难治性肾病综合征动脉硬化指数的变化及其影响因素研究

Changes and Influencing Factors of ASI of Refractory Idiopathic Nephrotic Syndrome

目的探讨难治性肾病综合征(RNS)患者动脉硬化指数(ASI)变化及其影响因素。方法选取2010年1月—2012年9月重庆医科大学附属第二医院肾内科收治的RNS患者57例和激素敏感性肾病综合征(SSNS)患者40例,分别作为RNS组和SSNS组。另选取同期在本院行体检健康者40例作为对照组。测量24 h尿蛋白、总胆固醇、清蛋白、三酰甘油、低密度脂蛋白、高密度脂蛋白、脂蛋白a、ASI。对3组受试者在距第一次入院1年时,采用相同方法、相同仪器再次测量ASI。结果 3组受试者性别、年龄、体质指数(BMI)、三酰甘油比较,差异均无统计学意义(P>0.05)。3组受试者24 h尿蛋白、清蛋白、总胆固醇、低密度脂蛋白、高密度脂蛋白、脂蛋白a比较,差异均有统计学意义(P<0.05),其中RNS组和SSNS组24 h尿蛋白、总胆固醇、低密度脂蛋白、脂蛋白a均高于对照组,清蛋白均低于对照组(P<0.05)。入院时3组ASI比较,差异无统计学意义(P>0.05)。随访1年后3组ASI比较,差异有统计学意义(P<0.05),其中RNS组高于SSNS组和对照组(P<0.05)。对照组和SSNS组ASI入院时和随访1年后比较,差异均无统计学意义(t=1.416、-0.732,P>0.05);RNS组随访1年后ASI高于入院时(t=4.592,P<0.05)。相关分析结果显示,ASI与BMI、清蛋白、三酰甘油、低密度脂蛋白、高密度脂蛋白均无直线相关关系(P>0.05),与年龄、24 h尿蛋白、总胆固醇、脂蛋白a呈正相关(P<0.05)。结论 RNS患者动脉硬化较SSNS患者和健康成年人发生早、进展快。年龄、24 h尿蛋白、总胆固醇、脂蛋白a可影响ASI变化。

Objective To explore the change and influencing factors of atherosclerosis index（ ASI） in patients with refractory idiopathic nephrotic syndrome（ RNS）.Methods 57 RNS patients and 40 SSNS（ steroid- sensitive nephrotic syndrome） patients hospitalized in the Second Affiliated Hospital of Chongqing University of Medical Science from January,2010 to September,2012 were selected and grouped as RNS group and SSNS group.Another 40 healthy people for routine physical check- up were chosen as control group.Determine 24 hours urinary protein excretion,total cholesterol,albumin,triglyceride,low lipoprotein,high density lipoprotein,lipoprotein a and ASI,and re- determine ASI one year after discharge.Results The difference of gender,age,BMI,triglyceride of these three groups were not significant（ P 0.05）.24 hours urinary protein excretion,total cholesterol,albumin,low density lipoprotein,high density lipoprotein,lipoprotein a and ASI were all significant（ P 0.05）; in RNS group and SSNS group,24 hours urinary protein excretion,total cholesterol,low density lipoprotein and lipoprotein a were higher and albumin was lower than those in control group,with significant difference（ P 0.05）.Admission ASI difference in the three groups was not significant（ P 0.05）,but after one year follow- up,it was significant（ P 0.05） and RNS group was higher than SSNS group and control group（ P 0.05）.The differences of admission ASI and after one year follow- up ASI in SSNS group and control group were both not significant（ t = 1.416,- 0.732,P 0.05）.ASI after one year follow- up in RNS group was higher than that on admission（ t = 4.592,P 0.05）.The correlation analysis showed no linear correlation between ASI and BMI,albumin,triglyceride,low lipoprotein,high density lipoprotein（ P 0.05） and a positive correlation between ASI and age,24 hours urinary protein excretion,total cholesterol,lipoprotein a（ P 0.05）.Conclusion Refractory nephrotic syndrome patients＇ arterial stiffness occurs earlier and advances faster than that of steroid- sensitive nephrotic syndrome and healthy adults.Age,24 hours urinary protein excretion,total cholesterol,lipoprotein a are the influencing factors over ASI.