血清胆固醇及纤维蛋白原在评估肾病综合征患儿肾小球硬化风险中的意义

Significance of serum cholesterol and fibrinogen in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome

目的探讨血清胆固醇及纤维蛋白原(FIB)在评估肾病综合征患儿肾小球硬化风险中的意义。方法将63例原发性肾病综合征患儿按其病理类型分为微小病变肾小球病(MCG,n=39)组及局灶节段性肾小球硬化症(FSGS,n=24)组,回顾性分析两组患儿血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、FIB及24 h尿蛋白定量的水平。结果 FSGS组中TC、non-HDL-C及LDL-C水平均较MCG组增高(均P<0.05);HDL-C、FIB及24 h尿蛋白定量在两组间比较差异无统计学意义(均P>0.05)。Logistic回归分析结果显示LDL-C、non-HDL-C和TC是影响肾小球硬化的危险因素(均P<0.05)。两组口服足量激素4周尿蛋白不转阴的患儿进行对比分析,FSGS组中仅non-HDL-C较MCG组增高(P<0.05),而TC、LDL-C、HDL-C及FIB在两组间比较差异均无统计学意义(均P>0.05)。结论血清胆固醇水平尤其是non-HDL-C对评估肾小球硬化的风险有重要意义;血浆FIB的水平尚不足以来评估或预测肾小球硬化的风险。

Objective To investigate the significance of serum cholesterol and fibrinogen （Fib） in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome. Methods Sixty-three children with primary nephrotic syndrome were divided into two groups according to their pathological types： minimal change glomerulopathy （MCG） （n=39） and focal segmental glomerulosclerosis （FSGS） groups （n=24）. Serum levels of total cholesterol （TC）, low- density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDL-C）, non-HDL-C and Fib and 24- hour urinary protein excretion were retrospectively analyzed. Results Serum levels of TC, non-HDL-C, and LDL-C were significantly higher in the FSGS group than in the MCG group （P〈0.05）, but there were no significant differences in HDL-C, Fib and 24-hour urinary protein excretion between the two groups （P〉0.05）. According to the results of logistic regression analysis, high levels of LDL-C, non-HDL-C and TC were risk factors for FSGS （P〈0.05）. In patients whose proteinuria did not disappear after taking enough glucocorticoid for 4 weeks, the level of non-HDL-C was significantly higher in the FSGS group than in the MCG group （P〈0.05）; there were no significant differences in TC, LDL-C, HDL-C, and Fib between the MCG and FSGS groups （P〉0.05）. Conclusions Serum cholesterol, especially non-LDL-C, is of great significance in evaluating the risk of glomerulosclerosis in children with nephrotic syndrome. There is no sufficient evidence to support serum Fib as a marker for predicting glomerulosclerosis in these children.