原发性肾病综合征患儿脂肪因子的表达及与高脂血症相关性研究

Expression of adipokines in children with primary nephrotic syndrome and its association with hyperlipidemia

摘要:

目的 探讨原发性肾病综合征（primary nephrotic syndrome，PNS）患儿治疗前后脂肪因子的表达变化及其与血脂的相关性，以及脂肪因子在PNS患儿高脂血症中的作用。 方法 选取2015年3月至2018年3月确诊为PNS初发或激素停药6个月以上复发的PNS患儿90例为研究对象，另选取同期行健康体检的儿童30例为对照组。分别采集PNS患儿激素治疗前（活动期）及4周激素治疗尿蛋白转阴后（缓解期），以及对照组儿童静脉血，采用酶联免疫吸附试验检测脂肪因子水平，使用自动生化仪分析血脂水平。 结果 PNS患儿活动期、缓解期血网膜素（omentin-1）水平显著低于对照组，PNS患儿活动期血omentin-1水平低于缓解期（P<0.001）；PNS患儿活动期血趋化素水平高于缓解期及对照组（P<0.001）。PNS患儿活动期血浆致动脉粥样硬化指数、致动脉粥样硬化系数（atherogenic coefficient，AC）、castelli危险指数（castelli risk index，CRI）-1、CRI-2、非高密度脂蛋白高于缓解期及对照组，PNS患儿缓解期血浆致动脉粥样硬化指数、AC、CRI-1、非高密度脂蛋白高于对照组（P<0.001）。PNS患儿缓解期血清总胆固醇、三酰甘油、高密度脂蛋白（high-density lipoprotein，HDL）、低密度脂蛋白、载脂蛋白（apolipoprotein，apo）A、apoB水平均高于对照组（P<0.01）。PNS患儿血omentin-1治疗前后比值与HDL治疗前后比值、24 h尿蛋白定量治疗前后比值、HDL/apoA治疗前后比值呈正相关，与AC治疗前后比值、CRI-1治疗前后比值呈负相关（P<0.05）。低网膜素组PNS患儿活动期CRI-1、CRI-2、AC、apoB/apoA水平高于高网膜素组（P<0.05）。 结论 omentin-1可能与儿童PNS的疾病活动、血脂紊乱、蛋白尿机制有关。血脂比值可能在监测PNS患儿早期心血管风险方面比传统血脂指标更有效。

Abstract:

Objective To study the expression of adipokines in children with primary nephrotic syndrome (PNS) before and after treatment and its correlation with blood lipids, as well as the role of adipokines in PNS children with hyperlipidemia. Methods A total of 90 children who were diagnosed with incipient PNS or recurrence of PNS after corticosteroid withdrawal for more than 6 months were enrolled as subjects. Thirty children who underwent physical examination were enrolled as the control group. Venous blood samples were collected from the children in the control group and the children with PNS before corticosteroid therapy (active stage) and after urinary protein clearance following 4 weeks of corticosteroid therapy (remission stage). ELISA was used to measure the levels of adipokines. An automatic biochemical analyzer was used to measure blood lipid levels. Results Compared with the control group, the children with PNS had a significantly lower level of omentin-1 in both active and remission stages, and their level of omentin-1 in the active stage was significantly lower than that in the remission stage (P<0.001). For the children with PNS, the level of chemerin in the active stage was significantly higher than that in the remission stage, and the children with PNS in the active stage had a significantly higher level of chemerin than the control group (P<0.001). For the children with PNS, atherogenic index of plasma, atherogenic coefficient (AC), castelli risk index-1 (CRI-1), castelli risk index-2 (CRI-2), and non-high-density lipoprotein in the active stage were significantly higher than those in the remission stage (P<0.001), and these indices in the children with PNS in the active stage were significantly higher than those in the control group (P<0.001). The children with PNS in the remission stage had significantly higher atherogenic index of plasma, AC, CRI-1, and non-high-density lipoprotein than the control group (P<0.001). Compared with the control group, the children with PNS in the remission stage had significantly higher serum levels of total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, apolipoprotein B, and apolipoprotein A (P<0.01). In the children with PNS, the ratio of omentin-1 before and after corticosteroid therapy was positively correlated with that of high-density lipoprotein, 24-hour urinary protein excretion, and high-density lipoprotein/apolipoprotein A before and after treatment, and it was negatively correlated with the ratio of AC and CRI-1 before and after treatment (P<0.05). The PNS children with low omentin-1 levels in the active stage had significantly higher levels of CRI-1, CRI-2, AC, and apolipoprotein B/apolipoprotein A ratio than those with high omentin-1 levels (P<0.05). Conclusions Omentin-1 may be associated with disease activity, dyslipidemia, and proteinuria in children with PNS. Blood lipid ratios may be more effective than traditional blood lipid parameters in monitoring early cardiovascular risk in children with PNS.