Tao Min, Wang Hai-Ping, Sun Jing, Tian Jing
Department of Nephrology, Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong 250021, China.
Chronic Dis Transl Med. 2020 Apr 10;6(3):182-187. doi: 10.1016/j.cdtm.2020.03.002. eCollection 2020 Sep.
Nephrotic syndrome is a relatively common clinical disease. Associated dyslipidemia is a risk factor for the occurrence and development of cardiovascular and renal diseases that might gradually develop into atherosclerosis, glomerulosclerosis or tubulointerstitial injury. It also confers an elevated risk of complications such as thromboembolism. If not properly controlled over the long term, dyslipidemia will become a key factor in a poor prognosis. Furthermore, dyslipidemia correlates with an increase in hepatic compensatory synthetic lipoprotein levels and a decrease in lipoprotein clearance, which can be sourced to the downregulation of hepatic and lipoprotein lipase activities in endothelial cells, muscle, and adipose tissue, and clinically characterized as hypertriglyceridemia or hypercholesterolemia. However, further investigations into the mechanism(s) of dyslipidemia are needed, with the resultant detailed perspectives and analyses substantially aiding the further development of treatment guidelines. Currently, statins represent the most popular type of pharmaceutical intervention because they lower hepatic cholesterol production and promote the absorption of low-density lipoprotein-cholesterol from the bloodstream, followed by second-line and other potential therapies to regulate the expression of specific receptors.
肾病综合征是一种相对常见的临床疾病。相关的血脂异常是心血管疾病和肾脏疾病发生及发展的危险因素,这些疾病可能会逐渐发展为动脉粥样硬化、肾小球硬化或肾小管间质损伤。它还会增加血栓栓塞等并发症的风险。如果长期得不到有效控制,血脂异常将成为预后不良的关键因素。此外,血脂异常与肝脏代偿性合成脂蛋白水平升高和脂蛋白清除率降低相关,这可能源于肝脏和内皮细胞、肌肉及脂肪组织中脂蛋白脂肪酶活性的下调,临床上表现为高甘油三酯血症或高胆固醇血症。然而,需要进一步研究血脂异常的机制,由此得出的详细观点和分析将极大地有助于治疗指南的进一步完善。目前,他汀类药物是最常用的药物干预类型,因为它们可降低肝脏胆固醇生成并促进血液中低密度脂蛋白胆固醇的吸收,其次是二线及其他潜在疗法来调节特定受体的表达。