诺衡对激素耐药型肾病综合征高脂血症疗效的初步观察

Observation of gemfibrozil treating hyperlipidemia in nephrotic syndrome of steroid-resistance

目的观察降脂药物诺衡对于活动期激素耐药型肾病综合征(SR-NS)患儿高脂血症的疗效及安全性。方法观察在北京大学第一医院儿科住院的8例肝功能正常的活动期SR-NS患儿诺衡降脂治疗1个月,检测治疗前后血清脂质、脂蛋白、白蛋白、肝肾功能的变化及观察临床副反应表现,其中男6例,女2例;年龄214岁,平均8.4岁,所有患儿均接受激素治疗且用药前后尿蛋白持续+++++++。结果血脂及脂蛋白水平在用药2周后出现不同程度的变化,其中TG明显下降(P<0.05),TC、VLDL、LDL下降,HDL上升,差异均在4周后出现明显变化(P<0.05)。治疗前后血Alb、ALT、SCr差异均无统计学意义,且后两者在正常范围内。除1例服药中出现胃肠不适感外,所有患儿均无腹痛、腹泻及皮疹等副反应。结论结果显示对于持续未缓解的SR-NS患儿,尤以TG升高为主的高脂血症,短期应用诺衡降脂治疗是安全有效的,肾功能不全者慎用。

Objective It was known that hypedipidemia,as one complication of nephrotic syndrome,had renal toxicity. To observe the effect and seeurity of gemfibrozil treating hyperlipidemia in children with active steroid-resistance nephrotic syndrome （ SR-NS ）. Methods Eight children with SR-NS were administered gemfibrozil （ BWt 〈 20kg, 0. 3/d ; BWt 〉 20kg,0. 3 Bid） whit normal liver function before lipid-lowing treatment, The changes of plasma lipids （TC, TG） and lipoprotins （ LDL, VLDL, HDL ）, albumin, serum creatinine （ SCr ）, aminotransferase （ ALT ） and drug side-effects were observated for 4 weeks. Results We found that there were decreasing of plasma lipids and lipoproteins after 2 weeks of gemfibrozil treatment, especially TG（ P 〈 0. 05 ）. The decreasing of TC, VLDL, LDL and raising of HDL had significant difference at 4th week. The average reducing rate of TG was 48. 2% ,TC was 31.8%. There were no significant difference between before and after lipid-lowing treatment in renal and liver function. All of our patients＇renal and liver function was in normal range except that one boy who had renal insufficiency before gemfibrozil treatment had little raising of Scr. There was no side-effect found except another patient who had temporary abdominal pain and nausea. Conclusion Our result showed that it is effective and safe to treat the steroid-resistence nephrotic hyperlipidemia in childhood with genafibrozil for short-term, especially for patients with raising TG, but we would pay more attention to patients with renal insufficiency.