摘要
目的分析慢性肾脏病(CKD)患者连续性肾脏替代治疗(CRRT)后发生血脂异常的影响因素。方法选取2023年3月至2024年12月在该院接受CRRT的305例CKD患者作为研究对象,依据CRRT后是否出现血脂异常分为血脂异常组和血脂正常组。比较2组临床资料。采用多因素Logistic回归分析CKD患者CRRT后发生血脂异常的影响因素。采用Pearson相关分析血脂异常组血脂指标与脂蛋白a、游离脂肪酸(FFA)、同型半胱氨酸(Hcy)、血尿酸、白细胞介素-1β(IL-1β)、清蛋白(Alb)水平的相关性。结果305例CKD患者经CRRT后,有90例患者发生血脂异常,有215例患者未发生血脂异常,血脂异常发生率为29.51%。血脂异常组年龄,合并高血压、合并糖尿病、有吸烟史占比及首次透析前血清脂蛋白a、胱抑素C(Cys-C)、FFA、Hcy、血尿酸、IL-1β水平高于血脂正常组,差异均有统计学意义(P<0.05)。血脂异常组肾小球滤过率(eGFR)、血红蛋白(Hb)、血清Alb水平低于血脂正常组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,血脂异常组胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平与脂蛋白a、Hcy水平呈正相关(P<0.05),与Alb水平呈负相关(P<0.05)。血脂异常组TC、LDL-C水平与FFA、IL-1β水平呈正相关(P<0.05)。血脂异常组高密度脂蛋白胆固醇(HDL-C)水平与脂蛋白a、FFA、Hcy、血尿酸、IL-1β水平呈负相关(P<0.05),与Alb水平呈正相关(P<0.05)。血脂异常组LDL-C水平与血尿酸水平呈正相关(P<0.05)。多因素Logistic回归分析结果显示,年龄增长、有吸烟史及脂蛋白a、FFA、Hcy水平升高为CKD患者CRRT后发生血脂异常的危险因素(P<0.05),Alb水平升高为CKD患者CRRT后发生血脂异常保护因素(P<0.05)。结论CKD患者在CRRT后血脂异常发生率较高,年龄及吸烟史、脂蛋白a、FFA、Hcy、Alb均是CKD患者CRRT后发生血脂异常的影响因素,应在透析前加以监测并采取措施进行纠正。
Objective To analyze the influencing factors for the development of dyslipidemia in patients with chronic kidney disease(CKD)after continuous renal replacement therapy(CRRT).Methods A total of 305 patients with CKD who received CRRT in this hospital from March 2023 to December 2024 were selected as the research objects.According to whether dyslipidemia occurred after CRRT,they were divided into dyslipidemia group and normal blood lipid group.The clinical data of the two groups were compared.Multivariable Logistic regression was used to analyze the influencing factors for the development of dyslipidemia in CKD patients after CRRT.Pearson correlation analysis was used to analyze the correlation between blood lipid indexes and lipoprotein a,free fatty acid(FFA),homocysteine(Hcy),serum uric acid,interleukin-1β(IL-1β)and albumin(Alb)levels in dyslipidemia group.Results Among 305 CKD patients after CRRT,90 patients had dyslipidemia,215 patients did not have dyslipidemia,and the incidence of dyslipidemia was 29.51%.The age,proportion of hypertension,diabetes,smoking history and serum lipoprotein a,cystatin C(Cys-C),FFA,Hcy,blood uric acid and IL-1βlevels before the first dialysis in the dyslipidemia group were higher than those in the normal blood lipid group,and the differences were statistically significant(P<0.05).The levels of glomerular filtration rate(eGFR),hemoglobin(Hb)and serum Alb in the dyslipidemia group were lower than those in the normal blood lipid group,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that the levels of cholesterol(TC),triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)in the dyslipidemia group were positively correlated with the levels of lipoprotein a and Hcy(P<0.05),and negatively correlated with the level of Alb(P<0.05).TC and LDL-C levels were positively correlated with FFA and IL-1βlevels in dyslipidemia group(P<0.05).The level of high-density lipoprotein cholesterol(HDL-C)in dyslipidemia group was negatively correlated with the levels of lipoprotein a,FFA,Hcy,uric acid and IL-1β(P<0.05),and positively correlated with the level of Alb(P<0.05).LDL-C level was positively correlated with serum uric acid level in dyslipidemia group(P<0.05).Multivariable Logistic regression analysis showed that increased age,smoking history,and increased levels of lipoprotein a,FFA and Hcy were risk factors for the development of dyslipidemia in CKD patients after CRRT(P<0.05),and increased level of Alb was a protective factor for the development of dyslipidemia in CKD patients after CRRT(P<0.05).Conclusion The incidence of dyslipidemia in CKD patients after CRRT is high.Age,smoking history,lipoprotein a,FFA,Hcy,Alb are the influencing factors for the development of dyslipidemia in CKD patients after CRRT,which should be monitored before dialysis and take measures to correct.
作者
白秀秀
吕红红
胡江涛
张姣姣
李思思
BAI Xiuxiu;LYU Honghong;HU Jiangtao;ZHANG Jiaojiao;LI Sisi(Department of Renal Dialysis,Tangdu Hospital,Air Force Military Medical University,Xi′an,Shaanxi 713800,China)
出处
《检验医学与临床》
2026年第3期316-321,327,共7页
Laboratory Medicine and Clinic
基金
国家自然科学基金项目(82174166)。
关键词
慢性肾脏病
连续性肾脏替代治疗
血脂异常
临床特征
危险因素
chronic kidney disease
continuous renal replacement therapy
dyslipidemia
clinical feature
risk factor
