心血管疾病的肾脏损害研究及中西医认识
|
摘要
本论文主要包括文献综述和临床研究两个部分。
文献综述的题目为心血管疾病的肾脏损害研究及中西医结合认识,回顾了近年来国内外对心血管疾病及其相关危险因素对慢性肾脏病的影响及心肾相关疾病的中医认识。临床上长期高血压,心功能不全会导致肾脏损伤,而绝大多数慢性肾脏病患者均伴不同程度的高血压、冠心病等心血管疾病,可见心血管疾病与肾脏病关系密切。本文对心脏和肾脏的生理和病理方面的联系进行了系统分析,在临床上从冠心病、慢性心功能不全、心血管疾病的危险因素三个方面阐述了心血管疾病对慢性肾脏病的影响。通过中医对心肾相交和心肾不交的认识来说明心脏对肾脏的影响。
临床研究部分回顾性分析了中日友好医院2006年10月～2008年3月收治的197例急性心肌梗塞患者临床表现、实验室检查结果像,对数据进行单因素分析,结果发现急性心肌梗死后患者的心功能分级(Killip分级)与肾功能分级成正比,患者年龄与肾功能分级成正比。进行多因素分析,结果发现患者年龄、血浆总胆固醇水平与GFR成反比,甘油三酯水平与GFR成正比。结果中甘油三酯水平与GFR成正比的结果与目前大多数临床报道不相符。临床调查结果说明急性心肌梗死后患者肾功能可能会出现某种程度的降低,在处置急性心肌梗死患者时要充分注意肾功能的水平,以防止急性心肌梗死与肾功能不全成为恶性循环。由于本研究病例数较少,而且为回顾性研究,有必要进一步扩大样本例数进行研究。
This paper, including literature review and clinical research in two parts.
Literature Review on the subject for cardiovascular disease and kidney damage progress in understanding of Integrative Medicine, reviewed the past few years at home and abroad on cardiovascular disease and related risk factors for chronic kidney disease and the impact of heart and kidney disease related to the understanding of Chinese medicine. Clinical long-term high blood pressure, heart function does not lead to kidney damage plenary session, but the vast majority of chronic kidney disease patients caught with varying degrees of hypertension, coronary heart disease and other cardiovascular diseases, cardiovascular disease and that close to kidney disease.In this paper, heart and kidney physiology and pathology of a link analysis, clinical from chronic heart failure, coronary heart disease, cardiovascular disease risk factors on the three aspects of cardiovascular disease on the impact of chronic kidney disease.Chinese medicine through the intersection of heart and kidney and heart and kidney non-payment of understanding to explain the impact of the heart to the kidneys.
Clinical studies of the retrospective analysis of the Sino-Japanese Friendship Hospital in October 2006 to March 2008 treated 197 patients with acute myocardial infarction in patients with clinical manifestations, such as laboratory results, the data-analysis, found that patients with acute myocardial infarction Patients with heart function classification (Killip classification) and renal function is directly proportional to grade, age and patients with renal function is directly proportional to grade. Multi-factor analysis, found that patients with age, plasma total cholesterol levels and inversely proportional to GFR, and triglyceride level is directly proportional to GFR. Results in triglyceride levels and GFR is directly proportional to the results of the current majority of clinical reports do not match. Clinical findings that patients with acute myocardial infarction after renal function may be some degree of reduction in the disposal of patients with acute myocardial infarction, renal function should give full attention to the level to prevent acute myocardial infarction and renal insufficiency become a vicious cycle. As the number of cases of this study less, but also for the retrospective study, it is necessary to further expand the number of samples for research.
文献综述的题目为心血管疾病的肾脏损害研究及中西医结合认识,回顾了近年来国内外对心血管疾病及其相关危险因素对慢性肾脏病的影响及心肾相关疾病的中医认识。临床上长期高血压,心功能不全会导致肾脏损伤,而绝大多数慢性肾脏病患者均伴不同程度的高血压、冠心病等心血管疾病,可见心血管疾病与肾脏病关系密切。本文对心脏和肾脏的生理和病理方面的联系进行了系统分析,在临床上从冠心病、慢性心功能不全、心血管疾病的危险因素三个方面阐述了心血管疾病对慢性肾脏病的影响。通过中医对心肾相交和心肾不交的认识来说明心脏对肾脏的影响。
临床研究部分回顾性分析了中日友好医院2006年10月～2008年3月收治的197例急性心肌梗塞患者临床表现、实验室检查结果像,对数据进行单因素分析,结果发现急性心肌梗死后患者的心功能分级(Killip分级)与肾功能分级成正比,患者年龄与肾功能分级成正比。进行多因素分析,结果发现患者年龄、血浆总胆固醇水平与GFR成反比,甘油三酯水平与GFR成正比。结果中甘油三酯水平与GFR成正比的结果与目前大多数临床报道不相符。临床调查结果说明急性心肌梗死后患者肾功能可能会出现某种程度的降低,在处置急性心肌梗死患者时要充分注意肾功能的水平,以防止急性心肌梗死与肾功能不全成为恶性循环。由于本研究病例数较少,而且为回顾性研究,有必要进一步扩大样本例数进行研究。
This paper, including literature review and clinical research in two parts.
Literature Review on the subject for cardiovascular disease and kidney damage progress in understanding of Integrative Medicine, reviewed the past few years at home and abroad on cardiovascular disease and related risk factors for chronic kidney disease and the impact of heart and kidney disease related to the understanding of Chinese medicine. Clinical long-term high blood pressure, heart function does not lead to kidney damage plenary session, but the vast majority of chronic kidney disease patients caught with varying degrees of hypertension, coronary heart disease and other cardiovascular diseases, cardiovascular disease and that close to kidney disease.In this paper, heart and kidney physiology and pathology of a link analysis, clinical from chronic heart failure, coronary heart disease, cardiovascular disease risk factors on the three aspects of cardiovascular disease on the impact of chronic kidney disease.Chinese medicine through the intersection of heart and kidney and heart and kidney non-payment of understanding to explain the impact of the heart to the kidneys.
Clinical studies of the retrospective analysis of the Sino-Japanese Friendship Hospital in October 2006 to March 2008 treated 197 patients with acute myocardial infarction in patients with clinical manifestations, such as laboratory results, the data-analysis, found that patients with acute myocardial infarction Patients with heart function classification (Killip classification) and renal function is directly proportional to grade, age and patients with renal function is directly proportional to grade. Multi-factor analysis, found that patients with age, plasma total cholesterol levels and inversely proportional to GFR, and triglyceride level is directly proportional to GFR. Results in triglyceride levels and GFR is directly proportional to the results of the current majority of clinical reports do not match. Clinical findings that patients with acute myocardial infarction after renal function may be some degree of reduction in the disposal of patients with acute myocardial infarction, renal function should give full attention to the level to prevent acute myocardial infarction and renal insufficiency become a vicious cycle. As the number of cases of this study less, but also for the retrospective study, it is necessary to further expand the number of samples for research.
引文
1. 杜金行,曹 迎。心肾疾病相关性临床研究进展(J)中西医结合心脑血管病杂志2007.5(9),856-858
2. van Dokkum RP, Eijkelkamp WB, Kluppel AC, et al. Myocardial infarction enhances progressive renal damage in an experimental model for cardio-renal interaction. J Am Soc Nephrol, 2004, 15(12): 3103- 3110.
3. 袁伟杰,边琪. 心肾综合征的发病及治疗. 中国中西医结合肾病杂志,2006,7(6):311-313.
4. 李小鹰,阴大伟.肾脏和心血管系统相互影响的病理生理基础.第一届全国心肾疾病进展研讨会讲义,2006:9-17
5. Ishani A ,Weinhandl E ,Zhao Z ,et al . Angiotensin – converting enzyme inhibitor as a risk factor for t he development of anemia and t he impact of incident anemia on mortality in patient s with left vent ricular dysfunction [ J ] . J Am Coll Cardiol , 2005 , 45(3) :391 - 399
6. Vaziri ND. Eryt hropoietin and t ransferrin metabolism in nephrotic syndrome[J ] . Am J Kidney Dis ,2001(38) :1 - 8
7. Krack A ,Sharma R , Figulla HR ,et al . The importance of the gast rointestinal system in t he pat hogenesis of heart failure[J ] .Eur Heart J ,2005 ,26 (22) :2 368 - 2 374
8. Iverson PO ,Woldbaek PR ,Tonnessen T ,et al. Decreased hematopoiesis in bone marrow of mice wit h congestive heart failure[J ] . Am J Physiol ,2002 ,282(1) :166 – 172
9. Hillege HL , Janssen WM , BAK AA , et al . Microalbuminuria is common , also in a non - diabetic , non - hypertensive population , and an independent indicator of cardiovascular risk factors and cardiovascular morbidity[J ] . J Intern Med , 2001 ,249 : 519 - 526.
10. 沈卫峰. 重视心脏病学与肾脏病学的相互联系[J ] . 诊断学理论与实践,2006 ,5 (3) :197 - 198.
11. Shlipak MG. Pharmacotherapy for heart failure in patients with renal insufficiency[J ] . Ann Intern Med , 2003 , 138 : 917 - 924.
12. Silverberg DS , Wexler D , Blum M , et al . The interaction between heart failure , renal failure and anemia - the cardio - renal anemia syndrome[J ] . Blood Purif , 2004 , 22 : 277 - 284.
13. USRDS 2001 Annual Data Report . Atlas of end-stage renal disease in t he United States , national institutes of health , national institute of diabetes and digestive and kidney diseases [M] . Bethesda , MD , US Renal Data System ,2001.
14. 周福德,王梅. 北京市血液透析的发展和质量改进[ J ]. 中国血液净化杂志, 2006, 5 (3) : 117 - 118
15. The multiple risk factor intervention trial research group . Mortality after
16 years for participant s randomized to t he multiple risk factor intervention trial [J ] . Circulation ,1996 ,94 :9462951.
16. 中华医学会肾脏病分会透析移植登记工作组. 1999 年度全国透析移植登记报告[J ] . 中华肾脏病杂志,2001 ,17 :77-78.
17. Palmer BE. Impaired renal autoregulation: implication for the genesis of hypertension and hypertension - induced renal injury.Am J Med Sci, 2001, 321: 388 - 400.
18. Hill GS, Heudes D, Jacquot C, et al. Morphometric evidence for impairment of renal autoregulation in advanced essential hypertension.Kidney Int, 2006, 69: 823 - 831
19. Anderson WP, Kett MM, Stevenson KM, et al. Renovascular hypertension structural changes in the renal vasculature . Hypertension,2000, 36: 648 -
652.
20. Liao YH , Wei YM , Wang M , et al . Autoantibodies against AT1-Receptor and α1-Adrenergic receptor in patients with hypertension[J] . Hypertens Res ,2002 ,25 :641-646.
21. 赵林双,廖玉华,王敏,等. 高血压合并肾损害患者血清抗β1 和α1 受体自身抗体与血清肌酐水平的相互性分析[J] . 高血压志,2005 ,13 :549-551.
22. 赵林双,廖玉华,王敏,等. 血清抗AT1R、β1 、α1 受体自身抗体在高血压合并肾损害患者的初步研究[J] . 高血压杂志,2006 ,14 :181-184.
23. Hiratsuka N ,Shiba K,Nishide K,et al. Analysis of urinary albumin ,transferring ,N - acetylbeta - D - glucosaminidase and beta2 - microglobulin in patients with impaired glucose tolerance. J.Clin Lab Anal ,1998 ,12(6) :351 - 353.
24. Lang F, Capasso G, Schwab M, et al. Renal tubular transport and the genetic basis of hypertensive disease [ J ]. Clin Exp Nephrol,2005, 9 (2) : 91 - 99.
25. Langley-Evans SC, Langley2Evans AJ, Marchand MC. Nutritional programming of blood pressure and renal morphology[ J ]. Arch Physiol Biochem , 2003, 111 (1) : 8 - 16.
26. Moorhead J F ,Chan MK, El - Nahas M ,et al. Lipid nephrotoxicity in chronic progressive glomerular and tubulo - interstitial disease. Lancet 1982 ;2 :1309 - 1311.
27. Nosadini R ,Tonolo G. Polyunsaturated fatty acids and renal fi2brosis: pathophysiologic link and potential clinical implications. J Nephrol2003 ;16 (Suppl 7) :S42 - 47.
28. Muntner P ,Coresh J ,Smith C ,et al. Plasma lipids and risk of developing renal dysfunction : The Atherosclerosis Risk in Communities Study. Kidney Int 2000 ;58 :293 - 301.
29. Sammuelsson O ,Attman P ,Knight - Gibson C ,et al. Complex apolipoprotein B - containing lipoprotein particles are associated with a higher rate of progression of human chronic renal insufficiency. J Am Soc Nephrol 1998 ;9 :1482 - 1488.
30. Massy ZA, Nguyen KhoaT, Lacour B, et al. Dyslipidaemia and the progression of renal disease in chronic renal failure patients. Nephrol DialTransplant,1999,14:2392-2397.
31. Samulesson O,Attman PO, Knight-Gibson C, et al. plasma level of lipoprotein do not predict, progress of human chronic renal failure. Nephro1 Dial Tmnspl-ant,1996,11:2237-2243.
32. 乔 洁,宋怀东.脂代谢紊乱与肾损害及其临床处理. J实用糖尿病杂志 2007,3 卷,5 期5-6
33. 金玉华,祝之明,周方明,等. 代谢综合征肾脏损害及其相关因素的研究[J ] . 第三军医大学学报,2004 ,26(19) :1768 - 1770.
34. 曾定尹. 血脂异常与代谢综合征[J ] . 中国实用内科杂志,2004 ,24 (5) :1269 - 1271.
35. SHURRAB A, MAMTORA H, O ’DONOGHUED J, et al. Increasing the diagnostic yield of renal angiography for the Diagnosis of atheromatous renovascular disease. BJR, 2001, 74(5) : 1 – 6
36. Conlon PJ, Athirakul K, Kovalik E, et al1Survival in renal vascular disease [ J ] 1J Am Soc Nephrol, 1998, 9 (2) : 252-256
37. 赵志刚,祝之明,杜彦社. 代谢综合征的颈动脉粥样硬化特征[J ] . 中华内科杂志,2003 ,42 :625 - 627.
38. 徐兴森,杨万涛,刘道燕,等. 高血压合并代谢紊乱及对心肾血管的影响[J ] . 中华高血压杂志,2006 ,14 (11) :894 - 898.
39. 曹树臣,房铭. 肥胖相关性肾病临床和病理特点分析[J ] . 临床荟萃,2007 ,22 (5) :322 - 326 .
40. 董葆,陈文,程虹,等. 肥胖相关性局灶节段性肾小球硬化症临床与病理表现[J ] . 中华肾脏病杂志,2002 ,18 :389 - 392.。
41. Bal lantyne GH , Gumbs A ,Modl in IM. Changes in insul in resistance following bariatric surgery and the adipoinsular axis :role of the adipocytokines , lep tin , adiponectin and resistin [ J ] . Obes Surg ,2005 ,15 (5) :692 -699.
42. E1 一Atat FA ,Stas SN ,McFarlane SI ,et a1. The relationship between hyperinsul inemia. hypertension and progressive renal disease[J ] . J Am Soc Nephrol ,2004 ,15 :2816 - 2827
43. 刘志红,黄燕飞. 胰岛素抵抗与糖尿病肾病[J ] . 肾脏病与透析肾移植杂志,2002 ,11 :164.
44. Ginsberg HN. Insulin resistance and cardiovascular disease[J ] . J Clin Invest ,2000 ,106 :453 - 458 .
45. Orth SR , Ritz E ,Schrier RW. The renal risks of smoking.Kidney Int ,1997 ,51(6) :1669 - 1677.
46. Pinto - Sietsma SJ ,Mulder J ,Janssen WM ,et al. Smoking is related to albuminuria and abnormal renal function in nondiabetic persons. Ann Intern Med ,2000 ,133(8) :585 - 591.
47. Peter WF , Myers RH ,Larson MG. Apolipoprotein E alleles , dys-lipidemia and coronary heart disease : The framinghan offspring study[J ] . JAMA , 1994 , 272 :1666 - 1671.
1.Massy ZA, Nguyen KhoaT, Lacour B, et al. Dyslipidaemia and the progression of renal disease in chronic renal failure patients. Nephrol DialTransplant,1999,14:2392-2397.
2. Muntner P ,Coresh J ,Smith C ,et al. Plasma lipids and risk of developing renal dysfunction : The Atherosclerosis Risk in Communities Study. Kidney Int 2000 ;58 :293 - 301.
2. van Dokkum RP, Eijkelkamp WB, Kluppel AC, et al. Myocardial infarction enhances progressive renal damage in an experimental model for cardio-renal interaction. J Am Soc Nephrol, 2004, 15(12): 3103- 3110.
3. 袁伟杰,边琪. 心肾综合征的发病及治疗. 中国中西医结合肾病杂志,2006,7(6):311-313.
4. 李小鹰,阴大伟.肾脏和心血管系统相互影响的病理生理基础.第一届全国心肾疾病进展研讨会讲义,2006:9-17
5. Ishani A ,Weinhandl E ,Zhao Z ,et al . Angiotensin – converting enzyme inhibitor as a risk factor for t he development of anemia and t he impact of incident anemia on mortality in patient s with left vent ricular dysfunction [ J ] . J Am Coll Cardiol , 2005 , 45(3) :391 - 399
6. Vaziri ND. Eryt hropoietin and t ransferrin metabolism in nephrotic syndrome[J ] . Am J Kidney Dis ,2001(38) :1 - 8
7. Krack A ,Sharma R , Figulla HR ,et al . The importance of the gast rointestinal system in t he pat hogenesis of heart failure[J ] .Eur Heart J ,2005 ,26 (22) :2 368 - 2 374
8. Iverson PO ,Woldbaek PR ,Tonnessen T ,et al. Decreased hematopoiesis in bone marrow of mice wit h congestive heart failure[J ] . Am J Physiol ,2002 ,282(1) :166 – 172
9. Hillege HL , Janssen WM , BAK AA , et al . Microalbuminuria is common , also in a non - diabetic , non - hypertensive population , and an independent indicator of cardiovascular risk factors and cardiovascular morbidity[J ] . J Intern Med , 2001 ,249 : 519 - 526.
10. 沈卫峰. 重视心脏病学与肾脏病学的相互联系[J ] . 诊断学理论与实践,2006 ,5 (3) :197 - 198.
11. Shlipak MG. Pharmacotherapy for heart failure in patients with renal insufficiency[J ] . Ann Intern Med , 2003 , 138 : 917 - 924.
12. Silverberg DS , Wexler D , Blum M , et al . The interaction between heart failure , renal failure and anemia - the cardio - renal anemia syndrome[J ] . Blood Purif , 2004 , 22 : 277 - 284.
13. USRDS 2001 Annual Data Report . Atlas of end-stage renal disease in t he United States , national institutes of health , national institute of diabetes and digestive and kidney diseases [M] . Bethesda , MD , US Renal Data System ,2001.
14. 周福德,王梅. 北京市血液透析的发展和质量改进[ J ]. 中国血液净化杂志, 2006, 5 (3) : 117 - 118
15. The multiple risk factor intervention trial research group . Mortality after
16 years for participant s randomized to t he multiple risk factor intervention trial [J ] . Circulation ,1996 ,94 :9462951.
16. 中华医学会肾脏病分会透析移植登记工作组. 1999 年度全国透析移植登记报告[J ] . 中华肾脏病杂志,2001 ,17 :77-78.
17. Palmer BE. Impaired renal autoregulation: implication for the genesis of hypertension and hypertension - induced renal injury.Am J Med Sci, 2001, 321: 388 - 400.
18. Hill GS, Heudes D, Jacquot C, et al. Morphometric evidence for impairment of renal autoregulation in advanced essential hypertension.Kidney Int, 2006, 69: 823 - 831
19. Anderson WP, Kett MM, Stevenson KM, et al. Renovascular hypertension structural changes in the renal vasculature . Hypertension,2000, 36: 648 -
652.
20. Liao YH , Wei YM , Wang M , et al . Autoantibodies against AT1-Receptor and α1-Adrenergic receptor in patients with hypertension[J] . Hypertens Res ,2002 ,25 :641-646.
21. 赵林双,廖玉华,王敏,等. 高血压合并肾损害患者血清抗β1 和α1 受体自身抗体与血清肌酐水平的相互性分析[J] . 高血压志,2005 ,13 :549-551.
22. 赵林双,廖玉华,王敏,等. 血清抗AT1R、β1 、α1 受体自身抗体在高血压合并肾损害患者的初步研究[J] . 高血压杂志,2006 ,14 :181-184.
23. Hiratsuka N ,Shiba K,Nishide K,et al. Analysis of urinary albumin ,transferring ,N - acetylbeta - D - glucosaminidase and beta2 - microglobulin in patients with impaired glucose tolerance. J.Clin Lab Anal ,1998 ,12(6) :351 - 353.
24. Lang F, Capasso G, Schwab M, et al. Renal tubular transport and the genetic basis of hypertensive disease [ J ]. Clin Exp Nephrol,2005, 9 (2) : 91 - 99.
25. Langley-Evans SC, Langley2Evans AJ, Marchand MC. Nutritional programming of blood pressure and renal morphology[ J ]. Arch Physiol Biochem , 2003, 111 (1) : 8 - 16.
26. Moorhead J F ,Chan MK, El - Nahas M ,et al. Lipid nephrotoxicity in chronic progressive glomerular and tubulo - interstitial disease. Lancet 1982 ;2 :1309 - 1311.
27. Nosadini R ,Tonolo G. Polyunsaturated fatty acids and renal fi2brosis: pathophysiologic link and potential clinical implications. J Nephrol2003 ;16 (Suppl 7) :S42 - 47.
28. Muntner P ,Coresh J ,Smith C ,et al. Plasma lipids and risk of developing renal dysfunction : The Atherosclerosis Risk in Communities Study. Kidney Int 2000 ;58 :293 - 301.
29. Sammuelsson O ,Attman P ,Knight - Gibson C ,et al. Complex apolipoprotein B - containing lipoprotein particles are associated with a higher rate of progression of human chronic renal insufficiency. J Am Soc Nephrol 1998 ;9 :1482 - 1488.
30. Massy ZA, Nguyen KhoaT, Lacour B, et al. Dyslipidaemia and the progression of renal disease in chronic renal failure patients. Nephrol DialTransplant,1999,14:2392-2397.
31. Samulesson O,Attman PO, Knight-Gibson C, et al. plasma level of lipoprotein do not predict, progress of human chronic renal failure. Nephro1 Dial Tmnspl-ant,1996,11:2237-2243.
32. 乔 洁,宋怀东.脂代谢紊乱与肾损害及其临床处理. J实用糖尿病杂志 2007,3 卷,5 期5-6
33. 金玉华,祝之明,周方明,等. 代谢综合征肾脏损害及其相关因素的研究[J ] . 第三军医大学学报,2004 ,26(19) :1768 - 1770.
34. 曾定尹. 血脂异常与代谢综合征[J ] . 中国实用内科杂志,2004 ,24 (5) :1269 - 1271.
35. SHURRAB A, MAMTORA H, O ’DONOGHUED J, et al. Increasing the diagnostic yield of renal angiography for the Diagnosis of atheromatous renovascular disease. BJR, 2001, 74(5) : 1 – 6
36. Conlon PJ, Athirakul K, Kovalik E, et al1Survival in renal vascular disease [ J ] 1J Am Soc Nephrol, 1998, 9 (2) : 252-256
37. 赵志刚,祝之明,杜彦社. 代谢综合征的颈动脉粥样硬化特征[J ] . 中华内科杂志,2003 ,42 :625 - 627.
38. 徐兴森,杨万涛,刘道燕,等. 高血压合并代谢紊乱及对心肾血管的影响[J ] . 中华高血压杂志,2006 ,14 (11) :894 - 898.
39. 曹树臣,房铭. 肥胖相关性肾病临床和病理特点分析[J ] . 临床荟萃,2007 ,22 (5) :322 - 326 .
40. 董葆,陈文,程虹,等. 肥胖相关性局灶节段性肾小球硬化症临床与病理表现[J ] . 中华肾脏病杂志,2002 ,18 :389 - 392.。
41. Bal lantyne GH , Gumbs A ,Modl in IM. Changes in insul in resistance following bariatric surgery and the adipoinsular axis :role of the adipocytokines , lep tin , adiponectin and resistin [ J ] . Obes Surg ,2005 ,15 (5) :692 -699.
42. E1 一Atat FA ,Stas SN ,McFarlane SI ,et a1. The relationship between hyperinsul inemia. hypertension and progressive renal disease[J ] . J Am Soc Nephrol ,2004 ,15 :2816 - 2827
43. 刘志红,黄燕飞. 胰岛素抵抗与糖尿病肾病[J ] . 肾脏病与透析肾移植杂志,2002 ,11 :164.
44. Ginsberg HN. Insulin resistance and cardiovascular disease[J ] . J Clin Invest ,2000 ,106 :453 - 458 .
45. Orth SR , Ritz E ,Schrier RW. The renal risks of smoking.Kidney Int ,1997 ,51(6) :1669 - 1677.
46. Pinto - Sietsma SJ ,Mulder J ,Janssen WM ,et al. Smoking is related to albuminuria and abnormal renal function in nondiabetic persons. Ann Intern Med ,2000 ,133(8) :585 - 591.
47. Peter WF , Myers RH ,Larson MG. Apolipoprotein E alleles , dys-lipidemia and coronary heart disease : The framinghan offspring study[J ] . JAMA , 1994 , 272 :1666 - 1671.
1.Massy ZA, Nguyen KhoaT, Lacour B, et al. Dyslipidaemia and the progression of renal disease in chronic renal failure patients. Nephrol DialTransplant,1999,14:2392-2397.
2. Muntner P ,Coresh J ,Smith C ,et al. Plasma lipids and risk of developing renal dysfunction : The Atherosclerosis Risk in Communities Study. Kidney Int 2000 ;58 :293 - 301.