血清脂质和脂蛋白与慢性肾脏病进展的关系：慢性肾脏病预后研究协作组（CRIC）研究
Relation of serum lipids and lipoproteins with progression of CKD: The CRIC study.
作者信息
Rahman Mahboob, Yang Wei, Akkina Sanjeev, Alper Arnold, Anderson Amanda Hyre, Appel Lawrence J, He Jiang, Raj Dominic S, Schelling Jeffrey, Strauss Louise, Teal Valerie, Rader Daniel J
机构信息
Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio;
Center for Clinical Epidemiology and Biostatistics and.
出版信息
Clin J Am Soc Nephrol. 2014 Jul;9(7):1190-8. doi: 10.2215/CJN.09320913. Epub 2014 May 15.
BACKGROUND AND OBJECTIVES
Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Prospective cohort study in adults (n=3939) with CKD aged 21-74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR).
RESULTS
Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m(2); 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria<0.2 g/d, 1-SD higher LDL-C was associated with a 26% lower risk of the renal end point (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.59 to 0.92; P=0.01), and 1-SD higher total cholesterol was associated with a 23% lower risk of the renal end point (HR, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In participants with proteinuria>0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories.
CONCLUSIONS
In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria.
背景与目的
高脂血症在慢性肾脏病（CKD）患者中很常见。本研究的目的是评估血浆脂质和脂蛋白指标是否能预测CKD患者的肾病进展。
设计、地点、参与者及测量指标：对2003年至2008年招募的年龄在21 - 74岁的成年CKD患者（n = 3939）进行前瞻性队列研究，中位随访时间为4.1年。在基线时，测量总胆固醇、甘油三酯、极低密度脂蛋白胆固醇（VLDL-C）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A-I、载脂蛋白B和脂蛋白(a) [Lp(a)]。结局指标为终末期肾病（ESRD）或估算肾小球滤过率（eGFR）较基线下降50%的复合终点（GFR变化率）。
结果
研究人群的平均年龄为58.2岁，平均GFR为44.9 ml/min/1.73 m²；48%的患者患有糖尿病。没有任何脂质或脂蛋白指标与复合终点风险或GFR变化率独立相关。然而，蛋白尿水平存在显著（P = 0.01）的交互作用。在蛋白尿<0.2 g/d的参与者中，LDL-C升高1个标准差与肾脏终点风险降低26%相关（风险比[HR]，0.74；95%置信区间[95%CI]，0.59至0.92；P = 0.01），总胆固醇升高1个标准差与肾脏终点风险降低23%相关（HR，0.77；95%CI，0.62至0.96；P = 0.02）。在蛋白尿>0.2 g/d的参与者中，LDL-C（HR，0.98；95%CI，0.98至1.05）和总胆固醇水平均与肾脏结局无关。55%的患者报告使用了他汀类药物，且不同脂质类别使用情况存在差异。
结论
在这个大型CKD患者队列中，总胆固醇、甘油三酯、VLDL-C、LDL-C、HDL-C、载脂蛋白A-I、载脂蛋白B和Lp(a)与肾病进展无独立相关性。蛋白尿水平低的患者中，LDL-C和总胆固醇水平与肾脏疾病结局呈负相关。
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