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: steroidresistent 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), highdensity lipoprotein cholesterol (HDL-C), lowdensity 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 lipidlowering drugs early, while MCD cases should not be treated with lipid lowering drugs.
ZENG Hua-Song,GAO Yan,XU Jia-Yu et al. Relationship between Hyperlipidemia and Pathologic Renal Changes in Children with the Primary Nephrotic Syndrome[J]. CJCP, 2001, 3(2): 151-153.
