低密度脂蛋白胆固醇升高与慢性肾脏病进展的相关性研究

摘要

Objective To eXplore the correlation of low - density lipoprotein cholesterol(LDL - C)with the progres-sion of chronic kidney disease(CKD). Methods A total of 121 CKD patients at stages Ⅰ,Ⅱ who were followed - up in this hospital from January 2009 to April 2013 were divided,according CKD progression,into groups progression,non - progres-sion. The relevant factors of CKD progression were analyzed by univariate,multivariate analyses. Results There were 103 pa-tients who completed the follow - ups,thereinto 64 in non - progression group,39 in progression group. By univariate analysis, the proportion of females was larger,utilization of statins,LDL - C control rate,end - point estimated glomerular filtration rate (eGFR)lower,base - line eGFR,end - point total cholesterol(TC),HDL - C,LDL - C higher in progression group than in non - progression group(P é 0. 05). ROC curve showed that the optimal critical point of LDL - C rise in diagnosis of CKD pro-gression was 1. 075 mmol/ L〔AUC = 0. 718,95% CI(0. 611,0. 825),P é 0. 001〕. In progression group,LDL - C rise of 16 patients was higher than optimal critical point,that of 23 patients lower;in non - progression group,LDL - C rise of 1 pa-tient higher than optimal critical point,that of 63 patients lower. There was significant difference in survivorship curve between CKD patients whose LDL - C rise was higher than optimal critical point and those whose LDL - C rise was lower(long - rank χ2= 4. 405,P = 0. 036). CoX regression model multivariate analysis showed that LDL - C rise higher than optimal critical point was an independent risk factor of CKD progression〔OR = 0. 417,95% CI(0. 184,0. 944),P = 0. 036〕. Conclusion The optimal critical point of LDL - C rise in diagnosing CKD progression is 1. 075 mmol/ L. LDL - C rise higher than 1. 075 mmol/ L is an independent risk factor of CKD progression. LDL - C control should be strengthened clinically.%目的：探讨低密度脂蛋白胆固醇（LDL - C）升高与慢性肾脏病（CKD）进展的相关性。方法采取前瞻性研究设计，收集2009年1月-2013年4月在新疆医科大学第一附属医院体检中心门诊规律随访1年以上的 CKD 1~2期患者121例，进行随访并根据 CKD 进展情况将其分为非进展组和进展组。采用单因素分析和多因素分析对 CKD进展的相关因素进行分析。结果最终共103例患者完成随访，其中非进展组64例，进展组39例。单因素分析结果显示，进展组患者女性比例大于非进展组，他汀类药物使用率、LDL - C达标率、终点估算肾小球滤过率（eGFR）低于非进展组，基线 eGFR，终点总胆固醇（TC）、高密度脂蛋白胆固醇（HDL - C）、LDL - C升高高于非进展组（ P é0.05）。绘制 ROC 曲线发现，LDL - C较基线升高>1.075 mmol/ L 诊断 CKD 进展的最佳临界点〔曲线下面积=0.718，95% CI（0.611，0.825），P é0.001〕。进展组中，LDL - C升高高于最佳临界点者16例，低于最佳临界点者23例；非进展组中，LDL - C升高高于最佳临界点者1例，低于最佳临界点者63例。LDL - C升高高于最佳临界点的 CKD 患者与低于最佳临界点的 CKD 患者生存曲线比较，差异有统计学意义（long - rank χ2=4.405，P =0.036）。采用 CoX 回归模型进行的多因素分析结果显示，LDL - C较基线升高>1.075 mmol/ L 是 CKD 进展的独立危险因素〔OR =0.417，95% CI （0.184，0.944），P =0.036〕。结论 LDL - C较基线升高>1.075 mmol/ L 为诊断 CKD 进展的最佳临界点，也是 CKD进展的独立危险因素，临床应加强对LDL - C的控制。