Zhai Qi, Dou Jingtao, Wen Jing, Wang Meiping, Zuo Yingting, Su Xin, Zhang Yibo, Gaisano Herbert, Mu Yiming, He Yan
Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.
Endocrine. 2022 May;76(2):312-323. doi: 10.1007/s12020-022-03012-z. Epub 2022 Mar 3.
To investigate whether non-high-density lipoprotein cholesterol (Non-HDL-C), remnant cholesterol (RC), and the ratios of lipid indexes are more closely associated with early progression of kidney dysfunction than traditional lipid indexes; and to explore the association between changes in serum lipids during follow-up and annual decline rate in estimated glomerular filtration rate (eGFR).
In this prospective cohort study, 3909 participants with normal eGFR and age≥40 years at baseline were followed for 3.3 years. Progression of kidney dysfunction was assessed as annual decline rate in eGFR. Spearman correlation analysis, linear correlation models, and multiple logistic regression were used to assess the associations between lipid indexes at baseline/both baseline and follow-up and the annual decline rate in eGFR.
Compared with ΔLDL-C (β = 0.412), other lipid indexes such as ΔLDL-C/HDL-C (β = 0.565), ΔTC/HDL-C (β = 0.448), and ΔNon-HDL-C/HDL-C (β = 0.448) were more closely associated with annual decline rate in eGFR. High TG/HDL-C (OR = 1.699(1.177-2.454)) and TC/HDL-C (OR = 1.567(1.095-2.243)) at baseline, as well as high TC/HDL-C (OR = 1.478 (1.003-2.177)) and TG/HDL-C (OR = 1.53(1.044-2.244)) at both baseline and follow-up were associated with the annual decline rate in eGFR <0.5. High Non-HDL-C (OR = 1.633(1.025-2.602)) and LCI (OR = 1.631(1.010-2.416)) at both baseline and follow-up resulted in a 63% increase in risk of annual decline rate in eGFR >1.
High Non-HDL-C, RC and the ratios of lipid indexes were more closely associated with early progression of kidney injury than the increase of traditional lipid indexes. These lipid indexes should be monitored, even in participants with normal traditional serum lipid levels.
研究非高密度脂蛋白胆固醇（Non-HDL-C）、残余胆固醇（RC）以及脂质指标比值与肾功能障碍早期进展的关联是否比传统脂质指标更为密切；并探讨随访期间血脂变化与估计肾小球滤过率（eGFR）年下降率之间的关系。
在这项前瞻性队列研究中，对3909名基线时eGFR正常且年龄≥40岁的参与者进行了3.3年的随访。肾功能障碍进展以eGFR的年下降率来评估。采用Spearman相关性分析、线性相关模型和多元逻辑回归来评估基线/基线和随访时的脂质指标与eGFR年下降率之间的关联。
与ΔLDL-C（β = 0.412）相比，其他脂质指标如ΔLDL-C/HDL-C（β = 0.565）、ΔTC/HDL-C（β = 0.448）和ΔNon-HDL-C/HDL-C（β = 0.448）与eGFR年下降率的关联更为密切。基线时高TG/HDL-C（OR = 1.699(1.177 - 2.454)）和TC/HDL-C（OR = 1.567(1.095 - 2.243)），以及基线和随访时均高的TC/HDL-C（OR = 1.478 (1.003 - 2.177)）和TG/HDL-C（OR = 1.53(1.044 - 2.244)）与eGFR年下降率<0.5相关。基线和随访时高Non-HDL-C（OR = 1.633(1.025 - 2.602)）和LCI（OR = 1.631(1.010 - 2.416)）导致eGFR年下降率>1的风险增加63%。
高Non-HDL-C、RC以及脂质指标比值与肾损伤早期进展之间的关联比传统脂质指标升高更为密切。即使在传统血脂水平正常的参与者中，也应监测这些脂质指标。
