糖尿病肾病患者血脂异常与尿蛋白关系

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24h尿蛋白定量(24h 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(P0.05);TC、NHDL、Apo-B和Apo-E均分别与24h尿蛋白定量和糖化血红蛋白(HbA1C)相关(P0.01),Lpa与24h尿蛋白定量及肾小球滤过率(eGFR)相关,LDL-C及TG仅与HbA1C相关(P0.01),Apo-A1仅与24hpro相关(P0.05);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24h尿蛋白定量(≥3.5g)百分比例增高(P0.05),而LDL-C及HDL-C组内比较无统计学差异(P0.05).DN患者随着24h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.

Relationship Between Dyslipidemia and Proteinuria in Patients with Diabetic Nephropathy

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.