摘要
目的:观察双重血浆置换(DFPP)联合他汀类降脂药治疗肾病综合征(NS)严重高胆固醇血症的作用,并分别与单独使用DFPP与他汀类药物进行对比。方法:选取南京军区南京总医院全军肾脏病研究所门诊患者12例,住院患者10例,临床表现为肾病综合征合并严重高胆固醇血症[总胆固醇(TC)>10mmol/L]。门诊患者入选后在原有治疗基础上服阿托代他汀20mg/d(他汀组);住院患者入选后在原有治疗基础上,2例接受单纯DFPP治疗一次(DFPP组);8例接受DFPP一次治疗,同时在DFPP前3～4d开始服阿托代他汀20mg/d(联合组)。所有患者随访观察4周。结果:三组患者尿蛋白定量、血脂、血清肌酐(SCr)基线值比较无差异。DFPP单次治疗对血清白蛋白及IgG无明显影响,而IgA,IgM及纤维蛋白原显著下降(P<0.01)。各种脂蛋白TC,三酰甘油,低密度脂蛋白,高密度脂蛋白,载脂蛋白A1、B及E下降率分别为85.8%±7.2%,80.1%±6.2%,86.9%±11.4%,66.4%±9%,54.1%±6.3%,86.4%±9.4%,70.3%±6.9%(P<0.01)。三组患者随访4周后尿蛋白定量、SCr、血清白蛋白水平与治疗前无明显变化。DFPP组随访1周时TC水平为基线值85.9%,两周时恢复至基线水平,4周时略高于基线值;联合组患者随访1、2周时TC水平低于基线50%以下(显著低于另两组水平,P<0.05),4周时为基线值70.2%;他汀组患者随访两周及4周TC水平保持在基线81%左右。随访期间三组患者TG水平较基线值无明显差别。结论:单次DFPP联合他汀药物虽不能改善NS患者对原发病治疗的反应性,但较两种方法单用能更有效地降低其高胆固醇血症。
Objective ： by a case-controlled design, to investigate the effect of combined therapy using double filtration plasmapheresis （DFPP） and oral statins on severe hypercholesterolemia in resistant nephrotic syndrome （NS）. Methodology：Twenty two patients with severe hypercholesterolemia caused by resistant NS were enrolled in this study. They were divided into three groups as follow： 2 of them in the group receiving a single session of DFPP alone （ DFPP group） ,8 in the group receiving a single session of DFPP combined with oral Atorvastatin （Combination group）, and 12 in the group receiving oral Atorvastatin alone （ Statins group）. Other treatments for primary disease and symptom-control remained unchanged. All patients were followed-up to 4 weeks. Results：The baseline levels of serum total cholesterol （TC） were （ 12. 7 ± 1.40） mmol/L in DFPP group, （ 17.1 ± 4.70 ） mmol/L in combination group, and （ 15.4 ± 5.10） mmol/L in statins group （P 〉0. 05）. Single session of DFPP decreased serum TC by （85.8% ±0.20% ） （P 〈0. 01 ）, accompanied with a decline of plasma immunoglobulin A （IgA）, M and fibrinogen （P 〈 0. 01 ） but not albumin or IgG. No remission was found in the all groups during 4 weeks follow-up. During the follow-up period, compared with baselinedata,serum TC was 85.9% at the 1 week, 100% at the 2 week, and 134% at the end in DFPP group, serum TC was below 50% in the first 2 weeks,and 70.2% at the end in combination group,and serum TC was around 81.1% through the whole period in the statins group. The levels of serum TC were significantly lower than that in the other groups at the first two weeks （P 〈 0. 01 ）. Conclusion： Oral statin alone can only decline lipids slightly in patients with severe hypercholesterolemia due to resistant nephrosis ,while combined therapy using DFPP plus oral statin can decrease lipids to a larger extent in these patients.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2013年第2期101-105,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
肾病综合征
高胆固醇血症
双重血浆置换
nephrotie syndrome hypereholesterolemia double filtration plasmapheresis
