原发性肾病综合征患儿血脂和尿蛋白与血压的关系研究

发布时间：2018-01-25 10:58

本文关键词： 原发性肾病综合征儿童血脂血压高血压分型诊治　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨不同血压类型的原发性肾病综合征(PNS)患儿的血脂、尿蛋白的差异及其与血压的相关性,拟为PNS患儿的基础诊疗提供理论基础。方法:选择2014年3月至2016年3月在我院住院的初治原发性肾病综合征患儿(年龄满1周岁至14周岁)101例,同时选取同期住院的上呼吸道感染的患儿61例,详细记录病史、测量体重、血压等,应用Cobas-8000全自动生化分析仪测定生化指标,包括胆固醇(CHO)、三酰甘油(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A(ApoA)、载脂蛋白B(ApoB),应用BECKMAN COULTER-AU5800全自动生化分析仪测定24h尿蛋白定量。并根据血压值分为4组,正常血压组(21例),单纯收缩期高血压组(18例),单纯舒张期高血压组(18例),双期高血压组(44例),将4组间的各项检测指标进行比较研究,并运用相关分析得出影响血压的相关因素。结果:经独立样本t检验,实验组CHO、TG、HDL、ApoA、Lp(a)、收缩压及舒张压均较对照组明显升高(P0.05),经独立样本秩和检验结果示实验组LDL、ApoB均较对照组明显升高(P0.05)。并将PNS患儿按血压分为四组,经单因素方差分析结果示各组患儿发病性别及年龄构成无明显差异(P0.05)。双相高血压组CHO、TG、LDL-C均高于其余3组(P0.05);ApoA在单纯收缩期高血压组明显高于其余3组(P0.05);四组比较,Lp(a)、HDL-C、ApoB比较未见明显差异(P0.05);双期高血压组24h尿蛋白定量明显高于其余3组(P0.05);单纯收缩期高血压组患儿24小时尿蛋白定量高于正常血压组(P0.05),而单纯舒张期高血压组较正常血压组无明显差异(P0.05)。经非参数秩和检验四组间比较:双相高血压组LDL-C值高于其余3组(P0.05);而其余各组比较均未见明显差(P0.05);ApoB值四组间比较未见明显差异(P0.05)。相关性分析:分别将收缩压及舒张压列为因变量,将CHO、TG、LDL-C、ApoA、24h尿蛋白定量列为自变量,应用pearson及spearman相关分析法,结果显示,CHO、TG、ApoA及24h尿蛋白定量与收缩压呈正相关,CHOL、TG、24h尿蛋白定量与舒张压呈正相关。结论:依据PNS患儿血脂代谢特点及不同类型血压特点,临床上有必要对PNS患儿血压进行动态监测,并且对血压高的患儿进行分型诊治有一定的临床价值,将PNS患儿高血压诊断标准细化,从而提高儿童PNS的诊疗水平,为国内儿童PNS的基础诊疗提供理论基础。
[Abstract]:Objective: to investigate the differences of blood lipid, urine protein and blood pressure in children with primary nephrotic syndrome (PNSs) with different blood pressure types. To provide theoretical basis for the basic diagnosis and treatment of children with PNS. Methods: children with primary nephrotic syndrome (aged from 1 to 14 years) who were hospitalized in our hospital from March 2014 to March 2016 were selected. 101 cases. At the same time, 61 children with upper respiratory tract infection in the same period were selected to record the history, measure body weight and blood pressure, and use Cobas-8000 automatic biochemical analyzer to measure biochemical indexes. These include cholesterol Cho, triglyceride (TGG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and apolipoprotein (ApoA). Apolipoprotein (ApoB) was measured by BECKMAN COULTER-AU5800 automatic biochemical analyzer and divided into 4 groups according to blood pressure. Normal blood pressure group (n = 21), systolic hypertension group (n = 18), diastolic hypertension group (n = 18), double-phase hypertension group (n = 44). The relative factors affecting blood pressure were obtained by correlation analysis. Results: the experimental group was tested by t test, and the experimental group was tested with CHOTGG HD-ApoA. Compared with the control group, the systolic blood pressure and diastolic blood pressure were significantly higher than that of the control group (P 0.05). The results of independent sample rank sum test showed that the LDL of the experimental group was higher than that of the control group. ApoB was significantly higher than that of the control group (P 0.05). According to the blood pressure, the children with PNS were divided into four groups. The results of univariate ANOVA showed that there was no significant difference in the sex and age composition of the children in each group, and the LDL-C levels in CHOU TGN in the bipolar hypertension group were higher than those in the other three groups (P 0.05). ApoA in the simple systolic hypertension group was significantly higher than that in the other three groups (P 0.05). There was no significant difference between the four groups in the comparison of HDL-Con ApoB between the four groups (P 0.05). The 24-hour urinary protein in the two phase hypertension group was significantly higher than that in the other three groups (P 0.05). The 24 hour urine protein quantity in simple systolic hypertension group was higher than that in normal blood pressure group (P0.05). However, there was no significant difference between the simple diastolic hypertension group and the normal blood pressure group (P 0.05). The LDL-C value of the bipolar hypertension group was higher than that of the other three groups by nonparametric rank sum test. However, there was no significant difference between the other groups (P 0.05). There was no significant difference in ApoB value among the four groups (P 0.05). Correlation analysis: systolic blood pressure and diastolic blood pressure were regarded as dependent variables respectively. 24 hours urine protein was quantified as independent variable. Pearson and spearman correlation analysis were used. The results showed that Cho TG. ApoA and 24h urinary protein were positively correlated with systolic blood pressure (SBP). Conclusion: according to the characteristics of blood lipid metabolism and different types of blood pressure in children with PNS, it is necessary to dynamically monitor blood pressure in children with PNS. And the diagnosis and treatment of high blood pressure of children with certain clinical value, PNS children with hypertension diagnosis criteria refined, thereby improving the level of diagnosis and treatment of children with PNS. To provide a theoretical basis for the basic diagnosis and treatment of PNS in children in China.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9

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