肾病综合征患者微血管并发症发生情况及影响因素研究

doi:10.12114/j.issn.1007-9572.2019.07.013

摘要/Abstract

摘要： 背景　肾病综合征患者体内存在脂质代谢紊乱、低蛋白血症、大量蛋白尿等症状，动脉硬化危险性增加，探讨其影响因素是疾病诊治的关键点之一。目的　探讨肾病综合征患者的微血管并发症发生情况及影响因素。方法　选取2017年1—6月贵州省遵义市第一人民医院肾内科收治的肾病综合征患者42例为观察组，选择同期在本院健康体检者40例为对照组。比较观察组与对照组的炎性因子、脂质代谢指标、动脉硬化指数（ASI）等，采用多因素Logistic回归分析肾病综合征患者发生微血管并发症的影响因素，采用Pearson相关分析ASI与脂质代谢指标的相关性。结果　观察组超敏C反应蛋白（hs-CRP）、α-脂蛋白（LP-α）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FBG）、三酰甘油（TG）、总胆固醇（TC）、全血白细胞计数（WBC）、24 h尿蛋白（24 hUpro）、胰岛素抵抗指数（HOMA-IR）高于对照组，高密度脂蛋白胆固醇（HDL-C）、清蛋白（ALB）、总蛋白（TP）低于对照组（P<0.05）。观察组的微血管并发症发生率为64.3%（27/42）。多因素Logistic回归分析结果显示，高水平hs-CRP、LDL-C、LP-α、FBG是肾病综合征患者发生微血管并发症的危险因素（P<0.05），高水平HDL-C是肾病综合征患者发生微血管并发症的保护因素（P<0.05）。随访18个月后，观察组ASI高于入院时，且高于对照组（P<0.05）。Pearson相关分析结果显示，ASI与LP-α、TC呈线性正相关（P<0.05）。结论　肾病综合征患者的微血管并发症发生率较高，hs-CRP、LDL-C、LP-α、FBG、HDL-C是其发生发展的影响因素。

关键词: 肾病综合征；动脉硬化；微血管并发症；超敏C反应蛋白；&alpha, -脂蛋白；影响因素分析

Abstract: Background　Patients with nephrotic syndrome have symptoms such as disorders of lipid metabolism，hypoproteinemia，massive proteinuria，and increased risk of arteriosclerosis.The discussion of related influencing factors is one of the key starting points for the diagnosis and treatment of this disease.Objective　To investigate the incidence and influencing factors of microvascular complications in patients with nephrotic syndrome.Methods　The 82 participants were recruited from The First People's Hospital of Zunyi from January to June 2017，including 42 cases of nephrotic syndrome（observation group） from Department of Nephrology，and 40 health examinees（control group）．The glycemic markers，lipid metabolism markers，and atherosclerosis score index（ASI） were compared between the observation group and control group.Multivariate Logistic regression analysis was performed to explore the influencing factors of microvascular complications in nephrotic syndrome.Pearson correlation analysis was performed to explore the correlation between ASI and lipid metabolism markers.Results　Compared with the control group，the observation group demonstrated much higher average levels of hypersensitivity C-reactive protein（hs-CRP），α-lipoprotein（LP-α），low-density lipoprotein cholesterol（LDL-C），fasting blood glucose（FBG），triacylglycerol（TG），total cholesterol（TC），white blood cell count（WBC），24-hour urine protein（24 hUpro） and homeostatic model assessment of insulin resistance index（HOMA-IR），but much lower average levels of serum high-density lipoprotein cholesterol（HDL-C），albumin（ALB），total protein（TP）（P<0.05）．The incidence of microvascular complications in nephrotic syndrome patients was 64.3%（27/42）．Multivariate Logistic regression analysis found that elevated hs-CRP，LDL-C，LP-α and FBG were risk factors and elevated HDL-C was a protective factor for microvascular complications in nephrotic syndrome（P<0.05）．At the end of 18 months follow-up，the average ASI of the observation group was found to be obviously higher than the baseline level，and was significantly higher than that of the control group（P<0.05）．Pearson correlation analysis revealed that ASI had a positive linear correlation with LP-α and TC（P<0.05）．Conclusion　The incidence of microvascular complications in nephrotic syndrome is relatively high.Its occurrence and development are influenced by serum hs-CRP，LDL-C，LP-α，FBG and HDL-C levels.

Key words: Nephrotic syndrome；Arteriosclerosis；Microvascular complications；Hypersensitive C-reactive protein；&alpha, -lipoprotein；Root cause analysis

袁立英,何鸿,班遵浦,等. 肾病综合征患者微血管并发症发生情况及影响因素研究[J]. 中国全科医学, 2019, 22(7): 812-816. DOI: 10.12114/j.issn.1007-9572.2019.07.013.
YUAN Liying,HE Hong,BAN Zunpu, et al. Incidence and Influencing Factors of Microvascular Complications in Patients with Nephrotic Syndrome　[J]. Chinese General Practice, 2019, 22(7): 812-816. DOI: 10.12114/j.issn.1007-9572.2019.07.013.

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