伴有血脂异常的老年慢性肾小球肾炎CKD1-2期患者临床及病理分析

目的探讨伴有血脂异常的老年慢性肾小球肾炎CKD1-2期患者临床及病理特点,以评估血脂异常对慢性肾脏病的影响。方法纳入2014年至2017年首次行肾活检诊断并符合CKD1-2期原发性慢性肾小球肾炎的老年患者111例,根据有无高脂血症分为高脂血症组(HL组,76例)和非高脂血症组(非HL组,35例),回顾分析两组患者的一般资料、临床及病理特点。结果(1)两组患者年龄、性别比、体质指数、高血压患病率、病理分布类型、血肌酐、高敏C反应蛋白等差异无统计学意义。HL组的血尿酸水平、24 h尿蛋白定量、尿转铁蛋白、尿白蛋白、尿α1微球蛋白、尿NAG酶均高于非HL组,血清白蛋白低于非HL组(P<0.05);(2)HL组血管损伤评分高于非HL组(P<0.05),而肾小球硬化比例、新月体比例、系膜增生、肾小管损伤等评分两组差异无统计学意义;(3)通过二元变量相关分析,24 h尿蛋白、尿转铁蛋白与血清胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白相关,血尿酸、尿白蛋白与与血清胆固醇、甘油三酯、低密度脂蛋白相关,血清白蛋白、尿NAG酶与血清胆固醇、甘油三酯、低密度脂蛋白相关。结论伴血脂异常的老年慢性肾小球肾炎CKD1-2期患者尿蛋白、肾小管损伤更重,肾微血管病变程度更高。

Clinical and pathological analysis of CKD 1-2 patients with chronic glomerulonephritis associated with dyslipidemia

Aim To investigate the clinical and pathological features of chronic kidney disease(CKD)1-2 stage in chronic glomerulonephritis elderly patients with dyslipidemia,and to evaluate the effect of dyslipidemia on CKD.Methods A total of 111 elderly patients who underwent renal biopsy and were eligible for CKD1-2 with primary chronic glomerulonephritis from 2014 to 2017 were enrolled.According to the presence of hyperlipidemia,they were divided into hyperlipidemia group(HL Group)of 76 patients,and non-hyperlipidemia group(non-HL group)of 35 patients,the general data,clinical and pathological features of two groups were reviewed.Results(1)There were no significant differences in age,sex ratio,body mass index,prevalence of hypertension,pathological distribution,serum creatinine,and high-sensitivity C-reactive protein between the two groups.The levels of serum uric acid,24 h urine protein,urinary transferrin,urinary albumin,urinaryα1 microglobulin and urinary NAG were higher in the HL group than in the non-HL group,and serum albumin was lower than that in the non-HL group(P<0.05).(2)The vascular injury scores of HL group was higher than that of non-HL group(P<0.05),but the scores of glomerular sclerosis,proportion of crescent,mesangial hyperplasia and tubular injury were not statistically different.(3)By binary variable correlation analysis,24 h urine protein and urinary transferrin were associated with serum cholesterol,triglyceride,low density lipoprotein,and high density lipoprotein;blood uric acid and urinary albumin were associated with serum cholesterol,triglycerides and low density lipoprotein;serum albumin and urinary NAG enzymes were associated with serum cholesterol,triglycerides,and low-density lipoprotein.Conclusion The CKD 1-2 elderly patients with chronic glomerulonephritis associated with dyslipidemia are more likely to get more severe urinary protein and tubule injury,and have higher risk of getting renal microvascular disease.