肾病综合征患者蛋白质及脂类代谢变化的临床分析

Clinical analysis of protein and lipid metabolic changes in patients with nephritic syndrome(NS)

目的探讨原发性肾病综合征(NS)与继发性NS患者蛋白质及脂类代谢变化规律,寻找灵敏准确、实用价值较大的血清蛋白质及脂类实验室检测指标。方法用醋酸纤维素膜电泳法对52例原发性NS与40例继发性NS分别进行血清蛋白检测,分析其血清蛋白电泳图谱变化特征。用免疫透射比浊法(IT)测定血清免疫球蛋白IgGI、gA、IgM含量,同时进行血清脂蛋白(LP)琼脂糖凝胶电泳检测,分析LP电泳图谱变化特征,并用IT法测定这两类患者血清载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)含量。对所收集的血清标本用酶学方法测定甘油三酯(TG)、总胆固醇(TC)含量。结果与对照组相比,原发性NS组出现血清IgG、白蛋白(A)、γ-球蛋白及白蛋白/球蛋白(A/G)比值的明显降低,而血清α2-球蛋白及β-球蛋白明显升高。在继发性NS组,血清A、A/G比值显著下降,而α2-球蛋白、β-球蛋白、γ-球蛋白明显升高(P<0.01)。与对照组相比,两类NS均表现为血清低密度脂蛋白(LDL)、ApoB、TG、TC的明显升高(P<0.01)。结论无论何类NS患者,体内都存在明显的蛋白质与脂类代谢紊乱,这些实验室检测指标在两类NS时不同的变化规律具有重要临床应用价值。

Objective To investigate the change pattern of protein and lipid metabolism in two types of patients with nephrotic syndrome（NS）,in order to find out sensitive and accurate biomakers of protein and lipid metabolism for clinical laboratory diagnosis. Methods Serum samples of 52 cases of primary NS（PNS）,40 cases of secondary NS（SNS） were collected, and 90 cases of normal persons were used as control group. Serum proteins were checked by cellulose acetate membrane electrophoresis. Serum lipoproteins were detected by agarose gel electrophoresis. The electrophoretogram features were analyzed. Immunoglobulins IgG, IgA and IgM were determined by IT method. Serum apolipoprotein A1 （ApoA1）, apolipoprotein B（ApoB） were checked by IT method. Serum total cholesterol（TC）, triglycerides（TG） were checked in enzyme coupled assay. Results As compared with the healthy individuals, serum IgG, albumin（A）, γ-globulin, aibumin/globulin （A/G） ratio decreased significantly in the patients with PNS, while α2-globulin and β-globulin increased obviously. The serum A, A/G decreased,β-globulin and γ-globulin increased in the patients with secondary NS（P〈0.01）. Serum lowdensity lipoprotein（LDL）, ApoB,TG and TC in two types of NS patients increased obviously （P〈 0. 01）. Conclusion The patients with NS manifest disorders of protein and lipid metabolism. The changing pattern is different in two types of patients with NS. Laboratory examination of biomakers in protein and lipid metabolism may have beneficial effect to the diagnosis and treatment of NS.