045], and glutamyl aminotransferase （GGT）[193.0（64.3, 454.8）U/L vs. 105.5（53.5, 179.5）U/L, Z=2.02, P=0.043], alkaline phosphatase（ALP）[183（86, 351）U/L vs. 135（85, 188） U/L, Z=1.98, P=0.048] in PBC patients with dyslipidemia were significantly higher than thosein patients with normal serum lipids.Pearson regression analysis showed that in PBC patients with dyslipidemia, the ALT was positively corrected with TG and TC（r=0.248 and 0.272, P=0.015 and 0.008）; ALB was positively correlated with LDL-C（r=0.335, P=0.002）; DBIL was positively corrected with HDL-C（r=0.252, P=0.022）; TC was positively correlated with ALP and GGT（r=0.313 and 0.346, P=0.002 and 0.001）; GGT was positively correlated with LDL-C（r=0.251, P=0.022）. ConslusionIncreased TC and LDL-C were more common in PBC patients. PBC patients with dyslipidemia have more severe liver damage than the patients with normal serum lipids.

关 键 词：胆管炎 肝硬化 胆汁性 血脂异常 高脂血症 

分 类 号：R575.22[医药卫生—消化系统]