CAJ | 학술논문

目的：分析维持性血液透析（Maintenance hemodialysis，MHD）患者影响血脂的因素。方法43例MHD患者常规血液透析前抽取空腹静脉血行实验室检查，分析血脂与年龄、民族、性别、血透龄和血透频率的相关性，P<0.05的变量选为控制变量进行血脂与实验室指标的偏相关分析；偏相关分析结果为P<0.05的变量进行血脂与实验室指标的多元回归线性分析。结果单因素相关分析显示仅性别及血透龄和血脂（脂蛋白a除外）的相关性有统计学意义（P<0.05）。偏相关分析结果示血常规、胆红素、血浆蛋白、果糖胺、透析前血肌酐、二氧化碳结合力、血钾和血钙均与血脂相关（P<0.05）。多元线性回归分析显示血钙和果糖胺升高是总胆固醇、低密度脂蛋白胆固醇及载脂蛋白B升高的危险因素；血常规中性粒细胞百分比降低是甘油三酯升高、高密度脂蛋白胆固醇降低的危险因素，白细胞计数低是脂蛋白a升高的危险因素；血浆总蛋白降低及血透龄是高密度脂蛋白胆固醇及载脂蛋白A1降低的危险因素（P<0.05）。结论高血钙、高果糖胺、低血浆总蛋白、血透龄长、血白细胞计数低及中性粒细胞百分比降低是MHD患者影响血脂的危险因素。
목적：분석유지성혈액투석（Maintenance hemodialysis，MHD）환자영향혈지적인소。방법43례MHD환자상규혈액투석전추취공복정맥혈행실험실검사，분석혈지여년령、민족、성별、혈투령화혈투빈솔적상관성，P<0.05적변량선위공제변량진행혈지여실험실지표적편상관분석；편상관분석결과위P<0.05적변량진행혈지여실험실지표적다원회귀선성분석。결과단인소상관분석현시부성별급혈투령화혈지（지단백a제외）적상관성유통계학의의（P<0.05）。편상관분석결과시혈상규、담홍소、혈장단백、과당알、투석전혈기항、이양화탄결합력、혈갑화혈개균여혈지상관（P<0.05）。다원선성회귀분석현시혈개화과당알승고시총담고순、저밀도지단백담고순급재지단백B승고적위험인소；혈상규중성립세포백분비강저시감유삼지승고、고밀도지단백담고순강저적위험인소，백세포계수저시지단백a승고적위험인소；혈장총단백강저급혈투령시고밀도지단백담고순급재지단백A1강저적위험인소（P<0.05）。결론고혈개、고과당알、저혈장총단백、혈투령장、혈백세포계수저급중성립세포백분비강저시MHD환자영향혈지적위험인소。
Objective To explore the risk factors of serum lipid in patients undergoing maintenance hemodi-alysis (MHD). Methods Blood simple of 43 MHD patients were obtained for laboratory tests before routine hemodi-alysis. The correlation between serum lipid and clinical characteristics including age, gender, ethnicity, dialysis vin-tage and dialysis frequency was analyzed. Pearson and spearman correlation were used to assess the relationship be-tween serum lipid and clinical characteristics and variables were treated as control variables in partial correlation anal-ysis when P<0.05. Partial correlation was used to assess the relationship between serum lipid and laboratory parame-ters. Multivariable linear regression was used to assess the association of serum lipid and some laboratory parameters which were significantly related to serum lipid in partial correlation. Results Only gender and dialysis vintage were significantly related to serum lipid (but not lipoprotein (a)) in univariate correlation analysis. Blood component, biliru-bin, plasma protein, fructosamine, pred-dialysis serum creatinine, CO2cp, serum potassium and calcium were signifi-cantly related to serum lipid in partial correlation analysis. Multivariable linear regression showed that increased se-rum calcium and fructosamine were risk factors of higher total cholesterol (βequal to 0.434, 0.403, respectively), high-er low density lipoprotein cholesterol (βequal to 0.397, 0.395, respectively) and higher apolipiprotein B (βequal to 0.25, 0.307, respectively). Meanwhile, Lower neutrophil percentage was risk factor of higher triglyceride (β=-0.357) and lower high density lipoprotein cholesterol (HDL-c) (β=0.358) and white blood cell counts decrease was risk factor of higher lipoprotein(a) (β=-0.406). Additionally, total protein decrease and longer dialysis vintage were risk factors of lower HDL-c (βequal to 0.367,-0.378, respectively) and apolipoprotein A1 (βequal to 0.272,-0.343, respectively), P<0.05. Conclusion Higher serum calcium, higher fructosamine, lower plasma total protein, longer dialysis vintage, lower white blood cell counts and neutrophil percentage may act as risk factors of lipid profile in MHD patients.