难治性肾病患儿血浆脂质代谢紊乱

Study on Abnormalities of Lipid Metabolism in Children with Intractable Nephrotic Syndrome

为了解难治性肾病患儿血浆脂质代谢的特点，采用生化分析法、酶联免疫法和免疫浊度法分别测定血浆脂质、脂蛋白和载脂蛋白浓度。结果显示：⑴和３０ 例健康儿童相比，１８ 例难治性和１２ 单纯性肾病患儿血浆ＴＣ、ＴＧ、ＬＤＬ－ ｃｈ、ＶＬＤＬ－ ｃｈ 、Ｌｐ（α）、ＡｐｏＢ１００ 均显著升高，且难治性肾病ＴＣ，ＬＤＬ－ ｃｈ 增高更明显，而ＡｐｏＡ１ 升高仅见于单纯性肾病；⑵所有患儿２４ｈ 尿蛋白定量与血浆ＴＧ、ＶＬＤＬ－ｃｈ 呈正相关，血浆Ａｌｂ 与ＴＣ、ＬＤＬ－ｃｈ 呈负相关。说明难治性肾病患儿较单纯性者血浆脂质代谢紊乱更趋严重且更持久，其罹患动脉粥样硬化和肾小球硬化的风险可能更大。

To understand the characteristics of lipid metabolism in intractable nephrotic syndrome,the levels of plasma lipid,lipoprotein and apolipoprotein in 18 intractable nephrotic,12 simple nephrotic and 30 normal children were determined by biochemical test,enzyme-linked immunosorbent assay and immunoturbidimetric analysis.The results showed that the plasma total cholesterol(TC),triglyceride(TG),low density lipoprotein-cholesterol(LDL-ch),very low density lipoprotein-ch(VLDL-ch),lipoprotein(α) [Lp(α)] and apolipoprotein B 100 (ApoB 100 ) were significantly increased in both intractable and simple nephrotic children,as compared with health controls.The elevation of plasma TC and LDL-ch was more obvious in intractable nephrotic children than in simple nephrotic ones.The elevated apolipoprotien A 1(ApoA 1) was only found in simple nephrotic children.There was a positive correlation between plasma TG(or VLDL-ch) and the quantity of 24h proteinuria,a negative correlation between plasma TC (or LDL-ch) and plasma albumin in all patients.The data suggest that the intractable nephrotic children have probably a more serious and persistent abnormalities of lipid metabolism,and a higher risk of atherosclerosis and glomerulosclerosis than simple nephrotic ones.