非微小病变型肾病综合征患儿脂质紊乱及载脂蛋白E基因的研究

The hyper lipidemia and apolipoprotein E gene in the children with with no-minimal change glomerulopathy of primary nephrotic syndrome

目的 研究非微小病变型肾病综合征患儿脂质紊乱及载脂蛋白E基因,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 用酶法测定了50例非微小病变型(NMCD)患儿及80例健康儿童血脂、脂蛋白、载脂蛋白三个水平共七个脂质代谢指标,用PCR-SSCP法测定了研究对象载脂蛋白E(ApoE)基因型,并行肾穿刺活检术检查NS患儿病理类型。结果 临床表现为难治性肾病综合征的NMCD患儿存在明显脂质紊乱(P<0.01),随诊半年后仍有绝大多数NMCD患儿存在明显脂质紊乱。NMCD组ApoE2等位基因显著高于健康儿童(11.00％vs5.00％,P<0.05)。结论 NMCD患儿脂质紊乱持续的时间较长,这类患儿,尤其携ApoE_2等位基因者,更易发生进行性肾脏损害,动脉粥样硬化及冠心病。

Objective To study the hyperlipidemia and apolipoprotein E gene in the children with no-minimal change glomerulopathy of primary nephrotic syndrome (NS). Method 50 children with no-minimal change glomerulopathy( NMCN group, the clinical type was steroid-resistent NS) were observed group, 80 age and sex-matched healthy children were control group. 7 Lipoprotein metabolism parameters including serum total-cholesterol(TC), triglyceride(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein AI(ApoAI), apolipoprotein B (ApoB), lipoprotein (a) [Lp(a)]were detected by enzyme method and Single-strand conformational polymorphism (PCR - SSCP) was used to determine the ApoE genotypes in 2 groups. Results Serum TC, TG, HDL-C, LDL-C, ApoAI, ApoB, Lp(a) in two observed group were highter than healthy cotrols significantly (P<0.01). After treated by prednison, The incidence of abnormal lipoprotein metabolism parameters in observed group were higher than those in the cotrol group significantly (P<0.01), After 6 month, the abnormal incidence of Serum TC, TG, LDL-C, ApoB, Lp (a)were 80.00 % , 76. 67 % , 83. 33 % , 87. 67 % , 76. 67 % respectively in 30 cases. the ApoE2 allele gene frequence in observed group is highter than healthy cotrols significantly (P<0.05) .Conclusion There had been obvions and long time ahnomilities of serum lipoprotein metabolism parameters in the children with no-minimal change glomerulopathy of primary nephrotic syndrome, the ApoE2 allele gene frequence is highter in those cases. There are the risk facters of suffering from atherosclerosis and cardiovascular diseases in those cases. The lipids-reduced drugs should be considered use in those cases.