CAJ | 학술논문

目的：研究慢性肾脏病(CKD)患者血游离脂肪酸(FFA)的变化，并探讨其与标准(常规)血脂谱的相关性。方法：对入选 CKD 患者236例(非透析)的临床及实验室资料进行回顾性分析。根据 K/DOQI 慢性肾脏病临床实践指南，通过 MDRD 简化公式估算肾小球滤过率( eGFR)，将 CKD 患者分为CKD1-5期共5组。收集血 FFA 及三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白 A1(apoA1)、载脂蛋白 B(apoB)、脂蛋白 a [Lp(a)]标准(常规)血脂谱等相关数据进行统计分析。结果：入选 CKD 患者共236例，血 FFA 水平从 CKD1期至 CKD5期逐渐升高[CKD1期(0.21±0.05)mmol/ L，CKD2期(0.24±0.04) mmol/ L，CKD3期(0.35±0.06) mmol/ L，CKD4期(0.42±0.10) mmol/ L，CKD5期(0.47±0.13) mmol/ L]，且前后组比较均有统计学意义( P<0.05)。经Pearson 相关分析，FFA 与 TG(r＝0.141，P<0.05)、Lp(a)(r＝0.225，P<0.01)呈正相关，与 apoA1(r ＝-0.214， P<0.01)、eGFR(r ＝-0.728，P<0.01)呈负相关。多元逐步回归分析显示，FFA 与 eGFR(β＝-0.714，P<0.01)、apoA1(β＝-0.090，P<0.05)呈负相关。结论： FFA 可早期反映 CKD 患者的脂代谢紊乱；可作为评估 CKD进展的指标之一；CKD 患者血 FFA 代谢异常可能与 apoA1相关，肾功能减退可能是导致血 FFA 升高的危险因素。
목적：연구만성신장병(CKD)환자혈유리지방산(FFA)적변화，병탐토기여표준(상규)혈지보적상관성。방법：대입선 CKD 환자236례(비투석)적림상급실험실자료진행회고성분석。근거 K/DOQI 만성신장병림상실천지남，통과 MDRD 간화공식고산신소구려과솔( eGFR)，장 CKD 환자분위CKD1-5기공5조。수집혈 FFA 급삼선감유(TG)、총담고순(TC)、고밀도지단백담고순(HDL-C)、저밀도지단백담고순(LDL-C)、재지단백 A1(apoA1)、재지단백 B(apoB)、지단백 a [Lp(a)]표준(상규)혈지보등상관수거진행통계분석。결과：입선 CKD 환자공236례，혈 FFA 수평종 CKD1기지 CKD5기축점승고[CKD1기(0.21±0.05)mmol/ L，CKD2기(0.24±0.04) mmol/ L，CKD3기(0.35±0.06) mmol/ L，CKD4기(0.42±0.10) mmol/ L，CKD5기(0.47±0.13) mmol/ L]，차전후조비교균유통계학의의( P<0.05)。경Pearson 상관분석，FFA 여 TG(r＝0.141，P<0.05)、Lp(a)(r＝0.225，P<0.01)정정상관，여 apoA1(r ＝-0.214， P<0.01)、eGFR(r ＝-0.728，P<0.01)정부상관。다원축보회귀분석현시，FFA 여 eGFR(β＝-0.714，P<0.01)、apoA1(β＝-0.090，P<0.05)정부상관。결론： FFA 가조기반영 CKD 환자적지대사문란；가작위평고 CKD진전적지표지일；CKD 환자혈 FFA 대사이상가능여 apoA1상관，신공능감퇴가능시도치혈 FFA 승고적위험인소。
Objective:To investigate the change of serum free fatty acid (FFA) in chronic kidney disease (CKD) and the correlation with the standard (conventional ) lipid profile.Methods Clinical and laboratory data of selected CKD patients (non-dialysis) were retrospectively analyzed.According to the K/ DOQI clinical practice guidelines for CKD,the CKD patients were divided into five groups from CKD1 to CKD5 through simplified MDRD equation to estimate glomerular filtration rate (eGFR).Serum FFA,the standard ( conventional ) lipid profile such as triglycerides (TG),total cholesterol ( TC),high density lipoprotein cholesterol ( HDL-C),low density lipoprotein cholesterol ( LDL-C),apolipoprotein A1 ( apoA1),apolipoprotein B ( apoB),lipoprotein a [Lp (a)] and other relevant data were collected for further statistical analysis. Results A total of 236 CKD patients were enrolled.Serum FFA level gradually increased from CKD1 to CKD5 [CKD1 (0.21±0.05) mmol/ L, CKD2 (0.24 ± 0.04) mmol / L,CKD3 (0.35 ± 0.06) mmol / L,CKD4 (0.42±0.10) mmol / L,CKD5 (0.47±0.13) mmol / L],compared with the group of before and after were statistically significant (P<0.05).FFA was positively correlated with TG (r= 0.141,P<0.05) and Lp (a) (r = 0.225,P<0.01),but negatively correlated with apoA1 (r = -0.214,P<0.01) and eGFR (r = -0.728,P<0.01) by Pearson correlation analysis.Multiple regression analysis showed that FFA was negatively correlated with eGFR (β = -0.714,P<0.01) and apoA1 (β=-0.090,P<0.05).Conclusions Serum FFA level begins to increase in stage CKD1 and it was increased with the progress of renal failure,suggesting that one,FFA may reflect CKD patients lipid metabolism disorders early,and may be a more sensitive index of serum lipids; two,FFA may be used as one of the indexes to assess the progress of CKD; three,serum FFA metabolic disorders may be associated with apoA1,and renal function decline may be a risk factor for elevated FFA in CKD.