儿童原发性肾病综合征VCAM-1、hs-CRP水平及与脂代谢的关系

目的　通过检测血管细胞黏附分子1（VCAM-1）及超敏C反应蛋白（hs-CRP）了解儿童原发性肾病综合征（PNS）脂代谢紊乱对血管内皮细胞功能、微炎症状态及凝血功能的影响。方法　选取符合PNS标准的患儿65例为病例组，选取性别、年龄与之匹配的健康体检儿童45例为对照组。分别应用酶联免疫吸附测定（ELISA）法及免疫比浊法测定病例组治疗前后及对照组血清中VCAM-1和hs-CRP的水平，应用特种蛋白分析仪测定2组24 h尿蛋白定量，并检测血浆白蛋白（ALB）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、载脂蛋白（Apo）A1、ApoB、脂蛋白a［LP（a）］、纤维蛋白原（Fb）及D二聚体水平。采用Pearson法分析上述指标与VCAM-1、hs-CRP的相关性。结果　病例组治疗前VCAM-1和hs-CRP水平明显高于对照组，治疗后VCAM-1和hs-CRP水平明显低于治疗前；血浆VCAM-1、hs-CRP与尿蛋白定量、血TG、TC、LDL-C、ApoB、LP（a）、Fb、D二聚体水平呈正相关，而与血清ALB、HDL-C呈负相关（P＜0.05）。结论　PNS患儿急性期VCAM-1、hs-CRP水平明显增高，监测血浆VCAM-1和hs-CRP水平可对PNS微炎症状态、内皮细胞损伤、高凝状态及血栓形成进行预测及评估。

Relationship between VCAM-1, hs-CRP and lipid metabolism in children with primary nephrotic syndrome

Objective　To understand the effect of lipid metabolism disorder on the function of vascular endothelial cells, microinflammatory state and coagulation function through the detection of VCAM-1 and hs-C-reactive protein (CRP)in children with primary nephrotic syndrome (PNS). Methods　Sixty-five children who met the PNS standard were selected as the case group, and 45 healthy children matched in gender and age were selected as the control group. The serum levels of VCAM-1 and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA) and immunoturbidimetry in PNS group and control group. The 24 hour urine protein quantity was measured by special protein analyzer in the two groups. The serum levels of albumin (ALB), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), ApoA1, ApoB, lipoprotein a [(LP(a)], fibrinogen (Fb) and D-dimer were also measured by special protein analyzer. Pearson method was used to detect urinary protein, blood levels of ALB, TG, TC, LDL-C, HDL-C, ApoA1, ApoB, LP(a)， Fb, and D-dimer and their relationship with VCAM-1 and hs-CRP. Results　The levels of VCAM-1 and hs-CRP were significantly higher before treatment in the case group than those in the control group. The levels of VCAM-1 and hs-CRP were significantly lower after hormone treatment than those before treatment in the case group. The blood levels of VCAM-1 and hs-CRP were positively correlated with urinary protein, serum levels of TG, TC, LDL-C, ApoB, LP(a)， Fb and D-dimer (P＜0.05). There was a negative correlation between blood levels of VCAM-1 and serum levels of ALB and HDL-C (P＜0.05). Conclusion　The significant increase of VCAM-1 and hs-CRP levels in PNS indicates that there is endothelial cell injury and micro inflammation in PNS children at acute stage. The level of VCAM-1 and hs-CRP can predict and evaluate the micro inflammatory state, endothelial cell injury, hypercoagulable state and thrombosis of PNS.