血脂水平在不同CKD分期患者中与心血管事件和全因死亡预后关系研究(1)
【摘要】 目的 研究HDL-C、LDL-C、甘油三酯、載脂蛋白A(APOA)、APOB在不同慢性肾脏病(CKD)分期患者中与心血管事件以及全因死亡的关系。方法 收集CKD患者数据并进行汇总及分期，随访结局(心血管事件和全因死亡)，采用Cox回归分析HDL-C、LDL-C、甘油三酯、APOA、APOB与各CKD分期患者心血管事件和全因死亡之间的关系。结果 经校正年龄、性别、BMI、糖尿病与否、现吸烟与否、现饮酒与否、血清尿酸、血清前白蛋白、血钾、血红蛋白后，LDL-C在CKD1、2、4、5期患者中均为心血管事件的危险因素(P均< 0.05)，甘油三酯和APOB在CKD1 ～ 5期患者中均为心血管事件的危险因素(P < 0.001)，而HDL-C与APOA在CKD1 ～ 5期患者中均非心血管事件的危险因素(P均> 0.05);HDL-C在CKD1 ～ 4期患者中均为全因死亡的危险因素(P均< 0.05)，甘油三酯在CKD1 ～ 3期患者中均为全因死亡的危险因素(P均< 0.001)，APOB在CKD1期患者为全因死亡的危险因素(P = 0.015)，而LDL-C和APOA在CKD1 ～ 5期患者中均非全因死亡的危险因素(P均> 0.05)。结论 甘油三酯和APOB在CKD患者心血管事件和全因死亡中可能有重要预测作用，需要高度关注，HDL-C在全因死亡预测中起到一定作用，LDL-C在心血管事件预测中起到一定作用，APOA则在心血管事件和全因死亡中均无预测作用。
【关键词】 高密度脂蛋白胆固醇;低密度脂蛋白胆固醇;甘油三酯;载脂蛋白A;载脂蛋白B;慢性肾脏病;心血管事件;全因死亡
【Abstract】 Objective To investigate the correlation between high-density lipoprotein-cholesterol (HDL-C)， low-density lipoprotein-cholesterol (LDL-C)， triglyceride， apolipoprotein A (APOA) and APOB， and cardiovascular events and all-cause death in patients with different stages of chronic kidney diseases (CKD). Methods Baseline data of all enrolled CKD patients were collected. Clinical prognosis (cardiovascular events and all-cause death) was evaluated during follow-up. The correlation between HDL-C， LDL-C， triglyceride， APOA and APOB， and cardiovascular events and all-cause death was analyzed by Cox’s regression analysis. Results After the adjustment of age， gender， body mass index (BMI)， diabetes mellitus， smoking， alcohol drinking， serum uric acid， serum prealbumin， serum potassium and hemoglobin， LDL-C was the risk factor of cardiovascular events in patients with stage Ⅰ，Ⅱ，Ⅳ，Ⅴ CKD (all P < 0.05)， triglyceride and APOB were the risk factors of cardiovascular events (all P < 0.001)， whereas HDL-C and APOA were not the risk factors of cardiovascular events (all P > 0.05). HDL-C was the risk factor of all-cause death in patients with stage Ⅰ-Ⅳ CKD (all P < 0.05). Trigleceride was the risk factor of all-cause death in patients with stage Ⅰ-Ⅲ CKD (all P < 0.001). APOB was the risk factor of all-cause death in patients with stage I CKD (P = 0.015). However， LDL-C and APOA were not the risk factors of all-cause death in patients with stage I-V CKD (all P > 0.05). Conclusions Trigleceride and APOB and TG may play an important role in predicting the prognosis of cardiovascular events and all-cause death in patients with different stages of CKD， which should be highly stressed. HDL-C is of certain significance in predicting all-cause death， whereas LDL-C plays a certain role in predicting the risk of all-cause death. APOA is not involved with the prediction of cardiovascular events and all-cause death., http://www.100md.com(胡文涛 李少敏 刘佩佳 DesmondY.H.Yap 刘迅)
【关键词】 高密度脂蛋白胆固醇;低密度脂蛋白胆固醇;甘油三酯;载脂蛋白A;载脂蛋白B;慢性肾脏病;心血管事件;全因死亡
【Abstract】 Objective To investigate the correlation between high-density lipoprotein-cholesterol (HDL-C)， low-density lipoprotein-cholesterol (LDL-C)， triglyceride， apolipoprotein A (APOA) and APOB， and cardiovascular events and all-cause death in patients with different stages of chronic kidney diseases (CKD). Methods Baseline data of all enrolled CKD patients were collected. Clinical prognosis (cardiovascular events and all-cause death) was evaluated during follow-up. The correlation between HDL-C， LDL-C， triglyceride， APOA and APOB， and cardiovascular events and all-cause death was analyzed by Cox’s regression analysis. Results After the adjustment of age， gender， body mass index (BMI)， diabetes mellitus， smoking， alcohol drinking， serum uric acid， serum prealbumin， serum potassium and hemoglobin， LDL-C was the risk factor of cardiovascular events in patients with stage Ⅰ，Ⅱ，Ⅳ，Ⅴ CKD (all P < 0.05)， triglyceride and APOB were the risk factors of cardiovascular events (all P < 0.001)， whereas HDL-C and APOA were not the risk factors of cardiovascular events (all P > 0.05). HDL-C was the risk factor of all-cause death in patients with stage Ⅰ-Ⅳ CKD (all P < 0.05). Trigleceride was the risk factor of all-cause death in patients with stage Ⅰ-Ⅲ CKD (all P < 0.001). APOB was the risk factor of all-cause death in patients with stage I CKD (P = 0.015). However， LDL-C and APOA were not the risk factors of all-cause death in patients with stage I-V CKD (all P > 0.05). Conclusions Trigleceride and APOB and TG may play an important role in predicting the prognosis of cardiovascular events and all-cause death in patients with different stages of CKD， which should be highly stressed. HDL-C is of certain significance in predicting all-cause death， whereas LDL-C plays a certain role in predicting the risk of all-cause death. APOA is not involved with the prediction of cardiovascular events and all-cause death., http://www.100md.com(胡文涛 李少敏 刘佩佳 DesmondY.H.Yap 刘迅)