慢性肾衰竭患者不同分期及原发病血脂变化临床研究

目的本研究通过分析慢性肾衰竭（chronic renal failure，CRF）非透析患者不同分期及原发病血脂变化情况，探讨其脂质代谢紊乱特点，为预防CRF进展的临床治疗提供客观依据。方法对618例CRF非透析患者的血脂变化进行回顾性研究，根据不同肾功能分期及不同原发病进行分组，对其组间血脂水平与68例正常对照组进行比较分析。结果①CRF非透析患者不同分期血脂水平比较：a．总胆固醇（total cholesterol，Tc）水平：肾贮备能力下降期和氮质血症期均明显高于对照组（P〈0．01），尿毒症期明显低于前三期（P〈0．01）；b．甘油三酯（triglyceride，TG）水平：肾贮备能力下降期和氮质血症期均明显高于对照组（P〈0．01），尿毒症期明显低于肾贮备能力下降期和氮质血症期（P〈0．01）；C．高密度脂蛋白（high—density lipoprotein，HDL）水平：尿毒症期较对照组、贮备能力下降期及肾衰竭期明显下降（P〈0．05）。②CRF非透析患者不同原发病血脂水平比较：a．TC水平：糖尿病肾病组及系统性红斑狼疮（systemic lupusery—thematosus，SLE）并发狼疮性肾炎（lupus nephritis，LN）组与对照组比较明显升高（P〈0．05），其中SLE（LN）组水平升高更明显（P〈0．01），多囊肾组较对照组比较明显下降（P〈0．01）；b．TG水平：慢性肾炎组、糖尿病肾病组及SLE（LN）组较对照组升高（P〈0．05），其中糖尿病肾病组及SLE（LN）组升高更明显（P〈0．01）；c．HDL水平：糖尿病肾病组、多囊肾组及其他组较对照纽降低（P〈0．05），其中多囊肾组及其他组降低更明显（P〈0．01）。结论CRF非透析患者血脂异常发生率明显高于普通人群，其中TC及TG水平变化较明显，不同原发病及不同分期的CRF非透析患者血脂变化各有特点。

Clinical Study of Plasma Lipids Change in Chronic Renal Failure Patients with Different Stage and Primary Disease

Objective To investigate the changes of plasma lipids in chronic renal failure（CRF） non-dialysis patients with different stage and primary disease, and analyze the characteristic of dyslipidemia and provide the objective foundations for the prevention and therapy of CRF. Methods Six hundred and eighteen CRF patients with different stage and primary disease were collected and analyzed respectively, and 68 healthy people were taken as the control group. The lipid levels were compared among these groups. Results （1）lipid levels of CRF patients with different stage：（1）compared with control group,the blood total eholesterol（TC） increased significantly in the patients of the falling stage of reservoir capability and the urea nitrogen stage （P 〈 0.01 ） ; the uremia stage decreased significantly compared with the other three groups （ P 〈 0.01 ）＇. （2）the blood triglyceride （TG） increased significantly in the patients of the falling stage of reservoir capability and the urea nitrogen stage compared with control group （P 〈 0.01 ） ;the uremia stage decreased significantly compared with above two groups （P 〈 0.01 ）. （3） high-density lipopro- tein（HDL） in the uremia stage decreased significantly compared with the control, the falling stage of reservoir capability and the renal failure stage （P 〈 0.05 ）. （2） lipid levels of CRF with different primary disease：（1）compared with control group, the blood TC increased significantly in the groups of diabetic nephropathy（ DN ） and systemic lupus erythematosus （SLE） , lupus nephritis （ LN）, P 〈 0.05, especially the LN group （ P 〈 0.01 ）, but the polycystic kidney decreased significantly （ P 〈 0.01 ）. （2）the blood TG increased significantly in the groups of chronic nephritis, DN and LN compared with control group （ P 〈 0.05 ）, especially the DN and LN group （P 〈0.01 ）. （3） HDL in the DN ,polycystic kidney and the other groups decreased significantly compared with the control（ P 〈 0.05 ）, especially the polycystic kidney and the other group （ P 〈 0.01 ）. Conclusion The incidence of dyslipidemia in CRF（ non-dialysis patients） is more common than in the general population, especially the levels of TC and TG. It suggests that the changes of piasma lipids may correlate with the different stage and primary disease.