慢性肾脏病患者血清胆红素与肾小管萎缩或间质纤维化的关系  

Relationship between serum bilirubin and renal tubular atrophy or interstitial fibrosis in patients with chronic kidney diseases

作　　者：刘炳曼 赵良玉 杨青青 司晓芸[1] LIU Bingman;ZHAO Liangyu;YANG Qingqing;SI Xiaoyun(Dept.of Nephrology,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院肾内科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2022年第1期110-116,共7页Medical Journal of Wuhan University

摘　　要：目的:旨在探讨血清胆红素与慢性肾脏病患者肾小管萎缩/间质纤维化病理、临床参数之间的关系。方法:纳入199例慢性肾脏病患者(108例IgA肾病和91例膜性肾病)。根据患者肾小管萎缩/间质纤维化的病变程度,将患者分为两组:不合并/轻度肾小管萎缩/间质纤维化组(T0组)、中度肾小管萎缩/间质纤维化组(T1组);根据患者血清胆红素(BIL)[总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IDBIL)]三分位数,将患者分为三组:BIL(TBIL/DBIL/IDBIL)-1、BIL-2、BIL-3组。对比患者的一般资料及临床病理参数,分析主要临床病理参数与血清胆红素的相关性;多因素Logistic回归分析评估血清胆红素是否为中度肾小管萎缩/间质纤维化的独立危险因素。结果:血清胆红素水平(TBIL、DBIL、IDBIL)与血清白蛋白水平呈显著正相关,与24-h尿蛋白定量、总胆固醇水平、肾小管萎缩/间质纤维化呈显著负相关,与估计的肾小球滤过率(eGFR)无显著相关性。T0组患者胆红素水平(TBIL、DBIL、IDBIL)明显高于T1组患者。较低水平的血清胆红素(TBIL、DBIL、IDBIL)是IgA肾病和膜性肾病患者中度肾小管萎缩/间质纤维化的危险因素。结论:血清胆红素可能对肾脏具有保护作用,胆红素水平高低可能用于辅助评估肾小管萎缩或间质纤维化。Objective:To explore the relationship between serum bilirubin and renal tubular atrophy/interstitial fibrosis pathology and clinical parameters in patients with chronic kidney diseases.Methods:The present study enrolled 199 chronic kidney disease patients(108 IgA nephropathy and 91 membranous nephropathy).According to the degree of renal tubular atrophy/interstitial fibrosis lesions,patients were divided into two groups,the group without or with mild renal tubular atrophy/interstitial fibrosis(T0)and the group with moderate renal tubular atrophy/interstitial fibrosis(T1).According to the tertiles of serum bilirubin(BIL),including total bilirubin(TBIL),direct bilirubin(DBIL),and indirect bilirubin(IDBIL),the patients were divided into three groups as BIL(TBIL/DBIL/IDBIL)-1,-2,and-3,to compare their general data and clinicopathological parameters.The correlation between main clinicopathological parameters and serum bilirubin were analyzed.Multivariate logistic regression analysis was used to evaluate whether serum bilirubin was an independent risk factor for moderate renal tubular atrophy/interstitial fibrosis.Results:Serum bilirubin levels(TBIL,DBIL,and IDBIL)were significantly positively correlated with serum albumin levels,and significantly negatively correlated with 24-hour urine protein quantification,total cholesterol levels,and renal tubular atrophy/interstitial fibrosis,while no significant correlation with estimate glomerular filtration rate(eGFR)was found.The levels of serum bilirubin(TBIL,DBIL,and IDBIL)in T0 group were significantly higher than those in T1 group.Lower levels of serum bilirubin(TBIL,DBIL,and IDBIL)were risk factors for moderate tubular atrophy/interstitial fibrosis in patients with IgA nephropathy and membranous nephropathy.Conclusion:Serum bilirubin may have a protective effect on kidney and the levels of bilirubin may be used to assist in the assessment of renal tubular atrophy or interstitial fibrosis.

关 键 词：血清胆红素 肾小管萎缩或间质纤维化 慢性肾脏病 病理 

分 类 号：R692.6[医药卫生—泌尿科学]