小儿肾病综合征红细胞膜电荷及血液流变学变化的研究

Study of the change of red blood cell membrane′s charge and of hemorheology in nephrotic children

目的 探讨肾病综合征患儿蛋白尿的发生机制及其影响因素。方法 以红细胞 (RBC)膜Alcian蓝 (AB)结合量为指标观测 36例肾病综合征 (NS)患儿 RBC膜电荷量 ,并测定其血液流变学各指标。结果 (1 )患儿 RBC膜 AB结合量明显降低 ,但其 RBC表面主要阴离子涎酸含量并未减少 ,提示 NS患儿 RBC膜电荷量呈“功能性”降低。 (2 )患儿全血粘度 (高切及低切 )、血浆粘度、血沉、红细胞压积、红细胞电泳时间、血沉方程 K值、红细胞聚集指数、全血还原比粘度等指标均明显增高 ,提示 NS患儿血液呈现高粘滞、高聚集、高浓缩状态。 (3)多元逐步回归分析结果提示 NS患儿尿蛋白量受 RBC膜电荷及血粘度的影响。结论 恢复肾小球电荷屏障功能、纠正血流变异常对于减少蛋白尿、改善血流状态、减少并发症。

Objective To study the mechanism and relative effects about nephrotic syndrome.Methods The charge on the surface of RBC which was indicated by Alcian Blue(AB) bindig amount was determined in 36 patients of nephrotic syndrome (NS) .Some hemorheological indexes of these patients were also measured.Results ①The AB binding amount on RBC of NS children is decreased, but the sialic acid (the main negative charge substance) content on RBC is normal.It meant that the reduction of negative charge on nephrotic RBC was“ functional”;②The hemorheological indexes such as:blood viscosity(Vb 1,Vb 2), plasma viscosity(Vp),haematocrit (HCT), erythrocyte sedimentation rate(ESR),erythrocyte electrophoretic time(EPT),erythrocyte aggregation index(EAI), reduced blood viscosity(Vb 1 ’) and K value of NS children were significantly higher than that of normal control.It indicated that the blood stream of NS children showed a state with “high viscosity”,“high aggregation” and “high concentration”;③Multiple linear regression and stepwise regression analytic results:nephrotic proteinuria was influenced by the membrane charge of RBC and blood viscosity. Conclusion It is very important to recover the membrane charge of RBC and to change hemorheological condition for children suffering NS.