目的　研究难治性肾病综合征 (steroid- resistant idiopathic nephrotic syndrome,SRINS)患儿载脂蛋白 E基因多态性 ,为临床上正确选择合适的脂质代谢紊乱病例进行降脂治疗提供依据。方法　用酶法测定了 6 0例 SRINS患儿及 80例健康儿童血脂、脂蛋白、载脂蛋白 3种物质共 7个脂质代谢指标 ,用PCR- SSCP法检测载脂蛋白 E(apo E)基因型 ,并行肾穿刺活检术检查肾病综合征患儿病理类型。结果SRINS患儿存在明显脂质紊乱 ,与健康儿童比较差异有显著性 (P<0 .0 1) ,随诊半年后仍有绝大多数SRINS患儿存在明显脂质代谢紊乱。难治性肾病综合征 apoε2等位基因显著多于健康儿童 (P<0 .0 5 )。结论　 SRINS患儿脂质代谢紊乱持续的时间较长 ,这类患儿 ,尤其携带ε2等位基因者 ,更易发生进行性肾脏损害 ,动脉粥样硬化及冠心病。应考虑给这类患儿使用降脂药物 Objective To study the polymorphism of apolipoprotein E gene in children with steroid-resistant idiopathic nephrotic syndrome (SRINS) and provide evidence for the correct choice of lipid metabolism disorders in clinical practice. Methods Serum lipids, lipoproteins and apolipoproteins in 70 children with SRINS and 80 healthy children were assayed by enzyme-linked immunosorbent assay (ELISA) for the determination of 7 lipid metabolism parameters. The levels of apo E, Genotype, parallel renal biopsy to check the pathological type of children with nephrotic syndrome. Results There was a significant lipid disorder in SRINS children, which was significantly different from healthy children (P <0.01). After six months, there was still a significant lipid metabolic disorder in most SRINS children. Refractory nephrotic syndrome apoε2 allele was significantly more than healthy children (P <0. 05). Conclusion The lipid metabolic disorder in children with SRINS lasted longer. These children, especially those with ε2 allele, were more prone to progressive renal damage, atherosclerosis and coronary heart disease. Consideration should be given to such children with lipid-lowering drugs