原发性肾病综合征患儿脂肪因子的表达及与高脂血症相关性研究  

Expression of adipokines in children with primary nephrotic syndrome and its association with hyperlipidemia

作　　者：张如心 张瑄[1] 张碧丽[1] 刘竹枫[1] 林书祥 ZHANG Ru-Xin;ZHANG Xuan;ZHANG Bi-Li;LIU Zhu-Feng;LIN Shu-Xiang(Department of Nephrology,Tianjin Children's Hospital,Tianjin 300074,China;不详)

机构地区：[1]天津市儿童医院肾内科,天津300074 [2]天津医科大学研究生院,天津300070 [3]天津市儿科研究所/天津市儿童出生缺陷防治重点实验室,天津300074

出　　处：《中国当代儿科杂志》2021年第8期828-834,共7页Chinese Journal of Contemporary Pediatrics

基　　金：天津市卫计委科研基金项目(2015K2040)。

摘　　要：目的探讨原发性肾病综合征(primary nephroticsyndrome,PNS)患儿治疗前后脂肪因子的表达变化及其与血脂的相关性,以及脂肪因子在PNS患儿高脂血症中的作用。方法选取2015年3月至2018年3月确诊为PNS初发或激素停药6个月以上复发的PNS患儿90例为研究对象,另选取同期行健康体检的儿童30例为对照组。分别采集PNS患儿激素治疗前(活动期)及4周激素治疗尿蛋白转阴后(缓解期),以及对照组儿童静脉血,采用酶联免疫吸附试验检测脂肪因子水平,使用自动生化仪分析血脂水平。结果PNS患儿活动期、缓解期血网膜素(omentin-1)水平显著低于对照组,PNS患儿活动期血omentin-1水平低于缓解期(P<0.001);PNS患儿活动期血趋化素水平高于缓解期及对照组(P<0.001)。PNS患儿活动期血浆致动脉粥样硬化指数、致动脉粥样硬化系数(atherogenic coefficient,AC)、castelli危险指数(castelli riskindex,CRI)-1、CRI-2、非高密度脂蛋白高于缓解期及对照组,PNS患儿缓解期血浆致动脉粥样硬化指数、AC、CRI-1、非高密度脂蛋白高于对照组(P<0.001)。PNS患儿缓解期血清总胆固醇、三酰甘油、高密度脂蛋白(high-density lipoprotein,HDL)、低密度脂蛋白、载脂蛋白(apolipoprotein,apo)A、apoB水平均高于对照组(P<0.01)。PNS患儿血omentin-1治疗前后比值与HDL治疗前后比值、24 h尿蛋白定量治疗前后比值、HDL/apoA治疗前后比值呈正相关,与AC治疗前后比值、CRI-1治疗前后比值呈负相关(P<0.05)。低网膜素组PNS患儿活动期CRI-1、CRI-2、AC、apoB/apoA水平高于高网膜素组(P<0.05)。结论omentin-1可能与儿童PNS的疾病活动、血脂紊乱、蛋白尿机制有关。血脂比值可能在监测PNS患儿早期心血管风险方面比传统血脂指标更有效。Objective To study the expression of adipokines in children with primary nephrotic syndrome(PNS)before and after treatment and its correlation with blood lipids,as well as the role of adipokines in PNS children with hyperlipidemia.Methods A total of 90 children who were diagnosed with incipient PNS or recurrence of PNS after corticosteroid withdrawal for more than 6 months were enrolled as subjects.Thirty children who underwent physical examination were enrolled as the control group.Venous blood samples were collected from the children in the control group and the children with PNS before corticosteroid therapy(active stage)and after urinary protein clearance following 4 weeks of corticosteroid therapy(remission stage).ELISA was used to measure the levels of adipokines.An automatic biochemical analyzer was used to measure blood lipid levels.Results Compared with the control group,the children with PNS had a significantly lower level of omentin-1 in both active and remission stages,and their level of omentin-1 in the active stage was significantly lower than that in the remission stage(P<0.001).For the children with PNS,the level of chemerin in the active stage was significantly higher than that in the remission stage,and the children with PNS in the active stage had a significantly higher level of chemerin than the control group(P<0.001).For the children with PNS,atherogenic index of plasma,atherogenic coefficient(AC),castelli risk index-1(CRI-1),castelli risk index-2(CRI-2),and non-high-density lipoprotein in the active stage were significantly higher than those in the remission stage(P<0.001),and these indices in the children with PNS in the active stage were significantly higher than those in the control group(P<0.001).The children with PNS in the remission stage had significantly higher atherogenic index of plasma,AC,CRI-1,and non-high-density lipoprotein than the control group(P<0.001).Compared with the control group,the children with PNS in the remission stage had significantly higher serum levels of total

关 键 词：血浆致动脉粥样硬化指数 原发性肾病综合征 网膜素 治疗前后 患儿活动 自动生化仪 酶联免疫吸附试验 脂肪因子 

分 类 号：R726.9[医药卫生—儿科]