不同治疗方法对原发性肾病综合征患儿血脂水平的影响  

Effect of different therapeutics on dyslipidemia in children with primary nephrotic syndrome

作　　者：康硕 张瑄[1] 张碧丽[2] 刘妍[1] 刘竹枫[2] Kang Shuo;Zhang Xuan;Zhang Bili;Liu Yan;Liu Zhufeng(Department of Nephrology of General Ward,Tianjin Children's Hospital,Tianjin 300204,China;Department of Nephrology,Tianjin Children's Hospital,Tianjin 300314,China)

机构地区：[1]天津市儿童医院综合内科肾脏科,天津300204 [2]天津市儿童医院肾脏科,天津300134

出　　处：《中国中西医结合急救杂志》2022年第4期444-449,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市医药卫生科研项目(2015KZ2040)。

摘　　要：目的观察左卡尼汀、槐杞黄对原发性肾病综合征(PNS)患儿血脂及血脂比值的影响。方法回顾性分析2015年7月至2018年12月天津市儿童医院肾内科90例住院初发和激素停药6个月以上复发的激素敏感型PNS患儿临床数据。其中激素治疗组、激素联合槐杞黄治疗组(槐杞黄治疗组)、激素联合左卡尼汀组(左卡尼汀组)各30例;另选择同期健康体检儿童30例作为健康对照组。收集激素治疗前及治疗4周后血脂〔三酰甘油(TG)、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)〕、血脂比值〔TG/HDL-C、非HDL-C(nHDL-C)/HDL-C〕、血浆白蛋白(ALB)水平及24 h尿蛋白定量(UTP),并比较各组上述指标的差异;同时观察不良反应发生情况。结果治疗前3个治疗组与健康对照组性别、年龄及3个治疗组间TG、总胆固醇、HDL-C、LDL-C、TG/HDL-C、nHDL-C/HDL-C、ALB、UTP水平比较差异均无统计学意义;治疗后3个治疗组TG、总胆固醇、LDL-C、TG/HDL-C、nHDL-C/HDL-C、UTP水平均较治疗前明显降低,但均明显高于健康对照组(均P<0.05);HDL-C、ALB水平均较治疗前显著升高(均P<0.05),HDL-C与健康对照组比较差异均无统计学意义,ALB均明显低于健康对照组(均P<0.05)。治疗后左卡尼汀组总胆固醇、LDL-C、nHDL-C/HDL-C水平均较激素治疗组、槐杞黄治疗组明显降低〔总胆固醇(mmol/L):5.17(1.81)比6.83(1.72)、6.25(2.32),LDL-C(mmol/L):2.51(0.93)比3.51(1.59)、3.02(0.90),nHDL-C/HDL-C:1.59(0.77)比1.95(1.31)、1.86(0.69),均P<0.05〕;TG水平较激素治疗组明显降低〔mmol/L:1.26(0.53)比1.55(0.89),P<0.05〕;槐杞黄治疗组UTP水平均较激素治疗组、左卡尼汀组降低〔mg·kg^(-1)·d^(-1):9.2(8.0)比10.2(10.1)、10.9(6.5)〕,但差异无统计学意义(均P>0.05);左卡尼汀组与激素治疗组UTP比较差异亦无统计学意义;3个治疗组间ALB水平比较差异无统计学意义。左卡尼汀组患儿1例出现皮疹、恶心,无发�Objective To observe the effects of L-carnitine and Huaiqihuang on blood lipid and blood lipid ratio in children with primary nephrotic syndrome(PNS).Methods A retrospective study was conducted.The clinical data of 90 children with steroid-sensitive PNS who were hospitalized in the department of nephrology of Tianjin Children's Hospital from July 2015 to December 2018,including cases with primary onset and cases initially diagnosed and relapsed after steroid withdrawal for more than 6 months were selected.The children were divided into 3 groups:hormone treatment group,hormone combined with Huaiqihuang treatment group(Huaiqihuang treatment group),and hormone combined with L-carnitine group(L-carnitine group),30 cases in each group;30 healthy children who underwent physical examination during the same period were selected as the healthy control group.The levels of blood lipids[triglyceride(TG),total cholesterol,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)]and blood lipid ratio[TG/HDL-C,non-HDL-C(nHDL-C)/HDL-C],plasma albumin(ALB)and 24-hour urinary protein(UTP)were collected before hormone therapy and after 4 weeks of treatment and the differences of the above indicators among the groups were compared;at the same time,the occurrence of adverse reactions was observed.Results Before treatment,the gender,age and the levels of TG,total cholesterol,HDL-C,LDL-C,TG/HDL-C,nHDL-C/HDL-C,ALB,and UTP among the three treatment groups and healthy control group were compared,the differences being not statistically significant;after 4 weeks of treatment,the levels of TG,total cholesterol,LDL-C,TG/HDL-C,nHDL-C/HDL-C,and UTP in the three treatment groups were lower than those before treatment,but were significantly higher than those in the healthy control group(all P<0.05);the levels of HDL-C and ALB were significantly higher than those before treatment(both P<0.05),there were no significant differences between the three treatment groups and healthy control group,the ALB level of the three t

关 键 词：左卡尼汀 槐杞黄 原发性肾病综合征 儿童 甘油三酯/高密度脂蛋白胆固醇 非高密度脂蛋白胆固醇/高密度脂蛋白胆固醇 

分 类 号：R692[医药卫生—泌尿科学]