Clinical Study On Characteristics Of Lipid Metabolism Disorder In Patients With Chronic Kidney Disease And Its Related Factors

Objective: To provide scientific evidence for traditional Chinese medicine(TCM)curing with Blood lipid metabolic disorder in chronic kidney disease(CKD),we are aimed to research for the characteristics of Blood lipid metabolic abnormalities and related factors,and to study for TCM syndrome characteristics of different lipid metabolic disorder in CKD。Methods: Choosing 419 patients with different chronic kidney disease(CKD) lipid metabolic disorder of outpatient and ward from March to October 2014 in total。 They were divided into four groups according to the clinical experience : Chronic glomerulonephritis group,nephrotic syndrome group,Chronic renal failure group and Maintenance hemodialysis group。We collected the clinical materials of the patients 。Based on the materials,we analyzed the lipid metabolic disturbance and lipid metabolism related indicators. And researching on the characteristics of blood lipid metabolism disorders and its related factors in chronic kidney disease(CKD)。Then we analyzed TCM syndrome distribution of hyperlipidemia in patients with chronic kidney disease(CKD),And discussed TCM syndrome differences of dyslipidemia in patients with different types of chronic kidney disease(CKD) 。Results:(1) The characteristics of this group of patients with blood lipid metabolic disorder was high TC(62.8%),high TG(60.2%) and high Lp(a)(61.9%)。Other lipid composition did not change significantly。It was the characteristics of NS with blood lipid metabolic disorder that lipid and lipoprotein both significantly increased,and it presented as high TC(98.1%),high TG(83.5%),high LDL- C(92.2%),high Apo- B(81.5%),high Lp(a)(86.4%),While low HDL-C and Apo-A1 accounted for 16.5% and 3.9% respectively。The CRF patients with blood lipid metabolic disorder characterized by high TG(70.7%),low HDL- C(68.1%),high Lp(a)-(62.9%),high TC(40.5%) and low TC(37.1%)。And that of blood lipid metabolic disorder in MHD patients was low TC(52.9%) and low HDL- C(54.0%),low Apo A1(47.12%),high TG(40.2%),high TC( 21.8%)。(2) TC,LDL-C and HDL-C of CGN patients were negatively correlated with ALB significantly(r=-0.480,P=0.005;r=-0.419,P=0.015;r=-0.460,P=0.007),while TC,LDL and ACR was significantly positive correlation(r=-0.437,P=0.011;r=-0.439,P=0.011)。 TC,LDL-C,Apo-B and Lp(a) of NS patients had significant negative correlation(r = 0.469, P = 0.000;r = 0.470,P = 0.000;r = 0.448,P = 0.000;r = 0.333,P = 0.001),Apo A1- was negatively correlated with 24 h urine protein quantitative(r = 0.240, P = 0.240)。And TC,LDL – C,Lp(a)of CRF patients had significantly negative correlation with ALB(r = 0.273,P = 0.003;r = 0.218,P = 0.019;r = 0.286,P = 0.002),while the TC, TG and GFR had significantly positive correlation(r = 0.215,P = 0.021;r = 0.230,P = 0.013),the Lp(a) was negatively correlated with PTH(r = 0.249,P = 0.249)。And Apo-A1 and ALB had positive correlation in MHD patients(r = 0.391,P = 0.391)。(3) In the 40 patients with CGN lipid metabolic disorder, spleen and kidney deficiency and damp heat syndrome is the most common(18 cases,45%),followed by spleen and kidney deficiency and blood stasis(11 cases,27.5%),spleen and kidney Yang deficiency and dampness intrinsic(7 cases,17.5%),qi and Yin deficiency syndrome(4 cases,10%).In NS patients with lipid metabolic disorders,TCM syndrome distribution as follows: the spleen and kidney Yang deficiency and dampness holds the most common(21 cases,52.5%),followed by the spleen and kidney deficiency and dampness turbidity intrinsic(12 cases,30%),qi and Yin deficiency and blood stasis(7 cases,17.5%);And that of CRF patients with blood lipid metabolic disorder is:the spleen and kidney deficiency and blood stasis ranked the first(15 cases,37.5%),followed by the spleen kidney Yang deficiency and dampness intrinsic(13cases,32.5%),Yin and Yang are two empty(8cases,20%),liver and kidney Yin deficiency(4,10 %)。The TCM syndrome distribution in patients of MHD blood lipid metabolic disorders were:spleen kidney Yang deficiency and blood stasis were in the first place(12 cases,30%),and the spleen kidney deficiency(10 cases,25%),Yin and Yang are two empty(10 cases,25%),liver and kidney Yin deficiency and pneumatic(8 cases,20%) following it。Conclusion:(1)Lipid metabolic disorder of chronic kidney disease(CKD) present different characteristics:Characteristic of CGN dyslipidemia is high TC,high TG,high Lp(a);Blood lipid metabolic disorder in NS patients is characterized by all kinds of lipid and lipoprotein significantly increasing,and presents as high TC,TG,LDL-C,Apo-B,Lp(a);and that of CRF patients is characterized by high TG and low HDL-C and high Lp(a);MHD patients blood lipid metabolic disorder is featured by low HDL- C and TC,high TG。In addition,dialysis and non-dialysis patients with end-stage kidney(ESRD) have significantly lower lipidemia,prompted that it widespreads malnutrition in patients with ESRD,which should cause enough attention。(2)Correlation study found dyslipidemia in chronic kidney disease has relativity with ourinary protein excretion,hypoalbuminemia,glomerular filtration rate dropping, and high parathyroid hormone。It prompts that we can reduce urinary albumin excretion rate,correct hypoalbuminemia,protect of residual renal function,reduce the parathyroid hormone to improve or correct lipid metabolic disorder in patients with chronic kidney disease.