血脂紊乱对代谢综合征早期肾功能损害的影响

目的探讨血脂异常对代谢综合征(metabolicsyndrome,MS)早期肾功损害的影响。方法将357例患者分为高血压组(EH)、糖尿病组(DM)和MS组,将3组依血脂水平变化分为血脂正常和异常2个亚组,亚组间的血压、血糖和病程无显著差别,分别比较每组血脂正常和血脂异常组的肾功能变化,并分析血脂和肾功能的关系。结果MS组中,血脂异常组24h微量蛋白尿(MA,mg/24h)显著高于血脂正常组犤(66±3)/(45±4),t=-3.904,P<0.01犦,内生肌酐清除率(Ccr,mL/min)显著低于血脂正常组犤(57±3)/(72±4),t=-3.838,P<0.01犦;而EH和DM组的MA和Ccr水平在血脂正常和异常组中差异无显著性意义。相关分析表明,MS组中TC,LDL,ApoB与MA和Ccr有显著相关,其中TC对MA和Ccr影响最大(MA:r=0.3807,P<0.01;Ccr:r=0.3807,P<0.05);而EH和DM组中TC,LDL,ApoB与MA和Ccr无显著相关。结论与EH和DM相比,在血压和血糖相似的情况下,血脂异常是致MS肾功能损害的重要因素,早期介入康复方法进行积极的调脂治疗对保护MS的肾功能有临床意义。

Influence of dyslipidemia on early renal functional lesions in patients with metabolic syndrome

Aim To explore the influence of dyslipidemia on early renal functional lesions in patients with metabolic syndrome(MS).Methods 109 cases with essential hypertension (56 males and 53 females, EH group), 73 cases with diabetes mellitus (39 males and 34 females, DM group) and 175 cases with metabolic syndrome (87 males and 88 females, MS group) were respectively divided into two subgroups: normal lipid groups and dyslipidemia groups according to the serum total cholesterol(TC), triglycerides(TG), low density lipoprotein(LDL), and apolipoprotein B(Apo B) levels. The changes of renal function were observed and comparde between the subgroups of normal and dyslipidemia respectively.Results In the MS group, the concentration of microalbuminuria(MA) in the dyslipidemia group was(66± 3) mg within 24 hours, significantly higher than that of the normal group (45± 4)mg,t=- 3.904,P< 0.01]; the endogenous creatinine clearance rate (Ccr) was (57± 3) mL/min in the dyslipidemia group, significantly lower than that in the normal group(72± 4)mL/min,t=- 3.838,P< 0.01].But in the DM and EH groups,the concentrations of MA and Ccr were insignificantly different between the normal and dyslipidemia groups respectively. The correlation analysis showed that TC, LDL and ApoB only in the MS group were significantly related with MA and Ccr, and the TC played a most important role in MA and Ccr(r=0.3807, P< 0.01; r=0.3807, P< 0.05).Conclusion Dyslipidemia is one of the important factors inducing renal dysfunction in patients with MS when blood pressure and glucose are controlled at the same levels. Thus, serum lipid lowering therapy may be necessary to prevent deterioration of renal function in patients with metabolic syndrome.