Hyperlipidemic profiles during remission in childhood idiopathic nephrotic syndrome

Hyperlipidemia, an important characteristic of idiopathic nephrotic syndrome in children (NS), is usually observed during the active phase of the disease and disappears with the resolution of the proteinuria. However, persisting lipid anomalies during remission have been reported in a few studies and raise the question of the later development of atherosclerosis. Plasma lipid profiles in 25 children with NS at remission, with or without active prednisone treatment, were compared with those of an age-matched population. The results indicate that plasma total and LDL-cholesterol levels were above the 95(th) percentile for age and sex in 12 of the 25 patients (48%) with 7 of them having apolipoprotein B and triglyceride concentrations above the 95(th) percentile. Moreover, frequently relapsing children were more likely to have abnormal lipid profile during the remission. We conclude that close monitoring of lipid levels during the remission of the NS especially in those with frequent relapses, is necessary to select the high-risk patients.     

Maternal erythrocyte omega-3 and omega-6 fatty acids, and plasma lipid concentrations, are associated with habitual dietary fish consumption in early pregnancy

OBJECTIVES: We investigated the relationship between selected maternal erythrocyte omega-3 and omega-6 polyunsaturated fatty acids (PUFA) and plasma lipids in early pregnancy and reported habitual fish consumption during the periconceptional period. DESIGN AND METHODS: This cohort study included 923 pregnant women who reported periconceptional dietary habits and provided a blood sample before 20 weeks of gestation. PUFA was determined by gas chromatography and plasma lipids by standard enzymatic methods. Differences in erythrocyte PUFA and plasma lipid concentrations were estimated using linear regression. RESULTS: Mean erythrocyte eicosapentanoic acid and other PUFA content (%/total) were positively associated with frequency of self-reported fish consumption. Arachidonic acid was inversely related with frequent fish consumption (p trend <0.001). Women who consumed fish >twice/week had lower plasma triglyceride (-11.5 mg/dl) and higher HDL-cholesterol (+2.8 mg/dl) concentrations than women consuming fish 相似文献   

原发性肾病综合征与免疫球蛋白的关系研究

目的　探讨原发性肾病综合征患者血中免疫球蛋白的变化及临床意义。方法　采用免疫比浊法对334例原发性肾病综合征患者血中的免疫球蛋白进行测定并比较。结果　①原发性肾病综合征患者免疫球蛋白的变化在性别间无差异(P>0. 05)。②年龄<20岁组的IgA升高者明显高于其他年龄组(P<0. 01),IgG和IgM水平在各年龄组间无差异(P>0. 05)。③血中IgG降低与尿蛋白含量有关,尿蛋白含量越大,其降低越明显。④血中IgG降低与血浆白蛋白有关,血浆白蛋白水平越低,其IgG降低越明显。IgA和IgM在各组间无差异。⑤IgA肾病患者IgA升高的比例明显高于系膜增生性肾炎和膜增生性肾炎(P<0. 01),IgM肾病患者中IgM升高者明显高于IgA肾病和系膜增生性肾小球肾炎患者(P<0. 01);IgG的降低在各组间无差异(P>0. 05)。⑥因感染而复发者血中IgG降低明显高于未复发组(P<0. 05)。结论　原发性肾病综合征患者常存在免疫球蛋白的异常,IgG降低与尿蛋白的多少有关;同时易合并感染。     

2型糖尿病患者合并代谢综合征空腹血浆游离脂肪酸的变化及其相关性分析

目的探讨2型糖尿病（T2DM）患者空腹游离脂肪酸（FFA）水平与代谢综合症（MS）的关系。方法按是否合并MS将T2DM患者分为MS组（A组150例）和非MS组（B组62例），与正常对照组（c组44例）分别比较空腹FFA水平，并进行相关性分析。结果A组较对照组FFA明显升高[（0.60±0.26）mmol／L vs（0.43±0.20）mmol／L，P〈0.01]，较B组FFA也明显升高[（0.60±0.26）mmol／L vs（0.50±0.i8）mmol／l，P〈0.01]，将腰围、总胆固醇（TCH）、低密度脂蛋白（LDL）、体重指数（BMI）、糖化血红蛋白（HbAlc）、年龄、性别进行多元回归分析显示：TG、BMI、LDL是影响血浆FFA水平的独立危险因素。结论T2DM合并MS人群空腹游离FFA水平明显升高，而FFA水平与TG、BMI等多种因素有关。     

Effect of hypoalbuminemia on the increased serum cholesteryl ester transfer protein concentration in children with idiopathic nephrotic syndrome

OBJECTIVES: To examine the alteration of cholesteryl ester transfer protein (CETP) mass with the regression of albumin level in childhood nephrotic syndrome (NS) in order to clarify the effect of albumin on CETP in NS. DESIGN AND METHODS: Serum concentrations of CETP, kidney parameters and lipid traits were determined in 110 children with idiopathic NS and 150 control subjects. Of the NS patients, 69 children with an active phase formed group 1, and 41 in remission formed group 2. RESULTS: Group 1 presented severe hypoalbuminemia and hyperlipidemia, while group 2 exhibited marked recovery in both serum albumin level and lipid/lipoprotein profile. CETP concentration was significantly higher in group 1 (7.36+/-2.43 mg/L, compared with controls 3.38+/-1.83 mg/L, P<0.0001), and declined to within normal range in group 2 (2.91+/-1.77 mg/L). CETP concentration had a strong inverse correlation with serum albumin level (r=-0.688, P<0.0001) in NS patients. Furthermore, when multiple linear regression analysis was performed, in which albumin, proteinuria, lipid traits, and prednisone dose were treated as independent variables, albumin was the only variable showing a significant correlation with CETP in the NS patients (R(2)=0.587, beta=-0.475, P<0.0001). CONCLUSIONS: The results demonstrate that the decreased serum albumin level might be a main determinant of the increased CETP concentration in pediatric NS.     

Bactericidal activity of ascitic fluid in patients with nephrotic syndrome

Patients with nephrotic syndrome are unusually susceptible to infections, including primary peritonitis. In this study, we have evaluated nine adult patients with nephrotic syndrome and ascites for ascitic fluid bactericidal activity, complement and immunoglobulin concentrations. Eight of nine patients had diminished ascitic fluid bactericidal activity while twelve control peritoneal fluids had normal bactericidal activity. Complement (C3 and C4) and immunoglobulin (IgG and IgM) concentrations were significantly lower in nephrotic syndrome ascitic fluid than peritoneal fluid from normal subjects. These findings may explain the high occurrence rate of primary peritonitis in nephrotic patients with ascites.     

儿童难治性肾病综合征的治疗进展

难治性肾病综合征(RNS)是临床上原发型肾病综合征(PNS)中频复发型(FRNS)、激素依赖型(SDNS)和激素耐药型(SRNS)肾病综合征的总称。按其对激素治疗是否敏感及尿蛋白转阴情况,可将原发性肾病综合征分为频复发型、激素依赖型和激素耐药型。临床观察发现80%⁹0%的PNS患儿经初始激素治疗即可获完全缓解,但有76%90%的PNS患儿经初始激素治疗即可获完全缓解,但有76%⁹3%的患儿复发,并超过半数的激素耐药型肾病儿童在10年内发展为终末期肾病(ESRD)。该文章就近年来关于儿童RNS临床治疗的方法作一综述。     

肾病综合征患者血清甲状腺激素水平临床观察

目的：观察肾病综合征（NS）患者继发性甲状腺激素水平下降的发生率，并探讨其发病机制。方法：分别用全自动免疫分析仪和全自动生化分析仪检测52例中、重度水肿的NS患者治疗前后及22例原发性甲状腺功能减退症患者、18例健康者的血清FT3，FT4、促甲状腺激素（TSH）、总蛋白、白蛋白及尿总蛋白、白蛋白水平，并分析其血清甲状腺激素与血、尿蛋白间的相关性。结果：52例NS患者中41例甲状腺激素水平较正常值有不同程度下降，其中FT3为（1．72±0．59）pg／mL，FT4为（8．63±1．92）pg／mL，TSH（7．32±3．05）μIU／mL。NS组患者治疗前血清FT3与血清白蛋白水平呈正相关（r=0．387，t=2．523，P〈0．05），FT4与血清白蛋白水平呈正相关（r=0．359，t=2．369，P〈0．05），与尿蛋白（尿总蛋白及尿白蛋白）间无相关性：TSH与血清白蛋白及尿蛋白间无相关性。结论：中、重度水肿的NS患者易出现继发性甲状腺激素水平下降，甲状腺激素改变水平与血清白蛋白水平相关。     

小剂量尿激酶联合激素和坎地沙坦治疗中重型肾病综合征

目的观察小剂量尿激酶联合激素和坎地沙坦治疗中重型肾病综合征(NS)的临床疗效和安全性。方法选择临床确诊为原发性NS的患者25例,尿蛋白≥3.5 g/24 h,血肌酐(Scr)≤265μmol/L,随机分为治疗组(UK组,n=13)和对照组(control组,n=12),治疗组接受尿激酶、激素和坎地沙坦治疗,对照组接受激素和坎地沙坦治疗,观察期限为4个月。结果①临床缓解率:UK组临床完全缓解率和部分缓解率分别为53.8%和38.5%,control组分别为25.0%和58.3%。两组疗效比较差异有统计学意义(P0.05)。②与治疗前相比UK组血肌酐明显下降〔(117±23)μmo/L vs(96±12)μmol/L,P0.05〕,control组血肌酐则变化不大〔(121±23)μmo)/L vs(123±19)μmol/L,P0.05〕。③两组患者尿蛋白均较治疗前下降,治疗0、2、4个月时UK组尿蛋白分别为(4.38±0.62)g/24 h、(1.59±0.26)g/24 h、(1.15±0.17)g/24 h,control组分别为(4.36±0.56)g/24 h、(2.24±0.29)g/24 h、(1.53±0.21)g/24 h,UK组尿蛋白下降快于control组,差异有统计学意义(P0.05)。结论小剂量尿激酶联合激素和坎地沙坦能有效改善中重型NS患者的肾功能,减少蛋白尿,治疗效果显著。     

ω-3多不饱和脂肪酸对急性呼吸窘迫综合征患者血清炎症介质的影响

目的观察ω-3多不饱和脂肪酸对急性呼吸窘迫综合征（ARDS）患者血清炎症介质释放的影响。方法将42例ARDS患者按随机化数字表原则,分为对照组和研究组,每组各21例。两组患者均接受等氮、等热量的全胃肠外营养,热量25kcal·kg^-1·d^-1、氮摄入量0.2g/kg,其中研究组加用ω-3多不饱和脂肪酸（0.2g·kg^-1·d^-1）,共7d。分别检测治疗前和治疗后第1、3、7天血清白细胞介素1（IL-1）、IL-6、肿瘤坏死因子α（TNF-α）水平,并观察动脉血氧分压和氧合指数的变化。结果加用ω-3多不饱和脂肪酸治疗后,研究组在不同时间点IL-1、IL-6、TNF-α均明显低于对照组（P均〈0.05）;两组患者动脉血氧分压和氧合指数均有改善,且研究组氧合指数较高,差异均有统计学意义（P均〈0.05）。结论ω-3多不饱和脂肪酸可降低ARDS患者IL-1、IL-6、TNF-α水平,在一定程度上有利于ARDS患者呼吸功能的恢复。     

Rituximab-induced IgG hypogammaglobulinemia in children with nephrotic syndrome and normal pre-treatment IgG values

BACKGROUND In paediatric patients with complicated nephrotic syndrome(NS), rituximab(RTX) administration can induce persistent IgG hypogammaglobulinemia among subjects showing low basal immunoglobulin G(IgG) levels.AIM To evaluate the effect of RTX on IgG levels and infections in patients with complicated NS and normal basal IgG levels.METHODS We consecutively enrolled all patients with complicated NS and normal basal IgG levels undergoing the first RTX infusion from January 2008 to January 2016. Basal IgG levels were dosed after 6 wk of absent proteinuria and with a maximal interval of 3 mo before RTX infusion. The primary outcome was the onset of IgG hypogammaglobulinemia during the follow-up according to the IgG normal values for age [mean ± standard deviation(SD)].RESULTS We enrolled 20 patients with mean age at NS diagnosis of 4.2 ± 3.3 years. The mean age at the first RTX infusion was 10.9 ± 3.5 years. Eleven out of twenty patients(55%) developed IgG hypogammaglobulinemia. None of these patients showed severe or recurrent infections. Only one patient suffered from recurrent acute otitis media and underwent substitutive IgG infusion. Three patients undergoing only the two "starting doses" experienced normalization of IgG levels. Using Kaplan-Meier analysis, the cumulative proportion of patients free of IgG hypogammaglobulinemia was 57.8% after the first RTX dose, 51.5% after the third dose, 44.1% after the fourth dose, and 35.5% after the fifth dose.CONCLUSION RTX can induce IgG hypogammaglobulinemia in patients with pre-RTX IgG normal values. None of the treated patients showed severe infections.     

高效液相色谱法分析人血清游离脂肪酸谱

建立了一种用高效液相色谱（ＨＰＬＣ）法分析人血清游离脂肪酸（ＦＦＡ）谱的方法。结果选定用２－硝基苯肼盐酸盐作衍生剂，在Ｃ＿（１８）反相柱上分离，乙腈－水作为流动相，正十六酸作内标，紫外－可见光吸收波长４０６ｎｍ。其回收率为８９．８％～１０４．４％，组内和组间变异系数分别小于７．０２％和９．１７％，血样直接一次衍生，色谱分离４０分钟内完成。同时分析了正常青年组和中老年组血清ＦＦＡ谱，两组之间差异无显著意义。     

以家庭为中心的护理模式在原发性肾病综合征患儿中的应用效果

目的:探讨以家庭为中心的护理模式在原发性肾病综合征（PNS）患儿护理中的应用效果。方法:采用便利抽样法,选取2018年1月—2019年12月南京医科大学附属儿童医院收治的120例PNS患儿作为研究对象,按照住院顺序分为观察组和对照组,各60例。对照组采用常规护理模式,观察组在对照组基础上采用以家庭为中心的护理模式。比较...     

肾病综合征患者蛋白质及脂类代谢变化的临床分析

目的探讨原发性肾病综合征(NS)与继发性NS患者蛋白质及脂类代谢变化规律,寻找灵敏准确、实用价值较大的血清蛋白质及脂类实验室检测指标。方法用醋酸纤维素膜电泳法对52例原发性NS与40例继发性NS分别进行血清蛋白检测,分析其血清蛋白电泳图谱变化特征。用免疫透射比浊法(IT)测定血清免疫球蛋白IgGI、gA、IgM含量,同时进行血清脂蛋白(LP)琼脂糖凝胶电泳检测,分析LP电泳图谱变化特征,并用IT法测定这两类患者血清载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)含量。对所收集的血清标本用酶学方法测定甘油三酯(TG)、总胆固醇(TC)含量。结果与对照组相比,原发性NS组出现血清IgG、白蛋白(A)、γ-球蛋白及白蛋白/球蛋白(A/G)比值的明显降低,而血清α2-球蛋白及β-球蛋白明显升高。在继发性NS组,血清A、A/G比值显著下降,而α2-球蛋白、β-球蛋白、γ-球蛋白明显升高(P<0.01)。与对照组相比,两类NS均表现为血清低密度脂蛋白(LDL)、ApoB、TG、TC的明显升高(P<0.01)。结论无论何类NS患者,体内都存在明显的蛋白质与脂类代谢紊乱,这些实验室检测指标在两类NS时不同的变化规律具有重要临床应用价值。     

肾病综合征血脂代谢紊乱与血胆红素的关系研究

目的 初探肾病综合征(NS)的高脂血症的发病机制与其血胆红素的关系.方法 患儿禁食6h,空腹抽取静脉血检测总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、甘油三酯(TG)、总胆固醇(CHO)、载脂蛋白B(APOB)、低密度脂蛋白(LDL-C)、载脂蛋白(a) (APOA).结果 NS组血清中TBIL、DBIL、IBIL、均低于正常对照组和肾炎组;NS组血清中TG、CHO、LDL、APOB、LDL-C、APOA均高于正常对照组和肾炎组(P＜0.01);胆红素与TG、CHO采用相关性分析:TBIL与CHO、TG呈负相关(r=-0.55、P＜0.01;r=-0.41,P＜0.01);DBIL与CHO、TG呈负相关(r=-0.61,P＜0.01;r=-0.45,P＜0.01);IBIL与CHO、TG呈负相关(r=-0.52,P＜0.01;r=-0.36,P＜0.01).结论 胆红素水平与NS患者血脂的高低呈负相关,NS的血胆红素水平明显偏低.     

整体护理在肾病综合征患者中的应用及效果观察

目的:探讨整体护理在肾病综合征(NS)患者中的应用方法及临床效果.方法:将82例NS患者随机分为观察组和对照组各41例,观察组给予整体护理,对照组给予常规护理.比较两组护理质量评分、并发症发生率及病情变化情况.结果:观察组护理质量评分高于对照组(P<0.05),并发症发生率低于对照组(P<0.01);随访3个月,观察组血白蛋白和24 h尿蛋白定量等指标变化均优于对照组(P<0.05,P<0.01).结论:整体护理可以明显改善NS患者病情,减少并发症发生,提高护理质量,值得临床推广.     

原发性肾病综合征和紫癜性肾炎患儿营养状况分析

目的比较分析肾病综合征和紫癜性肾炎患儿的膳食摄入量和营养不良指标,以制订其营养治疗方案。方法记录50例肾病综合征和50例紫癜性肾炎患儿的膳食营养素摄入量3 d,同时测定两组患儿营养评价相关指标,经SPSS 13.0软件统计学分析。结果两组患儿在能量、脂肪及钙、铁、锌、维生素A的摄入水平明显低于中国居民膳食营养素参考摄入量(DRIs),蛋白质和维生素E则明显超过推荐量。紫癜性肾炎组患儿在能量、脂肪、钠、钾、铁、维生素A和胆固醇的平均摄入量明显低于肾病综合征组患儿(P<0.01)。肾病综合征组在总蛋白、白蛋白和血钙检测值显著低于紫癜性肾炎组(P<0.01)。结论肾病综合征和紫癜性肾炎患儿的主要营养素摄入量不足,能量和蛋白质营养不良的问题较为突出,应尽早干预。     

肾病综合征患者出院准备度现状及影响因素分析

目的:调查肾病综合征患者的出院准备度情况,并分析其相关的影响因素.方法:采用一般资料调查表、出院准备度量表和出院指导质量量表对250例肾病综合征患者进行横断面调查.结果:共回收有效问卷226份,出院准备度总得分为(156.83±23.82)分,项目均分为(7.13±1.08)分.多元线性回归分析显示,患者的个人月收入、...     

肾上腺白质营养不良症血浆中长碳链脂肪酸的测定

肾上腺白质营养不良症是由过氧化体酶缺陷引起的遗传性代谢病，其临床症状不足以确诊。血浆中长碳链脂肪酸是鉴定肾上腺白质营养不良症的主要生化指标。为配合临床检验，建立了血浆中长碳链脂肪酸的测定方法，将血浆用直接酯交换法处理，用气相色谱质谱联用确证血浆中正二十二酸甲酯、正二十四酸甲酯和正二十六酸甲酯的存在，再用气相色谱法测定血浆中正二十四酸甲酯与正二十二酸甲酯、正二十六酸甲酯与正二十二酸甲酯的峰面积比值，应用建立的方法测定了８份血浆样品，结果表明肾上腺白质营养不良症患者血浆中正二十四酸甲酯与正二十二酸甲酯（Ｃ＿（２４：０）／Ｃ＿（２２：０））、正二十六酸甲酯与正二十二酸甲酯（Ｃ＿（２６：０）／Ｃ＿（２２：０））的比值比正常值高。