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目的探讨糖尿病慢性肾脏疾病(CKD)发展过程中血清总胆红素(TBIL)的变化。方法收集125例CKD患者临床资料,记录TBIL、纤维蛋白原(FIB)、白蛋白(ALB)、血红蛋白(Hb)、血肌酐(Scr)、BUN等生化指标。另选取112名健康者作为对照(NC)组。根据24hUAlb将CKD患者分为24h UAlb 30~299mg/24h(n=41)和24hUAlb≥300mg/24h(n=84)组。24hUAlb≥300mg/24h组再根据eGFR水平分为eGFR≥15ml/(min·1.73m2)(n=42)和eGFR<15ml/(min·1.73m2)(n=42)两亚组。结果 24hUAlb≥300mg/24h组TBIL低于24hUAlb 30~299mg/24h组,且24hUAlb≥300mg/24h和24hUAlb 30~299mg/24h组TBIL均低于NC组[(12.01±4.73)vs(10.23±7.74)vs(7.51±2.84)mmol/L,P<0.05]。eGFR<15ml/(min·1.73m2)亚组TBIL较eGFR≥15 ml/(min·1.73m2)亚组下降[(8.34±3.47)vs(6.92±2.40)mmol/L,P<0.01]。多元回归分析得出回归方程为:Y=15.67+2.32 X(Y为eGFR,X为TBIL),CKD患者TBIL与eGFR呈正相关,ALB、Hb及FIB与eGFR无相关性。结论 CKD患者的TBIL水平较健康人群低,其随着尿蛋白排出增多、eGFR下降而下降。TBIL水平为肾功能下降的相关危险因素。
Objective To investigate the changes of serum total bilirubin (TBIL) during the development of chronic kidney disease (CKD) in diabetic patients. Methods The clinical data of 125 patients with CKD were collected and the biochemical indexes such as TBIL, FIB, ALB, Hb, Scr and BUN were recorded. Another 112 healthy individuals were selected as the control (NC) group. CKD patients were divided into 24h UAlb 30 ~ 299mg / 24h (n = 41) and 24hUAlb≥300mg / 24h (n = 84) group according to 24hUAlb. 24hUAlb≥300mg / 24h group were divided into eGFR≥15ml / (min.1.73m2) (n = 42) and eGFR <15ml / (min.1.73m2) (n = 42) subgroup according to the level of eGFR. Results TBIL in 24hUAlb≥300mg / 24h group was lower than that in 24hUAlb30 ~ 299mg / 24h group, 24hUAlb≥300mg / 24h and 24hUAlb30 ~ 299mg / 24h group were lower than those in NC group [(12.01 ± 4.73) vs (10.23 ± 7.74) vs (7.51 ± 2.84) mmol / L, P <0.05]. The subgroup of eGFR <15ml / (min · 1.73m2) subgroup had a decrease of TBIL compared with eGFR≥15 ml / (min · 1.73m2) subgroup [(8.34 ± 3.47) vs (6.92 ± 2.40) mmol / L, P <0.01]. Multivariate regression analysis showed that the regression equation was: Y = 15.67 + 2.32 X (Y is eGFR and X is TBIL). There was a positive correlation between TBIL and eGFR in CKD patients and no correlation between ALB, Hb, FIB and eGFR. Conclusions Patients with CKD have lower levels of TBIL than healthy people, with a decrease of eGFR as urinary protein excretion increases. TBIL levels are associated risk factors for decreased renal function.