199 Patients With Idiopathic Membranous Nephropathy Lipid Metabolism And The Relevant Clinical Analysis

Objective: To Analysis the blood lipid metabolism (including total cholesterol, triglycerides,high-density lipoprotein cholesterol,low density lipoprotein cholesterol) of 199 cases with idiopathic membranous nephropathy,and to find the relevance between blood lipid other commonly used clinical indicators, exploring the IMN patients’s lipid metabolism characteristics and risk factors for IMN dyslipidemia.Methods: selecting the patients treated in the nephrology department of the first affiliated hospital of guangxi medical university during August 2013 to September 2015,which renal pathology is confirmed to be membranous nephropathy, clinical manifestations and pathological Confirmed for idiopathic membranous nephropathy in a total of 199 patients.Selected cases which are ruled out the use of hormone,immune inhibitors and lipid regulation drugs prior to admission. Measuring patients’ height, weight, blood pressure and tested the patients’24 hours urinary protein、serum TC、TG、LDL-C、HDL-C、Hb、PLT、ALB、PT、Fe、IgA、IgG、IgM、25 (OH) D3、CRP、ESR、BUN、Scr and other clinical indicators. To Analysis of the characteristics and correlation with clinical indicators of lipid metabolism, and find the related risk factors of the lipid metabolism disorders.Results: (1) A total of 199 patients with IMN,The male to female ratio is about 3:2. The average age is 48.23±14.92 years old.Above 40 years old patients accounted for 78.0%. Clinical manifestations of nephrotic syndrome are 84 eases(42.2%) , the other 115 cases (57.8%) are not the nephrotic syndrome.2.Nephrotic syndrome IMN and non-nephrotic syndrome IMN patients,both occur dyslipidemia, Standing out with serum total cholesterol[8.22(6.15,11.54) vs 6.82 (5.05, 9.53) ] and LDL-C[4.95 (3.52, 7.35) vs4.27 (3.10,6.39) ] are rising, triglycerides[2.08 (1.42, 3.14) vs1.77 (1.24, 2.54) ] and HDL-C[1.25 (1.12, 1.59) vs1.38 (1.11, 1.78) ] level are normal.3.1n IMN patients, the incidence of dyslipidemia is 82.1% for male,female incidence of dyslipidemia is 76.3%.There is no significant difference between male and female on incidence of dyslipidemia (x =0.983,P=0.321).4. The incidence of nephrotic syndrome IMN patients with dyslipidemia was 83.3%,the incidence of hypercholesteremia is 73.8%,the incidence of hypertriglyceridemia is 45.2%,the incidence of high serum LDL-C is 65.5 %,the incidence of low serum HDL-C is 15.5. %The incidence of non-nephrotic syndrome IMN patients with dyslipidemia is 77.4%,the incidence of hypercholesteremia is 58.3%,the incidence of hypertriglyceridemia is 32.2%,the incidence of high serum LDL-C is 52.2 %,the incidence of low serum HDL-C is 14.8%.the incidence of dyslipidemia between this two group have no significant difference (χ2=1.607,P=0.302). Nephrotic syndrome IMN patients’s hypercholesterolemia incidence( 73.8%) compare with non-nephrotic syndrome IVMN patients (58.3%) is higher (χ2 = 5.147, p = 5.147); hypertriglyceridemia、high serum LDL-C 、 low serum HDL-C between this two group have no significant difference.5.The risk factors analysis of 199 IMN patients with dyslipidemia:PLT decrease, Hypersensitive c-reactive protein increase and serum IgG decrease are the independent risk factors of IMN patients hypercholesterolemia;Hypersensitive c-reactive protein increase is the independent risk factors for IMN’s hypertriglyceridemia; Glomerular filtration rate decrease, serum total protein decrease and albumin decrease are the independent risk factors of high serum LDL-C; Diastolic blood pressure increase and parathyroid hormone increase are the independent risk factors for low serum HDL-C.6.The risk factors analysis of nephrotic syndrome IMN patients’dyslipidemia: Hemoglobin decrease is the independent protective factor of hypercholesterolemia; Hypersensitive c-reactive protein increase is the independent risk factor for nephrotic syndrome IMN’s hypertriglyceridemia;Male, 24 hour urine protein > 8.0 g and FIB increase are the independent risk factors of high serum LDL-C; Anemia and hypertension the independent risk factors of low serum HDL-C.7.The risk factors analysis of non-nephrotic syndrome IMN patients’dyslipidemia: serum Fe decrease is the independent risk factor of hypercholesterolemia; Thrombin Time extending is the independent risk factors for hypertriglyceridemia, Prealbumin decrease is the independent protective factor for hypertriglyceridemia; Glomerular filtration rate decrease, total protein decrease and T3 decrease are the independent risk factors of high serum LDL-C;total protein decrease is the independent protective factor for low serum HDL-C.Conclusion: 1.The IMN patients are widely exist dyslipidemia,especially stand out with high total cholesterol and high LDL-C.2. In IMN patients, there is no significant difference between male and female on incidence of dyslipidemia,Nephrotic syndrome IMN patients’hypercholesterolemia incidence compare with non-nephrotic syndrome IMN patients is higher.3. In Nephrotic syndrome IMN patients ,Hemoglobin decrease is the independent protective factor of hypercholesterolemia; Hypersensitive c-reactive protein increase is the independent risk factor of hypertriglyceridemia; Male, 24 hour urine protein > 8.0 g and FIB increase are the independent risk factors of high serum LDL-C; Anemia and hypertension the independent risk factors of low serum HDL-C.4.In non-nephrotic syndrome IMN patients, serum Fe decrease is the independent risk factor of hypercholesterolemia; Thrombin Time extending is the independent risk factors for hypertriglyceridemia, Prealbumin decrease is the independent protective factor for hypertriglyceridemia; Glomerular filtration rate decrease, total protein decrease and T3 decrease are the independent risk factors of high serum LDL-C; total protein decrease is the independent protective factor for low serum HDL-C.