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目的观察原发性肾病综合征(PNS)患儿颈动脉结构和功能改变,并将之作为动脉粥样硬化(AS)的早期标志物进行分析研究。方法对122例PNS患儿(疾病活动期组82例和缓解期组40例)和正常儿童(正常对照组)40例进行颈动脉超声检查,同时测定受试者血清白蛋白、血脂、24 h尿蛋白定量。运用方差分析、Spearman秩相关分析、多元逐步回归分析等统计学方法对数据进行分析。结果疾病活动期组PNS患儿颈动脉内中膜厚度(cIMT)、颈动脉僵硬度系数(β)、平均管壁横截面积(WCSA)高于正常对照组(P均<0.05);血管壁运动度(△D)小于正常对照组(P<0.05)。相关分析显示cIMT与疾病反复次数呈正相关(r=0.29,P<0.01)。多元逐步回归分析显示,cIMT与总胆固醇、脂蛋白a独立相关(R~2=0.22,β=0.01,P<0.01;β=0.03,P=0.02)。结论 PNS患儿存在颈动脉结构及弹性功能改变,其发生AS的风险增加。cIMT可用来预示PNS患儿发生AS的潜在风险,且与PNS脂质代谢紊乱及疾病反复有关。
Objective To observe the changes of carotid artery structure and function in children with primary nephrotic syndrome (PNS), and analyze the carotid artery as an early marker of atherosclerosis (AS). Methods Totally 122 cases of PNS (82 active disease group and 40 remission group) and 40 normal children (normal control group) underwent carotid artery ultrasonography and serum albumin, Urinary protein quantitation. The data were analyzed using statistical methods such as analysis of variance, Spearman rank correlation analysis and multiple stepwise regression analysis. Results The carotid intima-media thickness (CIMT), carotid artery stiffness (β) and average wall area (WCSA) in active disease group were significantly higher than those in normal control group (P <0.05) The degree of exercise (△ D) was less than that of the normal control group (P <0.05). Correlation analysis showed that cIMT was positively correlated with the number of repeated illness (r = 0.29, P <0.01). Multivariate stepwise regression analysis showed that cIMT was independently associated with total cholesterol and lipoprotein (R ~ 2 = 0.22, β = 0.01, P <0.01; β = 0.03, P = 0.02). Conclusion There is a change of carotid artery structure and elasticity in children with PNS, and the risk of developing AS is increased. cIMT can be used to predict the potential risk of developing AS in children with PNS and is related to the disturbance of PNS lipid metabolism and disease recurrence.