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

作　　者：曾华松[1] 高岩[1] 徐家喻[1] 张小铃[1] 陈峥嵘[1] 

机构地区：[1]广州市儿童医院肾脏科,广东广州510120

出　　处：《中国当代儿科杂志》2001年第2期151-153,共3页Chinese Journal of Contemporary Pediatrics

基　　金：广东省卫生科技基金部分资助 !(编号B199915 0 )

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 .5 4± 4.33)mmol/Lvs (3.94± 0 .6 7)mmol/L ,(3 .45± 2 .5 6 )mmol/Lvs (0 .91± 0 .32 )mmol/L ,(1.6 2± 0 .79)mmol/Lvs (1.31± 0 .32 )mmol/L ,(2 .6 9± 0 .87)mmol/Lvs(2 .15± 0 .5 8)mmol/L ,(1.5 1± 0 .5 4) g/Lvs (1.30± 0 .5 8) g/L ,(1.45± 0 .5 4) g/Lvs (0 .6 7± 0 .16 ) g/L ,(36 0 .6± 179.4) g/Lvs (16 2 .5± 12 8.5 ) g/L ,(除ApoAIP <0 .0 5外 ,余均 <0 .0 1) ,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?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.

关 键 词：肾病综合征 高脂血症 肾脏病理 儿童 脂质紊乱 

分 类 号：R726.9[医药卫生—儿科]