肾病综合征脂质紊乱转归与蛋白代谢改变的关系  

Relationship between alteration of protein metabolism and conversion of hyperlipidemia in patients with idiopathic nephritic syndrome

作　　者：阮雪玲[1] 刘国辉[1] 吴恒莲[1] 林宏初[1] 

机构地区：[1]东莞市人民医院内科,广东东莞市523018

出　　处：《西部医学》2005年第3期209-211,共3页Medical Journal of West China

摘　　要：目的　探讨肾病综合征脂质紊乱及其转归与蛋白代谢异常的关系。方法　将70例原发性肾病综合征(NS)患者按对激素的反应及复发情况分为非难治性肾病组(A组)和难治性肾病组(B组) ,35名健康者作为对照组。检测3组血脂、血尿蛋白及白蛋白指标,分析激素治疗后脂质紊乱转归与蛋白代谢的关系。结果　1 NS患者存在脂质代谢紊乱,TC、TG、L DL - C、apo B水平升高,B组比A组更明显(P<0 .0 1 )。2经激素治疗,TC、TG、L DL、apo B显著下降(P<0 .0 1 ) ,但仍高于正常对照组(P<0 .0 1 )。3TC、TG、L DL - C、apo B与血白蛋白(AL B)呈显著负相关(P<0 .0 1 ) ,与尿白蛋白排泄率(UAER)呈显著正相关(P<0 .0 1 )。激素治疗早期(治疗1个月后) UAER、Up的下降量(ΔUAER、ΔUp)与治疗后期(治疗2个月后)血脂指标的变化量(ΔTC、ΔTG、ΔL DL、Δapo B)有一定的相关性(P<0 .0 5或P<0 .0 1 ) ;与ΔUp相比,ΔUAER、ΔTC、ΔTG、ΔL DL、Δapo B有更大的相关性(P<0 .0 5 )。结论　以白蛋白为代表的中分子蛋白在尿中丢失与肾病综合征脂质紊乱密切相关,激素治疗后尿白蛋白排泄率的早期变化是脂质紊乱治疗转归相对特异的临床实验指标。Objective To study the relationship between alteration of protein metabolism and conversion of hyperlipidemia after glucocorticoid therapy in patients with idiopathic nephritic syndrome(NS). Methods 70 patients with NS were divided into two groups, nonrefractory group(group A, n=35) and refractory group(group B, n=35), according to the reaction to steroid therapy and the condition of recurrence. Other 35 healthy persons were employed as control. Six lipoprotein metabolism parameters including serum total cholestrol(TC),triglyceride (TG),high-density lipoprotein cholesterol(HDL), low-density lipoprotein cholesterol(LDL), apolipoprotien A(apoA), apolipoprotien B(apoB) were measured. 24 h-urinary protein(UP), serum albumin(ALB)and urinary albumin excretion rate(UAER) were simultaneously detected. Results Compared with the control group, TC, TG, LDL,and apoB were obviously increased in patients with NS(P<0.01), which was more obvious in group B than group A(P<0.01). After the treatment with prednisone, TC, TG, LDL, and apoB were reduced but still higher than the controls(P<0.01). Before the treatment with prednisone, TC, TG, LDL, and apoB were correlated with ALB and UAER(P<0.01).The reducing amount of UAER and Up(ΔUAER,ΔUp) during 1 month after treatment was positively correlated with the level of TC, TG, LDL, and apoB(ΔTC, ΔTG, ΔLDL,ΔapoB)in 2 months after the treatment (P<0.05,P<0.01). As compared with ΔUp,ΔUAER was much more closely related to hyperlipidemia and followed by ΔTC,ΔTG,ΔLDL,and ΔapoB(P<0.05).Conclusion The elevated urinary albumin excretion is closely related with hyperlipidemia secondary to NS. The reduced UAER in response to the prednisone treatment at the early stage may be a specific laboratory indicator for the steroid-reduced remission of hyperlipidemia.

关 键 词：肾病综合征 高脂血症 尿白蛋白排泄率 

分 类 号：R586[医药卫生—内分泌]