Effect of dynamic changes of blood lipids on treatment of idiopathic membranous nephropathy with cyclophosphamide and glucocorticoid
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摘要: 目的 观察血脂动态变化对环磷酰胺联合糖皮质激素治疗特发性膜性肾病(idiopathic membranous nephropathy，IMN)效果的影响。方法 采用前瞻性队列研究，纳入医院2020年1月-2021年9月收治的106例IMN患者(最终有100例患者纳入研究)。全部患者给予环磷酰胺联合糖皮质激素治疗，于治疗前(T1)、治疗第1个月(T2)、第2个月(T3)、第3个月(T4)进行血脂检查。评估患者治疗效果，根据治疗效果分为良好组和不良组，比较2组各时间点的血脂变化、一般资料及其他实验室指标，分析IMN患者的血脂动态变化及其对患者治疗效果的影响。结果 治疗6个月，100例患者中19例治疗无效，占19.00%；不良组患者血清补体C3、C4水平高于良好组，差异有统计学意义(P < 0.05)；组间其他资料比较，差异无统计学意义(P>0.05)；T2~T4时，2组患者血清总胆固醇(TC)、甘油三酯(TG)水平较T1逐渐降低，且组间、时点、2组间指标趋势变化差异有统计学意义(P < 0.05)；2组低密度脂蛋白、高密度脂蛋白略有波动，但组间、2组间指标趋势变化比较差异无统计学意义(P>0.05)；不良组治疗期间血清TC、TG变化水平低于良好组，差异有统计学意义(P < 0.05)；经点二列相关系数检验，结果显示，IMN患者治疗效果与TC、TG水平变化呈负相关(r < 0，P < 0.05)；经logistic回归分析结果显示，治疗期间TC、TG水平变化会影响IMN患者治疗效果(OR < 1，P < 0.05)。结论 TC、TG动态变化会对IMN患者环磷酰胺联合糖皮质激素治疗效果产生影响，临床应加强IMN患者血脂管理。Abstract: Objective To observe the effect of dynamic changes of blood lipid on the treatment of idiopathic membranous nephropathy(IMN) with cyclophosphamide and glucocorticoid.Methods A prospective cohort study was used to study the patients with 106 IMN admitted from January 2020 to September 2021(100 patients were finally included in the study). All patients were treated with cyclophosphamide and glucocorticoid, and their blood lipids were examined before treatment(T1), at the first month(T2), at the second month(T3), and at the third month(T4). The therapeutic effect of the patients was evaluated and divided into good therapeutic effect group and poor therapeutic effect group. The changes of blood lipids, general data and other laboratory indicators were compared between the two groups at each time point, and the dynamic changes of blood lipids in IMN patients and their influence on the therapeutic effect of the patients were analyzed.Results After 6 months of treatment, 19 out of 100 patients were ineffective, accounting for 19.00%. The levels of serum complement C3 and C4 in the patients with poor therapeutic effect were higher than those in the patients with good therapeutic effect, with a statistical significant difference(P < 0.05). There was no statistical significant difference in other data between groups(P>0.05). At T2-T4, the levels of serum total cholesterol(TC) and triglyceride(TG) of patients in the two groups decreased gradually compared with those before treatment, and there was a statistical significant difference in the changes of index trends between groups, time points and between the two groups(P < 0.05). Low density lipoprotein and high density lipoprotein in the two groups fluctuated slightly, but there was no statistical significant difference between the two groups in comparison of index trend changes(P>0.05). The change level of serum TC and TG in poor therapeutic effect group was lower than that in good therapeutic effect group during the treatment period, with a statistical significant difference(P < 0.05). The point binary correlation coefficient test showed that the therapeutic effect of IMN patients was negatively correlated with the changes of TC and TG levels(r < 0, P < 0.05). Logistic regression analysis showed that changes in TC and TG levels during treatment would affect the treatment effect of IMN patients(OR < 1, P < 0.05).Conclusion The dynamic changes of TC and TG will affect the therapeutic effect of cyclophosphamide combined with glucocorticoid in the patients with IMN, and strengthen the management of blood lipid in the patients with IMN.
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Key words:
- idiopathic membranous nephropathy /
- cyclophosphamide /
- glucocorticoid /
- therapeutic effect /
- blood lipid
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表 1 不同疗效患者基线资料情况比较
项目 不良组(n=19) 良好组(n=81) χ2/t P 性别/例(%) 男 10(52.63) 39(48.15) 0.124 0.725 女 9(47.37) 42(51.85) 年龄/岁 56.21±6.70 56.53±7.28 0.184 0.855 体重指数/(kg/m2) 25.13±2.07 24.94±2.01 0.369 0.713 病理分期/例(%) Ⅰ期 11(57.89) 44(54.32) 0.079 0.778 Ⅱ期 8(42.11) 37(45.68) 饮酒史/例(%) 有 5(26.32) 11(13.58) 1.031 0.310 无 14(73.68) 70(86.42) 吸烟史/例(%) 有 3(15.79) 10(12.35) 0.001 0.982 无 16(84.21) 71(87.65) 高血压史/例(%) 有 4(21.05) 10(12.35) 0.381 0.537 无 15(78.95) 71(87.65) 糖尿病史/例(%) 有 1(5.26) 5(6.17) < 0.001 1.000 无 18(94.74) 76(93.83) Hb/(g/L) 117.89±10.57 115.43±9.81 0.970 0.335 WBC/(×109/L) 6.31±1.42 6.47±1.29 0.477 0.634 RBC/(×1012/L) 4.61±0.52 4.78±0.50 1.324 0.189 PLT/(×109/L) 221.08±29.45 225.34±25.69 0.633 0.529 C3/(g/L) 1.23±0.28 1.01±0.22 3.674 < 0.001 C4/(g/L) 0.28±0.08 0.21±0.05 5.322 < 0.001 
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表 2 不同治疗效果IMN患者血脂水平变化情况
mmol/L，X±S 组别 时间点 TC TG HDL-C LDL-C 不良组(n=19) T1 7.71±1.98 4.28±1.23 1.69±0.52 3.29±1.72 T2 6.59±1.53 3.41±1.15 1.50±0.43 2.91±1.60 T3 5.84±1.25 2.82±0.92 1.72±0.63 2.73±1.41 T4 5.51±1.02 2.01±0.15 1.61±0.49 2.58±1.50 良好组(n=81) T1 7.65±1.82 4.34±1.31 1.78±0.53 3.18±1.61 T2 5.79±1.41 2.19±1.09 1.62±0.49 2.94±1.42 T3 4.22±1.15 1.55±0.51 1.75±0.61 2.69±1.37 T4 1.69±0.73 0.72±0.20 1.46±0.59 2.41±1.29
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表 3 2组IMN治疗期间血脂动态变化
X±S 组别 TC TG 不良组(n=19) 2.03±2.25 1.06±0.80 良好组(n=81) 3.46±2.48 1.77±1.30
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表 5 治疗期间血脂水平变化对IMN患者治疗效果的影响
相关因素 β 标准误 Wald χ2 P OR 95%CI TC -0.344 0.159 4.720 0.030 0.709 0.519~0.967 TG -0.734 0.334 4.824 0.028 0.480 0.249~0.924 常量 5.841 1.289 13.852 < 0.001 - -
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