上海交通大学学报 ›› 2016, Vol. 50 ›› Issue (03): 478-482.

• 其他 • 上一篇    

糖尿病肾病患者血脂异常与尿蛋白关系

李军辉1,程东生2*,王锋2,费杨2,薛勤2,汪年松2   

  1. (1. 苏州大学 医学部, 江苏 苏州 215006; 2. 上海交通大学 附属第六人民医院 肾内科, 上海 200030)
  • 收稿日期:2015-04-15 出版日期:2016-03-28 发布日期:2016-03-28
  • 基金资助:
    国家自然科学基金项目(81270824)

Relationship Between Dyslipidemia and Proteinuria in Patients with Diabetic Nephropathy

LI Junhui,CHENG Dongsheng,WANG Feng,FEI Yang,XUE Qin,WANG Niansong   

  1. (School of Medicine, Soochow University, Suzhou 215006, Jiangsu, China; Department of Nephrology, Sixth People’s Hospital Affliated to Shanghai Jiaotong University, Shanghai 200233, China)
  • Received:2015-04-15 Online:2016-03-28 Published:2016-03-28

摘要: 摘要: 探讨糖尿病肾病(DN)患者血脂异常与尿蛋白关系.选取122例住院的DN患者,年龄(62.26±12.67)岁, 女性49例,男性73例,测定血脂代谢各指标,同时留取24 h尿蛋白定量(24 h pro),依据蛋白尿定量分为肾病和非肾病综合征组,比较两组相关血脂指标,并行相关性分析比较. 肾病综合征组患者的TC(总胆固醇)、NHDL、Lpa和ApoB水平均显著高于非肾病综合征组(P<0.05); TC、NHDL、ApoB和ApoE均分别与24 h尿蛋白定量和糖化血红蛋白(HbA1C)相关(P<0.01), Lpa 与24 h尿蛋白定量及肾小球滤过率(eGFR)相关,LDLC及TG仅与HbA1C相关(P<0.01),ApoA1仅与24 h pro相关(P<0.05);各血脂指标依据四分位法分组,TC、NHDLC、TG、ApoA1、ApoB、Lpa及ApoE随着数值升高,组内24 h尿蛋白定量(≥3.5 g)百分比例增高(P<0.05),而LDLC及HDLC组内比较无统计学差异(P>0.05).DN患者随着24 h蛋白尿增多,血脂异常更为显著,尤其在肾病综合征患者以TC、NHDL、 Lpa及ApoB升高为主,而血脂异常进一步加重肾脏病进展,有效控制血脂有望改善肾脏病预后.

关键词: 糖尿病肾病, 血脂异常, 非高密度脂蛋白胆固醇, 脂蛋白a, 尿蛋白

Abstract: Abstract: The relationship between 24 h urine protein excretion with dyslipidemia in diabetic nephropathy(DN) patients was evaluated. A total of 122 DN patients (49 females and 73 males) with an average age of (62.26±12.67) were included in this study. 24hour urine were collected for 24h protein(24 h pro) measurement and blood samples were taken as lipid parammeters. According to 24 h pro assays, subjects were divided into nephrotic group and nonnephrotic group. Lipid profiles and correlation analysis were compared between the two groups. It is found that the levels of total cholesterol(TC), non high density lipoprotein (NHDL), lipoprotein (a) [Lp(a)], and apolipoprotein B (ApoB) were much higher in nephrotic group compared with nonnephrotic one (P<0.05). In correlation analysis, TC, NHDL, ApoB and ApoE were found to be related to 24 h urine protein and HbA1C (P<0.01) respectively and Lpa was related to 24 h pro and eGFR. LDLC and TG were independently associated with HbA1C (P<0.01) while ApoA1 was only associated with 24 h pro (P<0.05). In each group classified according to quartiles of lipid profile, it is found that the proportion of patients with >3.5 g/24 h urine protein excretion grew progressively with the increase in TC, NHDLC, TG, ApoA1, ApoB,Lpa and ApoE (P<0.05) while LDLC and HDLC had no statistical differences (P>0.05). Conclusion: In patients with diabetic nephropathy, an obvious dyslipidemia was observed with increase of 24 h urine protein excretion, especially in those with nephrotic syndrome who mainly present with the an elevation in TC, NHDL, Lpa and ApoB. Since dyslipidemia could aggravate the progress of kidney disease, an effective control of lipid profile is likely to improve the prognosis.

Key words: Key words: diabetic nephropathy, dyslipidemia, nonhigh density lipoprotein, lipoprotein (a), urine protein

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