Mahmud S, Jahan S, Hossain M M
Paediatric Nephrology, Rajshahi Medical College, Rajshahi, Bangladesh.
Mymensingh Med J. 2011 Jul;20(3):402-6.
The objective of this study was to correlate hyperlipidemia during initial remission of nephrotic child with relapse. This observational prospective study was carried out among 26 children, between 1 to 8 years age with first attack idiopathic nephrotic syndrome, who was seen at Paediatric Nephrology Department of BSMMU and Paediatric Nephrology Department, NIKDU, from December'2005 to August'2006 and were followed-up for at least 6 months after initial attack. Twenty two age and sex matched hospitalized children, suffering from non-renal diseases, were enrolled as controls. Fasting blood samples for lipid profile were taken at the time of diagnosis of both cases and controls and also during remission of cases only. These patients were divided into two groups based on serum lipid profile during remission. Group-I consisted 16 patients who had normal lipid profile during remission and Group-II consisted 10 patients who had abnormal lipid profile during remission. Both Groups I & II had higher mean levels of serum cholesterol, LDL, TG and Lp(a) than those of controls during initial diagnosis. Between two groups on remission, Group-II patients showed higher mean serum cholesterol (332.9±105.19 mg/dL vs. 183.13±16.89 mg/dL; p<0.001), serum LDL (252±101.67 mg/dL vs. 119.19±21.33mg/dL; p<0.001), and serum TG (182.8±73.83 mg/dL vs. 93.31±20.95 mg/dL; p<0.001). Five patients out of 10 patients of Group-II (19% of total case) developed subsequent relapse within 6 months follow-up. Among the relapsers, mean cholesterol (334±46 vs. 232±34 mg/dL; p<0.05) was significantly higher than that of non-relapsers of Group-II patients. On the other hand, no patient of Group-I developed relapse within 6 months follow-up. It may be concluded from this study that hyperlipidemia in general at remission, specifically serum total cholesterol, may be regarded as predictor of relapse in childhood idiopathic nephrotic syndrome.
本研究的目的是探讨肾病患儿初始缓解期高脂血症与疾病复发之间的关联。本观察性前瞻性研究共纳入了26例年龄在1至8岁之间、首次发作特发性肾病综合征的患儿，这些患儿于2005年12月至2006年8月期间在孟加拉国谢赫穆吉布医学大学儿科肾脏病科和孟加拉国国立肾脏疾病研究所儿科肾脏病科就诊，并在首次发作后至少随访6个月。另外选取了22例年龄和性别匹配的患有非肾脏疾病的住院患儿作为对照。在病例组和对照组诊断时以及仅在病例组缓解期采集空腹血样进行血脂检测。根据缓解期血脂情况将这些患者分为两组。第一组有16例患者在缓解期血脂正常，第二组有10例患者在缓解期血脂异常。在初始诊断时，第一组和第二组患者的血清胆固醇、低密度脂蛋白、甘油三酯和脂蛋白(a)的平均水平均高于对照组。在缓解期，两组之间比较，第二组患者的血清总胆固醇平均水平更高（332.9±105.19mg/dL vs. 183.13±16.89mg/dL；p<0.001），血清低密度脂蛋白水平更高（252±101.67mg/dL vs. 119.19±21.33mg/dL；p<0.001），血清甘油三酯水平更高（182.8±73.83mg/dL vs. 93.31±20.95mg/dL；p<0.001）。第二组的10例患者中有5例（占总病例数的19%）在6个月的随访期内出现了疾病复发。在复发患者中，胆固醇平均水平（334±46 vs. 232±34mg/dL；p<0.05）显著高于第二组未复发患者。另一方面，第一组患者在6个月的随访期内均未复发。从本研究可以得出结论，一般来说，缓解期高脂血症，特别是血清总胆固醇，可被视为儿童特发性肾病综合征复发的预测指标。
