微小病变型肾病综合征患儿胆红素与尿蛋白水平的关系

Relationship between bilirubin and urine protein in pediatric patients with minimal change nephrotic syndrome

目的探讨微小病变型肾病综合征(MCNS)患儿应用糖皮质激素治疗后其胆红素与尿蛋白水平的关系。方法选取2012年2月至2014年2月该院MCNS患儿作为研究对象。单纯应用泼尼松药物短期治疗14d,再经24h尿蛋白(24hUpr)定量和晨尿蛋白定性试验,选取65例尿蛋白完全缓解患儿,观察治疗前、治疗7d、治疗14d的血清总胆红素(TBIL)、直接胆红素(DBIL)、总胆固醇(TC)、三酰甘油(TG)、清蛋白(ALB)和24hUpr指标水平变化,比较其差异并对患儿胆红素与尿蛋白水平进行相关性分析。结果 65例患儿TC、TG和ALB水平在治疗7d和14d后与治疗前比较,差异均无统计学意义(P>0.05),而24hUpr、TBIL和DBIL水平在治疗7d和14d后与治疗前比较,差异均有统计学意义(P<0.05)。相关性分析显示,治疗前24hUpr与TBIL、DBIL呈负相关(r=-0.413,P=0.001;r=-0.293,P=0.023);治疗后14d的24hUpr与TBIL、DBIL呈负相关(r=-0.301,P=0.018;r=-0.285,P=0.029)。结论糖皮质激素治疗对MCNS患儿尿蛋白和血清胆红素影响较大,且24hUpr与胆红素水平呈负相关,提示MCNS患儿尿蛋白丢失可能是导致机体血清胆红素水平降低的主要原因之一。

Objective To explore the relationship between bilirubin and urine protein（Upr） in pediatric pa-tients with minimal changed nephrotic syndrome （MCNS）treated by glucocorticoids. Methods The pediatric patients with MCNS in the hospital from February 2012 to February 2014 were selected as subjects. Short-term treatment with prednisone for 14 days. Subsequently,24-hour urine protein （24 hUpr） quantification and morning urine protein qualitative were tested. Totally 65 patients with complete relief of Upr were selected. The changes of serum levels of serum total bilirubin （TBIL）,direct bilirubin （DBIL）,total cholesterol （TC）, triglyceride （TG）, albumin （ALB） and 24 hUpr were observed. The levels of them were con^pared before treatment,7 days of treatment, and 14 days of treatment and the differences between bilirubin and Upr was compared and the correlation was analyzed. Results The levels of TC,TG and ALB didn＇t changed obviously, compared with those before treatment after 7 and 14 days of treatment. There was no statistical significance （P〉0.05）. While the 24 hUpr,TBIL and DBIL levels after treatment were statistically different than before （P〈0.05）. Correlation analysis showed there was a negative correlation between 24 hUpr and TBIL and DBIL 24 h before treatment （r= -0. 413,P=0. 001;r= -0. 293,P=0. 023）. 24 hUpr was negatively correlated with TBIL and DBIL at 14 days after treatment （r= -0. 301,P=0.018;r= -0. 285,P=0. 029）. Conclusion Glucocorticoid therapy has a greater effect on urinary protein and serum bilirubin in pediatric patients with MCNS. 24 hUpr negatively correlated with bilirubin levels, suggesting that urinary protein loss in pediatric pa-tients with MCNS may be one of the main causes of decreased serum bilirubin levels.