血清胆红素与慢性肾小球肾炎患者大量蛋白尿、血浆白蛋白、eGFR的相关性研究
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摘要
目的比较慢性肾小球肾炎患者不同水平蛋白尿、血浆白蛋白、eGFR(Estimated glomerular filtration rate,估算肾小球滤过率)间胆红素的差异,探讨血清胆红素对慢性肾小球肾炎患者蛋白尿、血浆白蛋白、eGFR的影响。方法回顾性研究诊断为慢性肾小球肾炎的患者。收集患者的一般资料、实验室检查资料,分析慢性肾小球肾炎患者蛋白尿、血浆白蛋白、eGFR与胆红素的关系。结果慢性肾小球肾炎患者289例,女性患者132例(45.7%),男性患者157例(54.3%)。将eGFR按照慢性肾脏病分期进行分组,随着eGFR水平逐渐下降,患者的收缩压、舒张压、尿酸、尿蛋白定量逐渐增加,胆红素、白蛋白逐渐下降(P<0.05)。将24 h尿蛋白定量以3.5 g为界分为2组,与24 h尿蛋白定量<3.5 g组相比,24 h尿蛋白定量≥3.5 g组患者的收缩压、舒张压、肌酐、胆红素、胆固醇高,白蛋白、eGFR低(P<0.05)。将血浆白蛋白以30 g/L为界分为2组,与血浆白蛋白≥30 g/L组相比,血浆白蛋白<30 g/L组患者的收缩压、肌酐、血糖、尿酸、甘油三酯、胆固醇、尿蛋白定量高,胆红素水平低(P<0.05)。慢性肾小球肾炎患者血清胆红素水平与尿蛋白定量呈负相关,与血浆白蛋白、eGFR呈正相关(P<0.05)。结论慢性肾小球肾炎患者的血清胆红素水平越高,血浆白蛋白、eGFR越高,尿蛋白定量越低,可作为慢性肾炎病情评价的一项间接指标。
Objective To compare the relationship between serum bilirubin and proteinuria,albumin,eGFR in patients with primary chronic glomerulonephritis,and to further study the effect of serum bilirubin on proteinuria,albumin and eGFR in patients with primary chronic glomerulonephritis in order to provide some proofs for the treatment of primary chronic glomerulonephritis.Methods A single center retrospective study was designed.The patients diagnosed with primary chronic glomerulonephritis were enrolled between Jan.2001 to Dec.2017 in Pingluo county people's hospital.The data including demographic information,laboratory items were collected.Then,the relationship between the serum bilirubin levels and the proteinuria,albumin,eGFR level in patients with primary chronic glomerulonephritis was analyzed.Results A total of 289 patients with chronic glomerulonephritis were included in this study.132 cases of the patients were male(45.8%),157 cases were female(54.2%).The eGFR levels were grouped by the chronic kidney disease stages method.With the gradually decreasing of the eGFR levels,the levels of DBP,SBP,UA,24 hour urinary protein quantitative were increased gradually,while ALB and TBIL were decreased gradually(P<0.05);The 24 hour urinary protein of patients were grouped into ≥ 3.5 g group and < 3.5 g group according to the 24 hour urinary protein quantitative data.The patients in ≥3.5 g group had higher levels of DBP,SBP,Scr,TG,CHOL,and lower levels of ALB,TBIL,eGFR when compared with the patients in <3.5 g group(P<0.05);The patients were grouped by ABL with 30 g/L cutoff.The patients with 30 ≥ g/L group were lower levels of SBP,Scr,GLU,UA,TG,CHOL and 24 hour urinary protein quantitative data,and higher levels of TBIL when compared with the patients with ALB<0 g/L group(P<0.05);The Pearson correlation analysis showed that the serum bilirubin level was negatively related to 24 hour urinary protein quantitative and positively related to eGFR and ALB.Conclusions The serum bilirubin of the primary chronic glomerulonephritis patients with higher eGFR and ALB may be higher,while the 24 hour urinary protein quantitative lower.
Objective To compare the relationship between serum bilirubin and proteinuria,albumin,eGFR in patients with primary chronic glomerulonephritis,and to further study the effect of serum bilirubin on proteinuria,albumin and eGFR in patients with primary chronic glomerulonephritis in order to provide some proofs for the treatment of primary chronic glomerulonephritis.Methods A single center retrospective study was designed.The patients diagnosed with primary chronic glomerulonephritis were enrolled between Jan.2001 to Dec.2017 in Pingluo county people's hospital.The data including demographic information,laboratory items were collected.Then,the relationship between the serum bilirubin levels and the proteinuria,albumin,eGFR level in patients with primary chronic glomerulonephritis was analyzed.Results A total of 289 patients with chronic glomerulonephritis were included in this study.132 cases of the patients were male(45.8%),157 cases were female(54.2%).The eGFR levels were grouped by the chronic kidney disease stages method.With the gradually decreasing of the eGFR levels,the levels of DBP,SBP,UA,24 hour urinary protein quantitative were increased gradually,while ALB and TBIL were decreased gradually(P<0.05);The 24 hour urinary protein of patients were grouped into ≥ 3.5 g group and < 3.5 g group according to the 24 hour urinary protein quantitative data.The patients in ≥3.5 g group had higher levels of DBP,SBP,Scr,TG,CHOL,and lower levels of ALB,TBIL,eGFR when compared with the patients in <3.5 g group(P<0.05);The patients were grouped by ABL with 30 g/L cutoff.The patients with 30 ≥ g/L group were lower levels of SBP,Scr,GLU,UA,TG,CHOL and 24 hour urinary protein quantitative data,and higher levels of TBIL when compared with the patients with ALB<0 g/L group(P<0.05);The Pearson correlation analysis showed that the serum bilirubin level was negatively related to 24 hour urinary protein quantitative and positively related to eGFR and ALB.Conclusions The serum bilirubin of the primary chronic glomerulonephritis patients with higher eGFR and ALB may be higher,while the 24 hour urinary protein quantitative lower.
引文
[1] 刘金涛,金燕,李福凤.中医药治疗慢性肾小球肾炎研究进展[J].中华中医药学刊,2013,10:2127-2129.
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[5] 韩艳萍,栾凤武,丁丽娜,等.血清胆红素水平对IgA肾病患者蛋白尿的影响[J].宁夏医学杂志,2018,40(3):217.
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[8] 傅淑霞.2012年肾脏疾病主要临床进展[J].临床荟萃,2013,28(4):361-367.
[9] Zhang Luxia,Wang Fang,Wang Li,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.
[10] Le Weibo,Liang Shaoshan,Hu Yanglin,et al.Long-term renal survival and related risk factors in patients with IgA nephropathy:results from a cohort of 1155 cases in a Chinese adult population[J].Nephrology,Dialysis,Transplantation,2012,27(4):1479-1485.
[11] Clark WF,Macnab JJ,Sontrop JM,et al.Dipstick proteinuria as a screening strategy to identify rapid renal decline[J].Journal of the American Society of Nephrology,2011,22(9):1729-1736.
[12] 王革,冯志红,俞敏,等.IgA肾病牛津病理分型与临床分析[J].宁夏医学杂志,2013,35(12):1151-1153.
[13] De Ba ran ano,Rao M,Ferris CD,et al.Biliverdin reductase:a major physiologic cytoprotectant[J].Proceedings of the National Academy of Sciences of the United States of America,2002,99(25):16093-16098.
[14] 聂文荣.高胆红素血症对肾功能影响[J].中国当代医药,2011,18(11):154-155.
[15] 方敬爱,张晓东,杜永成,等.获救矿难工人急性肾损伤中胆红素与血尿酸水平的分析[J].中国中西医结合肾病杂志,2013,14(8):704-705.
[16] Anraku M,Kitamura K,Shinohara A,et al.Intravenous Iron administration induces oxidation of serum albumin in hemodialysis patients[J].Kidney International,2004,66(2):841-848.
[2] Zhang Lu-xia,Zhao Ming-hui,Wang Hai-bo.Trends in chronic kidney disease in China[J].New England Journal of Medicine,2016,375(9):905-906.
[3] Park S,Kim DH,Hwang JH,et al.Elevated bilirubin levels are associated with a better renal prognosis and ameliorate kidney fibrosis[J].PLOS One,2017,12(2):172434.
[4] Tanaka S,Ninomiya T,Masutani K,et al.Prognostic impact of serum bilirubin level on long-term renal survival in IgA nephropathy[J].Clinical and Experimental Nephrology,2015,19(6):1062-1070.
[5] 韩艳萍,栾凤武,丁丽娜,等.血清胆红素水平对IgA肾病患者蛋白尿的影响[J].宁夏医学杂志,2018,40(3):217.
[6] 葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2013:474.
[7] Levey AS,Stevens LA,Schmid CH,et al.A new equation to estimate glomerular filtration rate[J].Annals of Internal Medicine,2009,150(9):604-607.
[8] 傅淑霞.2012年肾脏疾病主要临床进展[J].临床荟萃,2013,28(4):361-367.
[9] Zhang Luxia,Wang Fang,Wang Li,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.
[10] Le Weibo,Liang Shaoshan,Hu Yanglin,et al.Long-term renal survival and related risk factors in patients with IgA nephropathy:results from a cohort of 1155 cases in a Chinese adult population[J].Nephrology,Dialysis,Transplantation,2012,27(4):1479-1485.
[11] Clark WF,Macnab JJ,Sontrop JM,et al.Dipstick proteinuria as a screening strategy to identify rapid renal decline[J].Journal of the American Society of Nephrology,2011,22(9):1729-1736.
[12] 王革,冯志红,俞敏,等.IgA肾病牛津病理分型与临床分析[J].宁夏医学杂志,2013,35(12):1151-1153.
[13] De Ba ran ano,Rao M,Ferris CD,et al.Biliverdin reductase:a major physiologic cytoprotectant[J].Proceedings of the National Academy of Sciences of the United States of America,2002,99(25):16093-16098.
[14] 聂文荣.高胆红素血症对肾功能影响[J].中国当代医药,2011,18(11):154-155.
[15] 方敬爱,张晓东,杜永成,等.获救矿难工人急性肾损伤中胆红素与血尿酸水平的分析[J].中国中西医结合肾病杂志,2013,14(8):704-705.
[16] Anraku M,Kitamura K,Shinohara A,et al.Intravenous Iron administration induces oxidation of serum albumin in hemodialysis patients[J].Kidney International,2004,66(2):841-848.