儿童难治性肾病高脂血症的治疗研究

目的：研究儿童难治性肾病脂质代谢紊乱的特点及卡托普利和黄芪对其的治疗作用。方法：以42例正常儿童为对照组，选择难治性肾病患儿60例，随机分为常规治疗组（A组）、卡托普利组（B组）、卡托普利和黄芪联合治疗组（C组），每组20例。于治疗前、治疗后8周和12周查血脂各项指标观察疗效。结果：（1）60例患儿血清总胆固醇（TC）、甘油三酯（TG）、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apoA1及载脂蛋白apoB100均高于对照组（P〈0．01）。（2）治疗8周、12周末B组、C组1、C、TG、LDL-C均低于治疗前（P〈0．01），A组与治疗前相比差别无统计学意义（P〉0．05）。治疗12周末仅C组与8周末相比有降低（P〈0．05）。结论：（1）难治性肾病患儿，存在明显的脂代谢紊乱。（2）卡托普利和黄芪联合治疗可有效地减轻高脂血症，从而减轻高脂血症继发性肾损害。

The Treatment Research on Childhood Refractory Nephrotic Syndrome and Hyperlipidemia

Objective: To study the characteristics of lipid metabolism in childhood refractory nephrotic syndrome and the treatment effects of captopril and Astragalus to childhood refractory nephrotic syndrome and hyperlipidemia. Methods: Forty-two healty children were enrolled as the control and sixty cases of childhood refractory nephrotic syndrome were randomly divided into three groups:the conventional group(group A), the captopril-treated group(group B) and the captopril and Astragalus combination treatment group(group C) and twenty patients were assigned to each group. Blood-lipid figures were determined before treatment and eight, twelve weeks after the treatment to evaluate the effect. Results: (1)The levels of serum TC,TG,LDL-C,HDL-C, apoAI, apoB100 in all sixty patients with refractory nephrotic syndrome increased remarkably compared with the control group (P < 0.01).(2)The levels of serum TC,TG,LDL-C decreased (P < 0.01) at the end of eight and twelve weeks after the treatment in group B and group C compared with those before treatment.The figure difference was not statistically significant in group A compared with pretreatment(P > 0.05). The figures had decrease at the end of twelve weeks after the treatment compared with those at the end of eight weeks only in group C (P < 0.05). Conclusion:(1)Obviouse abnormality of lipid is seen in childhood refractory nephrotic syndrome. (2)Combination of captopril and astragalus treatment can reduce severe hyperlipidemia so that prevent the seconday renal injury in these children.