【作者】 陈恩静；

【导师】 甘华；

【作者基本信息】 重庆医科大学 ， 内科学， 2002， 硕士

【摘要】 目的：观察肾脏疾病患者血浆ox-LDL水平的变化，探讨其在这些疾病中检测的临床意义以及血液透析对血浆ox-LDL水平的影响。 方法：共观察病人226例，分为6组：1组为肾病综合征54例；2组为慢性肾炎18例；3组为慢性肾衰竭92例；4组为糖尿病肾病肾功能正常13例；5组为糖尿病肾病伴肾衰竭12例；6组为高血压肾病肾功能正常37例。第7组对照组为健康自愿者111位。其中慢性肾衰竭组根据是否血液透析及其透析时间不同分为3组：非血液透析组39例；短期血液透析组(血液透析时间＜3年)33例；长期血液透析组(血液透析时间≥3年)20例。非血液透析组根据慢性肾衰竭患者血肌酐水平分为2组：A组(血肌酐≤450μmol/L)19例；B组(血肌酐＞450μmol/L)20例。慢性肾衰竭患者根据是否合并冠心病分为2组：慢性肾衰竭合并冠心病组47例；慢性肾衰竭未合并冠心病组45例。所有入选人员均素食后空腹采静脉血，其中53例血液透析病人于血液透析前后各采静脉血一次，用ELISA方法测定血浆ox-LDL的水平，用全自动生化仪测定血浆TC、TG、HDL-C、LDL-C、Scr与ALB值及尿Upro值。 结果：1．血浆ox-LDL水平：肾病综合征组、慢性肾衰竭组、高血压肾病组均明显高于正常对照组(p＜0.05)；慢性肾炎组、糖尿病肾病肾功能正常组及糖尿病肾病伴肾衰竭组与正常对照组比较差异无显著性(p＞0.05)；慢性肾衰竭组血浆ox-LDL水平最高，明显高于肾病重庆医科大学临床硕士学位论文综合征组及糖尿病肾病肾功能正常组(p<O．05)。2．在非血液透析慢性肾衰竭中，A组血浆OX-I。DL水平与B组比较，差异无显著性(p>0．05)。3．慢性肾衰竭患者中，非血液透析组血浆OX-I,DI。水平明显低于短期血液透析组和长期血液透析组(P<O．05)；短期血液透析组与长期血液透析组间血浆OX-I。DL水平差异无显著性(P>0．05)。53例血液透析患者随机一次透析开始时血浆OX-I,DI。水平与透析结束时比较，差异无显著性(P>0．05)。在慢性肾衰竭合并冠心病组血浆OX-I_,DI。水平明显高于慢性肾衰竭未合并冠心病组但<O．05)。 结论：①。肾脏疾病患者血OX-I,DI，水平是升高的；在肾脏疾病晚期，血浆OX-I,DI。升高更明显，其中又以合并冠心病的患者血浆ox-LDI，水平为最高。提示OX-I,DI。与肾功能减退有一定关系，是合并冠心病的重要危险因素。②血液透析虽是慢性肾衰竭患者肾替代治疗的有效方法，但并不能降低血浆OX-I,DI。水平。⑧糖尿病肾病患者血浆OX-IDL升高不明显，可能与糖化I,DI，有关。更多还原

【Abstract】 Objective: To investigate the plasma levels and role of oxidized low density lipoprotein(ox-LDL) in patients with renal diseases, and to study effect of hemodialysis on the plasma oxidized low density lipoprotein levels.Methods: This study included 226 patients. Patients were divided into six groups. The first group is 54 nephrotic syndrome patients. The second group is 18 chronic nephritis patients. The third group is 92 chronic renal failure patients. The fourth is 13 diabetic nephropathy patients without renal failure. The fifth is 12 diabetic nephropathy patients with renal failure. The sixth is 37 hypertensive nephrosclerosis patients without renal failure. The seventh(control group) is 111 healthy subjects. Chronic renal failure patients were divided into three groups according to hemodialysis: The first group is 39 patients without hemodiahysis treatment; The second group is 33 patients with hemodialysis treatment for less 3 years; The third group is 20 patients with hemodialysis over 3 years. Chronic renal failure patients without hemodialysis treatment were divided into two groups according totheir serum creatinine (Scr): the group A had Scr<450 u mol/L and the group B had Scr>450 u mol/L. Chronic renal failure patients were divided into two groups according to complicated coronary heart disease: The first group is 47 chronic renal failure patients with coronary heart disease; The second group is 45 chronic renal failure patients without coronary heart disease. The blood samples of all subjects were collected after fasting for 12 hours. The blood samples were collected before and after hemodialysis in 53 patients with chronic renal failure. The plasma ox-LDL levels were measured with ELISA. Serum TC TG HDL-C LDL-C. Scr and ALB levels were measured with automatic biochemistry analyzer.Results: 1. The plasma levels of ox-LDL were significantly elevated in patients suffering from nephrotic syndrome, chronic renal failure, hypertensive nephrosclerosis compared with control subjects (p<0.05). The plasma levels of ox-LDL were no differences between the patients suffering from chronic nephritis, diabetic nephropathy without and with renal failure and control subjects(P>0.05). The plasma levels of ox-LDL were significantly elevated in patients suffering from chronic renal failure compared with patients with nephrotic syndrome and diabetic nephropathy without renal failure(p<0.05). 2. Among chronic renal failure patients without hemodilialysis, the plasma levels of ox-LDL in group A didn’tdiffer from those in group B (P>0.05). 3. The plasma levels of ox-LDL in patients suffering from chronic renal failure without hemodialysis were significantly lower than those in patients suffering from chronic renal failure with hemodialysis for less and over 3 years (P<0.05). The plasma levels of ox-LDL were no differences between patients suffering from chronic renal failure with hemodialysis for less and over 3 years (P>0.05). The plasma levels of ox-LDL in patients with chronic renal failure after hemodialysis were not significantly lower than those in patients with chronic renal failure before hemodialysis (P>0.05). The plasma levels of ox-LDL in patients with chronic renal failure with coronary heart disease were significantly higher than chronic renal failure without coronary heart disease.Conclusions: (1)The levels of plasma ox-LDL were elevated in patients with chronic renal diseases. The levels of plasma ox-LDL were higher in patients with end-stage renal disease with coronary heart disease than the other renal diseases. The levels of plasma ox-LDL may correlate with development of renal lesion and may be an important risk factor for complicated coronary heart disease.(2)Hemodialysis can’t reduce the plasma levels of ox-LDL.(3)The levels of plasma ox-LDL in patients with diabetic nephropathy were not significantly elevated. It may correlate with higherlevels of plasma glycated LDL in patients with diabetic nephropathy.更多还原