Comparative Analysis Of Different Pathological Types Of High Density Lipoproteip In Patients With Chronic Kidney Disease

IntroductionChronic kidney disease(CKD)has been recognized as a major public health problem worldwide.Dyslipidemia includes abnormal levels of total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C)or high-density lipoprotein cholesterol(HDL-C),which not only promote the progress of cardiovascular disease(CVD),but also increase the risk of CKD and reduce the quality of life and survival time of patients with CKD,that is,abnormal cholesterol parameters are strongly related to the occurrence of renal dysfunction.Abnormal lipids may be a potential target to prevent the development of CKD.The structure and function of HDL can be seriously changed in severe glomerulinuria(nephrotic syndrome)and advanced CKD,and show different serum lipid profiles with the development of CKD.In the early stage of CKD with proteinuria as the main injury,especially nephrotic syndrome,the concentration of HDL decreased,remained unchanged or even increased.As the disease progressed,HDL-C levels decreased significantly and were severely oxidized in most patients with advanced CKD and ESRD.HDL-mediated reverse cholesterol transport is impaired,so HDL promotes the formation of atherosclerosis from its original anti-atherosclerosis.ObjectiveIn order to make further efforts to explore the effect of HDL metabolic disorder on the progression of CKD in nephropathy,the concentration of serum albumin was stratified,and the lipoprotein levels of the three most common clinical primary nephropathy were compared,including Membranous nephropathy(MN),IgA nephropathy(IgAN)and Minimal change disease(MCD),and the differences of HDL levels among the three pathological types of albumin levels were compared.Statistical analysis was used to research the risk factors related to abnormal metabolism of CKD and HDL,and then to explore the effect of abnormal HDL on the occurrence,development and prognosis of glomerulosclerosis.MethodsPatients who were hospitalized in the Department of Nephrology of Shandong Provincial Hospital from January 2015 to June 2019 were diagnosed as proteinuria by renal biopsy for the first time.According to the electron microscopic results of renal biopsy,the patients with primary MCD,MN and IgA nephropathy were collected,including MCD group(n=207,239 cases),MN group(n=239)and IgAN group(n=214,660 cases).The medical history and physical examination of the selected patients were asked in detail,and the general information was recorded.According to the level of albumin,the patients were divided into 5 groups:less than 20g/l group,20-25g/l group,25-30g/l group,30-35g/l group,greater than 35g/l group.The serum samples of the above patients were divided into normal HDL group(HDL>1.0mmol/L)and HDL abnormal group(HDL-C≤1.0mmol/L).All data were expressed as mean±SD,while which with non-normal distribution are expressed by median(quartile spacing).Comparisons of continuous variables between two groups were assessed using t test or rank sum test as appropriate.Single factor analysis of variance(ANOVA)was used to compare the mean of multiple groups of samples for Duncan multiple comparison test.For the correlation analysis,the Pearson correlation analysis method is used in accordance with the normal distribution,and the Spearman’s rank correlation was used to analyze the non-normal distribution.P values<0.05 were considered statistically significant.P values<0.01 presentedand outstanding significantly difference.Statistical consequence was done using the IBM SPSS,version 20.0(IBM Corporation,Somers,NY,USA).Result1.Comparison of clinical indexes between normal HDL group and abnormal HDL group:Compared with normal HDL group,abnormal HDL group was older(P<0.05),serum albumin decreased(P<0.001),urinary albumin increased(P<0.001)and hematuria increased(P<0.01)in abnormal HDL group.2.Correlation analysis of risk factors of dyslipidemia:HDL was negatively correlated with age(r=-0.16,P<0.01),albumin(r=-0.234,P<0.001)and hematuria(r=-0.197,P<0.01).3.Comparison of serum lipids among different pathological types in each albumin stratification:when the albumin was less than 20g/L,the HDL-C of MCD was significantly higher than that of IgAN(P<0.01)and MN(P<0.01).IgAN was higher than that of MN(P<0.05),generally speaking,HDL-C showed MCD>IgAN>MN.When the albumin level was 20-25g/L,the mean of HDL-C in patients with MCD is still higher than MN and IgA.When the albumin level was in the range of 25-30g/l,the HDL-C of MCD was significantly higher than that of IgAN(P<0.01)and MN(P<0.01),IgAN was higher than that of MN,but there was no significant difference,HDL-C showed MCD>IgAN>MN.When the albumin level was in the range of 30-35g/l,the mean of HDL-C in patients with MCD(P<0.05)and MN(P<0.01)were higher than IgAN.