原发性肾病综合征高脂血症与肾功能的相关性研究

目的研究原发性肾病综合征(PNS)患者高脂血症与肾功能评价指标间的关系,并分析其尿液形态学特点。方法收集2018年1-12月解放军第970医院威海院区肾内科经临床和病理穿刺明确确诊为PNS病例59例作为PNS组,并选取同期就诊于该院肾内科的其他肾病病例57例作为疾病对照组,另选取同期体检中心进行查体健康且检测指标与疾病对照组均匹配的体检人群52例作为健康对照组。比较PNS组与疾病对照组、健康对照组的血脂水平,主要评价指标包括三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)等。Spearman相关分析和Logistic线性回归分析研究PNS组内各项血脂指标与肾功能指标,清蛋白(ALB)、肾小球滤过率(eGFR)、血肌酐(Scr)、血清尿素氮(BUN)和24 h尿蛋白定量(24 hPro)等之间的相关性,并对PNS患者尿液进行镜检,观察尿液形态学特征改变。结果PNS组各项血脂指标明显高于疾病对照组和健康对照组,差异有统计学意义(P<0.05);Spearman相关分析发现ALB、eGFR、SCr与血脂指标存在相关性;Logistic线性回归分析显示低ALB水平和LDL、eGFR和HDL互为水平变化的危险因素,同时低ALB水平还可促进TC、ApoB升高,eGFR还可促进ApoA1升高,低HDL水平促进SCr升高,而血脂升高的PNS患者镜下可见脂肪变性的肾上皮细胞或脂肪管型。结论PNS患者血脂指标明显升高,且存在血脂指标与肾功能指标相互促进关系。PNS尿液有形成分出现脂肪变性,可作为肾脏脂质沉积和肾功能损伤的表现。

Study on the correlation between hyperlipidemia and renal function in primary nephrotic syndrome

Objective To study the interaction between hyperlipidemia and renal function in primary nephrotic syndrome(PNS),and to analyze the characteristics of urine morphology.Methods From January to December 2018,59 cases of PNS clearly confirmed by clinical and pathological puncture in the department of Nephrology,Weihai District of 970 Hospital of the PLA Joint Logistic Support Force were collected as PNS group.Meanwhile,57 other cases of nephropathy in the department of nephrology of our hospital during the same period were selected as the disease control group.In addition,52 physical examination subjects whose physical examination indexes matched those of the disease control group were selected as the healthy control group.Compare the serum lipid levels of PNS with those of other nephrotic and healthy control groups,including triglyceride(TG),total cholesterol(TC),high density lipoprotein(HDL),low density lipoprotein(LDL),apolipoprotein(Apo)A1,ApoB.Spearman correlation analysis and logistic linear regression analysis were used to study the correlation and interaction between blood lipid and renal function in PNS group,including albumin(ALB),estimated glomerular filtration rate(eGFR),serum creatinine(SCr),blood urea nitrogen(BUN)and 24 hPro.The urine of PNS patients was examined,and the urine morphology was observed.Results The blood lipid indexes in PNS group were significantly higher than those in disease control group and healthy control group,with statistical significance(P<0.05).Spearman correlation analysis found that ALB,eGFR,SCr and blood lipid indicators were correlated.Logistic linear regression analysis showed that low ALB level and LDL,eGFR and HDL were risk factors for each other′s.Meanwhile,the low ALB level could also promote TC and ApoB,eGFR could also promote ApoA1,and the low HDL level could also promote SCr.In PNS cases,renal epithelial cells fatty degeneration or fatty casts could be seen under microscopy.Conclusion The serum lipids of PNS were significantly increased,and there was a mutually reinforcing and causal relationship between serum lipids and urine key indicators has formed fatty degeneration,which is the manifestation of lipid deposition of kidney and impairment of renal function.