原发性肾病综合征患儿不同尿蛋白排泄状态下血脂代谢特点

Characteristics of Serum Lipids Metabolism under Different Proteinuria Profilings in Children with Primary Nephritic Syndrome

目的探讨原发性肾病综合征(PNS)患儿不同尿蛋白排泄状态下血脂代谢特点,了解血脂代谢紊乱与尿蛋白定量的关系。方法根据尿蛋白排泄状态,将98例PNS患儿分成中度蛋白尿组[50mg/(kg.d)≤24h尿蛋白定量(24hUPr)<100mg/(kg.d),33例]和重度蛋白尿组[24hUPr≥100mg/(kg.d),65例],收集45例表现为轻度蛋白尿[24hUPr<50mg/(kg.d)]紫癜性肾炎患儿作为对照,检测血浆脂蛋白a(LPa)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、non-HDL、低密度脂蛋白(LDL)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、ApoA1/B及24hUPr等指标。结果3组血浆LPa、TC、TG、non-HDL、LDL、ApoA1、ApoB及ApoA1/B水平具有显著性差异(Pa<0.01);中度蛋白尿组血浆LPa、TC、non-HDL、LDL、ApoA1和ApoB水平显著高于轻度蛋白尿组;重度蛋白尿组血浆TC、TG、non-HDL和ApoB水平显著高于中度蛋白尿组,而ApoA1/B明显降低;重度蛋白尿组血浆LPa、TC、TG、non-HDL、LDL和ApoB水平显著高于轻度蛋白尿组,而ApoA1/B明显降低;中度蛋白尿组TC、HDL、non-HDL、LDL及ApoB分别与24hUPr呈高度正相关(r=0.84,0.54,0.84,0.83,0.70Pa<0.01),而ApoA1/B与24hUPr呈高度负相关(r=-0.48P=0.01)。结论PNS患儿血脂代谢紊乱继发于蛋白尿,且随尿蛋白排泄状况不同而表现各异,在中度蛋白尿组二者关系最密切。

Objective To probe the characteristics of serum lipids metabolism under different proteinuria profilings in children with primary nephritic syndrome（PNS）,and investigate the relationship between the disorder of serum lipids metabolism and proteinuria.Methods Ninety-eight children with PNS were divided into 2 groups,the medium-proteinuria group[50 mg/（kg·d）≤24 hour urine protein（24 h UPr）〈100 mg/（kg·d）,33 cases] and macro-proteinuria group[24 h UPr ≥100 mg/（kg·d）,65 cases],according to proteinuria profiling.Furthermore,45 children with Henoch-Schonlein purpura nephritis（HSPN）（24 h UPr〈50 mg/（kg·d）were collected as control group（micro-proteinuria group）.Serum lipoprotein a（LPa）,total cholesterol（TC）,triglyceride（TG）,high density lipoprotein（HDL）,non-HDL,low density lipoprotein（LDL）,apolipoprotein A1（ApoA1）,apolipoprotein B（ApoB）,ApoA1/B and 24 h UPr were detected.Results There were significant differences of serum LPa,TC,non-HDL,LDL,ApoA1 and ApoB levels among 3 groups（Pa〈0.01）.The serum levels of LPa,TC,non-HDL,LDL,ApoA1 and ApoB in medium-proteinuria group were higher than those in micro-proteinuria group.The serum levels of TC,TG,non-HDL and ApoB in macro-proteinuria were higher than those in medium-proteinuria group,while ApoA1/B was lower inversely.The serum levels of LPa,TC,TG,non-HDL,LDL and ApoB in macro-proteinuria were higher than those in micro-proteinuria group,but ApoA1/B was lower inversely.Positive correlations were observed between TC,HDL,non-HDL,LDL,ApoB and 24 h UPr respectively in medium-proteinuria children（r=0.84,0.54,0.84,0.83,0.70 Pa〈0.01）,while negative correlation between ApoA1/B and 24 h UPr（r=-0.48 P=0.01）.Conclusions The disorder of serum lipids metabolism is secondary to proteinuria in PNS children.There are diverse relationships between lipid abnormalities and proteinuria in PNS children under different proteinuria profiling,which is most intimate as for medium-proteinuria group.