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目的观察辛伐他汀治疗难治性肾病综合征(RNS)患儿高脂血症的疗效及其对预后的影响。方法对在本科住院的27例RNS患儿应用辛伐他汀(年龄<10岁,0.3 mg.kg-1.d-1;≥10岁,10 mg.d-1)降脂治疗2周,检测其治疗前后血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、极低密度脂蛋白(VLDL)、PLT、ALT、SCr变化,并观察其临床不良反应情况。结果辛伐他汀干预前,TC为(10.68±4.23)mmol.L-1、PLT为(155.21±34.43)×109L-1、HDL为(1.46±0.61)mmol.L-1、VLDL为(2.47±1.31)mmol.L-1、LDL为(6.74±3.96)mmol.L-1、TG为(4.56±1.83)mmol.L-1、ALT为(24.11±6.15)IU.L-1、SCr为(91.32±6.15)μmol.L-1。辛伐他汀干预1周后TC为(9.36±3.46)mmol.L-1,与干预前比较,差异有统计学意义(P<0.05),PLT为(123.34±31.32)×109L-1、TG为(3.03±0.74)mmol.L-1、VLDL为(1.36±0.33)mmol.L-1、LDL为(6.21±3.21)mmol.L-1、HDL为(1.82±0.90)mmol.L-1、ALT为(25.32±4.14)IU.L-1、SCr为(94.54±6.43)μmol.L-1,与干预前比较,差异均无统计学意义(Pa>0.05)。辛伐他汀干预2周后TC为(7.28±2.01)mmol.L-1、PLT为(86.65±34.23)×109L-1、TG为(2.36±1.16)mmol.L-1、VLDL为(1.25±0.99)mmol.L-1、LDL为(4.21±2.01)mmol.L-1、HDL为(2.23±0.93)mmol.L-1,与干预前比较,差异均有统计学意义(Pa<0.05),ALT为(25.31±5.14)IU.L-1、SCr为(94.53±6.23)μmol.L-1,与干预前比较差异均无统计学意义(Pa>0.05)。2例患儿服药后出现胃肠不适、1例患儿出现一过性ALT升高,该3例患儿停用辛伐他汀1周后均恢复正常,无其他不良反应。结论辛伐他汀干预能使RNS高脂血症缓解,其高凝状态亦明显改善,并能够使病情缓解,改善预后,同时无明显不良反应。
Objective To observe the effect of simvastatin on hyperlipidemia in children with refractory nephrotic syndrome (RNS) and its effect on prognosis. Methods 27 cases of RNS hospitalized with simvastatin (age <10 years old, 0.3 mg.kg-1.d-1; ≥10 years old, 10 mg.d-1) were treated with lipid-lowering therapy for 2 weeks. The changes of serum total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), PLT, ALT and SCr before and after treatment were Observe the clinical adverse reactions. Results Before simvastatin treatment, TC was (10.68 ± 4.23) mmol.L-1, PLT was (155.21 ± 34.43) × 109L-1, HDL was 1.46 ± 0.61 mmol.L- 1.31 mmol · L-1, LDL was (6.74 ± 3.96) mmol.L-1, TG was (4.56 ± 1.83) mmol.L-1, ALT was (24.11 ± 6.15) IU.L- 91.32 ± 6.15) μmol.L-1. After one week of simvastatin intervention, TC was (9.36 ± 3.46) mmol.L-1, which was significantly lower than that before intervention (P <0.05), and PLT was (123.34 ± 31.32) × 109L-1 (1.13 ± 0.33) mmol.L-1, (3.03 ± 0.74) mmol.L-1.VLDL was (1.36 ± 0.33) mmol.L-1.LDL was (6.21 ± 3.21) mmol.L- ALT was (25.32 ± 4.14) IU.L-1, SCr was (94.54 ± 6.43) μmol.L-1, there was no significant difference between before and after intervention (Pa> 0.05). After 2 weeks of intervention with simvastatin, TC was (7.28 ± 2.01) mmol.L-1, PLT was (86.65 ± 34.23) × 109L-1 and TG was (2.36 ± 1.16) mmol.L- (2.23 ± 0.93) mmol.L-1, LDL was (4.21 ± 2.01) mmol.L-1, and HDL was 2.99 ± 0.93 mmol.L-1.Compared with pre-intervention, the difference was statistically significant (P0.05) ALT was (25.31 ± 5.14) IU.L-1 and SCr was (94.53 ± 6.23) μmol.L-1, respectively. There was no significant difference between before and after treatment (Pa> 0.05). Two patients had gastrointestinal discomfort after taking the medication, one had a transient increase in ALT, and the three patients returned to normal after one week of withdrawal of simvastatin with no other adverse reactions. Conclusion Simvastatin can relieve RNS hyperlipidemia and its hypercoagulability state is also significantly improved, and can ease the disease and improve the prognosis, while no significant adverse reactions.