原发性肾病综合征患儿血浆脂质及脂蛋白的变化

Changes in plasma lipid and lipoprotein in childhood primary nephrotic syndrome

为了解小儿原发性肾病综合征（ＮＳ）时脂代谢的特点，观察了２０例原发性单纯型ＮＳ患儿的血脂、脂蛋白及载脂蛋白的变化。结果：（１）全部ＮＳ患儿血浆总胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）和脂蛋白（ａ）［Ｌｐ（ａ）］均明显升高；兼有ＴＣ、甘油三酯（ＴＧ）升高者，其极低密度脂蛋白胆固醇明显升高，高密度脂蛋白胆固醇明显降低。（２）ＮＳ患儿２４小时尿蛋白定量与血浆ＴＣ、ＴＧ和ＬＤＬ－Ｃ呈正相关（Ｐ＜０．０１）。提示：（１）ＮＳ患儿存在脂代谢异常，兼有ＴＣ、ＴＧ同时升高者，伴有更严重的脂蛋白及载脂蛋白的紊乱，存在着多种致动脉硬化及肾损伤的因素。（２）ＮＳ患儿脂代谢异常的程度与蛋白尿严重程度高度正相关。

To study the characteristics of lipid metabolism in childhood primary nephrotic syndrome, we observed the changes in plasma lipid and lipoprotein in 20 primary nephrotic children aged 4 12 years (11 boys and 9 girls). Plasma total cholesterol (TC), low density lipoprotein C (LDL C), and lipoprotein(a) were obviously increased in all of the nephrotic children. The patients with both elevated TC and triglyceride (TG) had high very low density lipoprotein C (VLDL C) and low high density lipoprotein C (HDL C) levels. There was a positive correlation between the quantity of 24hr proteinuria and plasma lipid (TC, TG and LDL C). We conclude that the changes in plasma lipids indicate the possible high risks of arteriosclerosis in nephrotic syndrome, especially in patients with both elevated TC and TG. The abnormalities of lipid metablism are related to the severity of proteinuria in nephrotic children.