儿童原发性肾病综合征患者小而密低密度脂蛋白胆固醇水平变化及其临床价值

Study on serum levels of sdLDL-C and their clinical significancein in children with nephrotic syndrome

目的分析肾病综合征(NS)患儿血清小而密低密度脂蛋白胆固醇(sdLDL-C)水平,探讨治疗前后NS患儿sdLDL-C水平的变化,评估其临床价值。方法收集2018年6—9月在南京大学医学院附属金陵医院肾内科住院并确诊的NS患儿50例(NS组)和同期健康对照儿童40例(对照组)。分别检测NS患儿治疗前后和对照组儿童的血清sdLDL-C水平,同时测定其总蛋白(TP)、清蛋白(ALB)、血脂[包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]及肾功能指标[尿素(UREA)、肌酐(Cr)、尿酸(UA)]水平,并进行统计学分析。结果治疗前NS组患儿血清sdLDL-C水平中位数(四分位数)[M(P 25,P 75)]为[47.61(29.41,99.54)]mg/dL,治疗后NS组血清sdLDL-C水平为[29.13(17.72,43.90)]mg/dL,均明显高于对照组[15.88(13.66,20.08)]mg/dL,差异有统计学意义(均P<0.001);且治疗后NS患儿血清sdLDL-C水平明显低于治疗前患儿(P<0.001)。Spearman相关性分析显示,NS患儿血清sdLDL-C水平与TC(r=0.949,P<0.001)、TG(r=0.597,P<0.001)和LDL-C(r=0.874,P<0.001)水平均呈显著正相关,与TP(r=-0.692,P<0.001)、ALB(r=-0.765,P<0.001)均呈显著负相关。逐步多元线性回归分析显示,在校正其他相关因素的影响后,NS患儿血清sdLDL-C水平与ALB水平仍独立相关(β=-0.780,P<0.001,校正R 2=0.604)。结论NS患儿血清sdLDL-C水平明显升高,治疗后明显下降;且NS患儿血清sdLDL-C水平有望作为其病情评估的新指标。

Objective To analyze serum levels of small dense low-density lipoprotein cholesterol(sdLDL-C)in children with nephrotic syndrome(NS),and investigate the changes of sdLDL-C levels in NS children before and after treatment and to evaluate their clinical values.Methods From June to September 2018,50 patients with NS(NS group)and 40 healthy control children(control group)who were hospitalized and diagnosed in the Department of Nephrology,Jinling Hospital Affiliated to Nanjing University School of Medicine were collected.Serum levels of sdLDL-C were measured in control children and NS children before treatment and after treatment.The total protein(TP),albumin(ALB),other lipid/lipoprotein[including total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)],renal function parameters[UREA,creatinine(Cr)and uric acid(UA)]were also analyzed.Multiple statistical analyses were performed.Results Compared with the control children,the[M(P 25,P 75)]of serum levels of sdLDL-C was[15.88(13.66,20.08)mg/dL],serum levels of sdLDL-C in NS children before treatment[47.61(29.41,99.54)mg/dL]and after treatment[29.13(17.72,43.90)mg/dL]were both significantly increased(all P<0.001).Compared with NS children before treatment,serum levels of sdLDL-C in NS children after treatment were significantly decreased(P<0.001).Spearman analyses showed that serum levels of sdLDL-C were positively correlated with the levels of TC(r=0.949,P<0.001),TG(r=0.597,P<0.001)and LDL-C(r=0.874,P<0.001),while negatively correlated with the levels of TP(r=-0.692,P<0.001)and ALB(r=-0.765,P<0.001).Multiple linear regression analyses revealed that serum levels of sdLDL-C were independently associated with ALB levels(β=-0.780,P<0.001,adjusted R 2=0.604)after adjusting for other coexisting conditions.Conclusion Serum levels of sdLDL-C were significantly increased in NS children and decreased after treatment.Serum levels of sdLDL-C may function as a novel parameter for assessing disease progression in NS children.