肾病综合征患儿血清胆红素水平的变化及意义

发布时间：2018-08-07 15:29

【摘要】：目的:肾病综合征(nephrotie syndrome,NS)是儿科临床上常见的肾脏疾病,发病率仅次于急性肾炎,患儿除肾脏本身病变外,高脂血症等也可导致心血管系统并发症。本文通过对我科收治的部分患儿的回顾性研究,分析血清胆红素在原发性肾病综合征患儿(primary nephrotie syndrome,PNS)体内的变化,并进一步分析引起胆红素变化的原因及意义。方法:收集山西医科大学第一医院儿科自2008年9月到2016年4月确诊的PNS患儿49例为肾病组,急性肾小球肾炎患儿30例为对照组;收集的临床资料包括血清总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DBIL)、间接胆红素(indirect bilirubin,IBIL),总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG),血白蛋白(albumin,ALB)及24h尿蛋白定量(24h urine proteinquantitation,24h Upr);应用SPSS17.0软件分析两组间胆红素差异及胆红素与血脂、24h Upr的关系。结果:(1)肾病组血清中TBIL、IBIL低于对照组;两组比较差异有统计学意义(P0.05);血清DBIL与对照组比较差异无统计学意义。(2)肾病组患儿按血脂正常和异常分为两组(TC、TG两项均在正常范围内即为血脂正常组),比较两组间胆红素的差异,血脂偏高组TBIL水平低于血脂正常组,两组间胆红素差异有统计学意义(P0.05)。血脂与胆红素经相关性分析无正负相关性。(3)肾病组TBIL与24h Upr经相关性分析(按血脂正常与异常),血脂正常组(P0.01;r=-0.517)无相关性;血脂异常组(P0.01;r=-0.562)呈负相关。结论:(1)NS患儿体内胆红素水平较对照组降低。(2)分析肾病组胆红素降低的原因,将NS患者依血脂正常和异常分组,血脂正常组胆红素高于血脂异常组,胆红素参与血脂代谢,可能对NS患儿心血管系统并发症的预防及治疗提供新的思路。(3)肾病组TBIL与24h Upr呈负相关(血脂异常组),血脂与胆红素无负相关性,提示血清低胆红素血症可能与大量蛋白尿导致胆红素随尿液流失有关。
[Abstract]:Objective: nephrotie syndrome (NS) is a common renal disease in pediatrics, the incidence of which is second only to acute nephritis. The changes of serum bilirubin in children with primary nephrotic syndrome (primary nephrotie syndrome) were analyzed retrospectively, and the causes and significance of the changes in bilirubin were analyzed. Methods: 49 children with PNS and 30 children with acute glomerulonephritis were collected from September 2008 to April 2016 in the first Hospital of Shanxi Medical University. Clinical data collected included total bilirubin (TB), direct bilirubin (DBIL), indirect bilirubin (IBIL), total cholesterol (TC), triglyceride (TG), serum albumin (Albumin) and 24 h urine protein (24 h Upr);). The relationship between serum lipids and serum bilirubin and 24 h Upr. Results: (1) Serum TBILIBIL in nephropathy group was lower than that in control group. The difference between the two groups was statistically significant (P0.05), and there was no significant difference between the serum DBIL and the control group. (2) the children in the nephropathy group were divided into two groups according to the normal blood lipid and abnormal blood lipids. The difference of bilirubin, The level of TBIL in hyperlipidemia group was lower than that in normal blood lipid group, and the difference of bilirubin between the two groups was statistically significant (P0.05). There was no positive or negative correlation between serum lipids and bilirubin. (3) in nephropathy group, there was no correlation between TBIL and 24 h Upr (according to normal and abnormal blood lipids), but there was no correlation between normal blood lipid group (P0.01r-0.517), and negative correlation was found in dyslipidemia group (P0.01r-0.562). Conclusion: (1) the level of bilirubin in NS group is lower than that in control group. (2) analyze the reason of bilirubin decrease in nephropathy group, group NS patients according to normal and abnormal blood lipids, bilirubin in normal blood lipid group is higher than that in dyslipidemia group, bilirubin is involved in lipid metabolism. It may provide a new idea for the prevention and treatment of cardiovascular complications in NS children. (3) in nephropathy group, TBIL is negatively correlated with 24 h Upr (dyslipidemia group), and there is no negative correlation between lipid and bilirubin. The results suggest that serum hypobilirubinemia may be related to the loss of bilirubin with urine loss caused by large amount of proteinuria.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9

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