肾病综合征患儿血载脂蛋白E变化及与中分子尿蛋白关系的研究

Apolipoprotein E level and medium-size urine protein in children with idiopathic nephrotic syndrome

目的 研究原发性肾病综合征 (INS)患儿血载脂蛋白E(ApoE)的变化及与中分子尿蛋白的关系。 方法 检测 5 0例INS患儿血ApoE及血胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇 (LDL C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)及血清总蛋白 (TP)、白蛋白 (Alb)、2 4h尿蛋白 (TUP)。用HYDRASYSLC(Sebia)全自动电泳分析系统测定INS患儿尿蛋白分子质量大小以确定其尿蛋白类型。以 5 0例年龄、性别相匹配的健康儿童为对照组。结果 活动期INS患儿血ApoE及血TC、TG、HDL C、LDL C、ApoB显著高于对照组 (均P <0 0 1)。 92 %INS患儿有高ApoE血症。血ApoE及血TC、TG、LDL C、ApoB与血TP、Alb呈显著负相关 (P <0 0 1) ,而血ApoE、TC、TG、LDL C、ApoB与TUP无相关。选择性中分子蛋白尿 (SMUP)组血ApoE显著高于非选择性蛋白尿 (NSUP)组 (P <0 0 1)。结论 INS患儿血ApoE明显升高 ,高ApoE血症广泛存在于INS患儿 ,血ApoE升高不能作为脂蛋白肾小球病的特异性诊断指标。中分子尿蛋白是INS患儿血ApoE升高的一个重要原因。

Objective To study apolipoprotein E(ApoE) level and its relation to medium-size urine protein in children with idiopathic nephrotic syndrome(INS).Methods Fifty children with INS were observed in comparison with 50 age-sex-matched healthy children.Blood ApoE and 6 lipoprotein metabolism parameters,including serum total-cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB) were detected by enzyme method.High density SDS-agrose gel with HYDRASYS LC(Sebia) automatic gel analysis system was used to determine the urinary protein types in INS.Results Serum ApoE,TC,TG,HDL-C,LDL-C and ApoB in the observed group were significantly higher than those in the healthy controls(P<0.01).There was high blood ApoE level in 92% of INS cases,ApoE,TC,TG,LDL-C and ApoB were negatively related to serum total protein(TP),albumnin(Alb)(P<0.01),but was unrelated to 24-hour total urine protein(TUP).Blood ApoE in selected medium molecule urine protein group(SMUP) was significantly higher than those in non selected urine protein group(NSUP).Conclusion There are markable high ApoE level in children with INS.High ApoE are common in children with INS,so it is not the specific parameter to diagnose the lipoprotein glomerulopathy.Medium molecule proteinuria may be one of the important cause of high blood ApoE in children with INS.