原发性肾病综合征患者蛋白尿缓解前后血脂改变

Lipid Abnormalities and Follow-up Observation after Remission of Proteinuria in Patients with Primary Nephrotic Syndrome

【目的】观察原发性肾病综合征(PNS)患者病情缓解前后脂质代谢改变及特点。【方法】142例PNS患者,分别于治疗前、缓解时、缓解后抽血检测胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白AⅠ(ApoAⅠ)、载脂蛋白B(ApoB)、脂蛋白(a)[Lp(a)]、非酯化脂肪酸(NEFA)水平,并与27例健康志愿者作对照。【结果】PNS患者治疗前血脂明显增高,以TC、LDL-C、Lp(a)增高为主(P<0.001);蛋白尿缓解初期血脂异常明显改善,缓解1个月后TG、LDL-C、ApoB、Lp(a)与对照组比较差异无显著性(P>0.05),但TC、ApoAⅠ高于对照组(P<0.05),17例随访病例于蛋白尿缓解后9个月时TC、ApoAⅠ仍高于对照组(P<0.05);PNS病理类型中,系膜增生性肾小球肾炎(MsPGN)和微小病变性肾小球病(MCN)LDL-C增高较明显(P<0.05)。【结论】PNS患者病情进展阶段存在以高胆固醇血症为特点的血脂异常;病情缓解后大部分血脂成分的异常随着血清白蛋白的恢复而短期内趋于正常,但血清胆固醇的回降较慢。

[Objective] To investigate the characteristics of dyslipidemia and its recovery after remission of proteinuria in patients with primary nephrotic syndrome（PNS）. [Methods] One hundred and forty two patients with PNS and 27 healthy volunteers were selected. The levels of cholesterol（TC）, triglyceride（TG）, high-density lipoprotein cholesterol（HDL-C）, low-density lipoprotein cholesterol（LDL-C）, apolipoprotein AⅠ （ApoA Ⅰ ）, apolipoprotein B（ApoB）, lipoprotein （a）[Lp（a）] and nonesterified fatty acid（NEFA） were determined. Follow-up study had been performed in 17 remission patients （proteinuria was negative or 〈0.3g/ d）. [Results] As compared with control group, nephrotic patients showed significant abnormalities of lipid metabolism before treatment, especially in levels of TC, LDL-C and Lp（a） （ P 〈0. 001）. No change was found in plasma NEFA concentration（ P 〉0.05）. The PNS group had obvious improvements in lipids at the beginning of remission, and had not marked differences in levels of TG, LDL-C, ApoB and Lp（a） versus control after one month（ P 〉0.05）. Levels of TC and ApoA Ⅰ in PNS group were still higher than those in control group after nine months（ P d0.05）. LDL-C concentration was different between minimal change glomerulopathy（MCN） and mesangioproliferative （MsPGN, P 〈0.05）. [Conclusion]Patients with PNS have severe lipid disorder in developing period. Lipid lowering therapy, such as HMG-COA reductase inhibitors and so on, should be applied early for NS patients. ACEI can be used at the same time. Most of lipid changes could return to normal with the recovery of hypoalbuminemia in a short time after remission, so lipid-lowering agents are not necessary at this stage.