成人原发肾病综合征病理类型与血脂代谢紊乱的关系

Relationship between Pathological Types with Lipid Abnormalities in Patients with Adult Primary Nephrotic Syndrome

目的:研究成人原发肾病综合征(PNS)肾脏病理改变与血脂代谢紊乱的关系。方法:选取成人PNS患者109例为研究对象,分析不同病理类型PNS患者血脂及血清脂蛋白代谢异常的发生率、代谢水平及胆固醇代谢异常的相关因素。结果:成人PNS患者血清总胆固醇(TC)升高、低密度脂蛋白胆固醇(LDL-C)升高、高密度脂蛋白胆固醇(HDL-C)降低、甘油三酯(TG)升高的发生率分别为89.90%、69.72%、9.17%、41.28%,高胆固醇血症占51.37%,混合型高脂血症占39.45%;微小病变型肾病(MCD)、膜性肾病(MN)、系膜增生性肾小球肾炎(Ms PGN)、局灶阶段性肾小球硬化(FSGS)组间TC、TG、LDL-C、HDL-C代谢异常发生率及代谢水平比较均无明显差别(P>0.05);病理类型为MCD及n-MCD的PNS患者,胆固醇水平均与24小时尿蛋白定量呈正相关(r=0.440,P=0.036;r=0.361,P=0.001),与血白蛋白水平无明显相关性(P>0.05)。结论:成人PNS患者血脂代谢异常以TC及LDL-C升高为主,临床分型中以高胆固醇血症及混合型高脂血症为主;病理类型为MCD及n-MCD的PNS患者,胆固醇水平均与24小时尿蛋白呈正相关,与血白蛋白水平无明显相关性。

Objective： To investigate the relationship between pathological changes of kidney and lipid abnormalities of patients with adult primary nephrotic syndrome（PNS）. Methods： One hundred and nine patients with adult PNS were selected, the incidence and metabolic levels of abnormal blood lipid and serum lipoprotein of different pathological types of PNS were evaluated and compared.Meanwhile, the factors related to abnormal cholesterol metabolism were analyzed. Results： The incidence rates of increased total cholesterol（TC）, increased low density lipoprotein cholesterol（LDL-C）, decreased high density lipoprotein cholesterol（HDL-C） and increased triacylglyceride（TG） were 89.90%, 69.72%, 9.17% and 41.28% respectively. The incidence rate of hypercholesterolemia of all cases was 51.37%, and mixed hyperlipidemia accounted for 39.45%. No significant difference was found in the metabolic levels of TC,TG, LDL-C and HDL-C and lipid metabolism disorders among the minimal change nephropathy（MCD）, membranous nephropathy（MN）,mesangial proliferative glomerulonephritis（Ms PGN） and focal segmental glomerulosclerosis（FSGS） groups（P〉0.05）. The cholesterol levels of MCD and n-MCD patients were associated with 24-hour urinary protein（r=0.440, P=0.036; r=0.361, P=0.001） instead of serum albumin（P〉0.05）. Conclusions： Increased TC and LDL-C were mainly the abnormalities of lipid metabolism in adult PNS,hypercholesteremia and mixed hyperlipidemia were the main clinical types. The cholesterol level was associated with 24-hour urinary protein instead of serum albumin in MCD and n-MCD patinets.