小儿肾病综合征肾脏病理与脂质紊乱的关系

Relationship between Hyperlipidemia and Pathologic Renal Changes in Children with the Primary Nephrotic Syndrome

摘要:

目的：研究小儿肾病综合征(NS)肾脏病理与脂质紊乱的关系，为临床上正确选择合适的病例进行降脂治疗提供依据。方法：行肾穿刺活检术检查NS患儿病理类型。用免疫比浊法测定了45例非微小病变型(NMCD)患儿、10例微小病变型(MCD)患儿及80例健康儿童血脂、脂蛋白、载脂蛋白3个水平共7个脂质代谢指标。结果：临床表现为难治性肾病的NMCD患儿在激素正规治疗2月后仍有明显脂质紊乱，血胆固醇(TC)，三酰甘油(TG)，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AI(ApoAI)，载脂蛋白B(ApoB)，脂蛋白(a)［LP(a)］与对照组比较分别为(6.54±4.33) mmol/L vs (3.94±0.67) mmol/L，(3.45±2.56) mmol/L vs (0.91±0.32) mmol/L，(1.62±0.79) mmol/L vs (1.31±0.32) mmol/L，(2.69±0.87) mmol/L vs (2.15±0.58) mmol/L，(1.51±0.54) g/L vs (1.30±0.58) g/L，(1.45±0.54) g/L vs (0.67±0.16) g/L，(360.6±179.4) g/L vs (162.5±128.5) g/L，(除ApoAI P<0.05外，余均<0.01)，差异有显著性意义。而MCD患儿的脂质紊乱均恢复正常。结论：NMCD患儿脂质紊乱持续的时间较长，有更易发生进行性肾脏损害，动脉粥样硬化及冠心病的可能。此类患儿应早用降脂药物治疗。

Abstract:

OBJECTIVE: To study the relationship between hyperlipidemia and pathologic renal changes in children with the primary nephrotic syndrome(NS). METHODS: Forty five children with no minimal change glomerulopathy (NMCD) (clinical type: steroidresistent NS) and 10 children with minimal change glomerulopathy (MCD) (clinical type: steroid sensitive NS) were compared with 80 healthy children. Seven lipoprotein metabolism parameters including serum total cholestero1 (TC), triglyceride (TG), highdensity lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C), apolipoprotein AI (ApoAI), apolipoprotein B (ApoB) and lipoprotein (a) ［Lp (a)］ were detected using enzyme methods. RESULTS: After the treatment of the children with prednisone for 2 months, lipoprotein metabolism parameters remained significantly higher in the NMCD group compared to the controls: serum TC ［(6.54±4.33) mmol/L (NMCD) vs (3.94±0.67) mmol/L (control)］, TG ［(3.45±2.56) mmol/L vs (0.91±0.32) mmol/L］, HDL-C ［(1.62±0.79) mmol/L vs (1.31±0.32) mmol/L］, LDL-C［ (2.69±0.87) mmol/L vs (2.15±0.58) mmol/L］, ApoAI ［(1.51±0.54) g/L vs (1.30±0.58) g/L］, ApoB ［(1.45±0.54) g/L vs (0.67±0.16) g/L］, Lp(a) ［(360.6±179.4) g/L vs (162.5±128.5) g/L］ (P<0.05 or 0.01). In contrast, all abnormal lipoprotein metabolism parameters in the MCD cases recovered after prednisone treatment. CONCLUSIONS: There are obvious and long-term abnormialities of serum lipoprotein metabolism parameters in the NMCD group. NMCD cases should be treated with lipidlowering drugs early, while MCD cases should not be treated with lipid lowering drugs.