本文關(guān)鍵詞： 原發(fā)性腎病綜合征 兒童 血脂 血壓 高血壓分型診治　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討不同血壓類型的原發(fā)性腎病綜合征(PNS)患兒的血脂、尿蛋白的差異及其與血壓的相關(guān)性,擬為PNS患兒的基礎(chǔ)診療提供理論基礎(chǔ)。方法:選擇2014年3月至2016年3月在我院住院的初治原發(fā)性腎病綜合征患兒(年齡滿1周歲至14周歲)101例,同時(shí)選取同期住院的上呼吸道感染的患兒61例,詳細(xì)記錄病史、測(cè)量體重、血壓等,應(yīng)用Cobas-8000全自動(dòng)生化分析儀測(cè)定生化指標(biāo),包括膽固醇(CHO)、三酰甘油(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、載脂蛋白A(ApoA)、載脂蛋白B(ApoB),應(yīng)用BECKMAN COULTER-AU5800全自動(dòng)生化分析儀測(cè)定24h尿蛋白定量。并根據(jù)血壓值分為4組,正常血壓組(21例),單純收縮期高血壓組(18例),單純舒張期高血壓組(18例),雙期高血壓組(44例),將4組間的各項(xiàng)檢測(cè)指標(biāo)進(jìn)行比較研究,并運(yùn)用相關(guān)分析得出影響血壓的相關(guān)因素。結(jié)果:經(jīng)獨(dú)立樣本t檢驗(yàn),實(shí)驗(yàn)組CHO、TG、HDL、ApoA、Lp(a)、收縮壓及舒張壓均較對(duì)照組明顯升高(P0.05),經(jīng)獨(dú)立樣本秩和檢驗(yàn)結(jié)果示實(shí)驗(yàn)組LDL、ApoB均較對(duì)照組明顯升高(P0.05)。并將PNS患兒按血壓分為四組,經(jīng)單因素方差分析結(jié)果示各組患兒發(fā)病性別及年齡構(gòu)成無明顯差異(P0.05)。雙相高血壓組CHO、TG、LDL-C均高于其余3組(P0.05);ApoA在單純收縮期高血壓組明顯高于其余3組(P0.05);四組比較,Lp(a)、HDL-C、ApoB比較未見明顯差異(P0.05);雙期高血壓組24h尿蛋白定量明顯高于其余3組(P0.05);單純收縮期高血壓組患兒24小時(shí)尿蛋白定量高于正常血壓組(P0.05),而單純舒張期高血壓組較正常血壓組無明顯差異(P0.05)。經(jīng)非參數(shù)秩和檢驗(yàn)四組間比較:雙相高血壓組LDL-C值高于其余3組(P0.05);而其余各組比較均未見明顯差(P0.05);ApoB值四組間比較未見明顯差異(P0.05)。相關(guān)性分析:分別將收縮壓及舒張壓列為因變量,將CHO、TG、LDL-C、ApoA、24h尿蛋白定量列為自變量,應(yīng)用pearson及spearman相關(guān)分析法,結(jié)果顯示,CHO、TG、ApoA及24h尿蛋白定量與收縮壓呈正相關(guān),CHOL、TG、24h尿蛋白定量與舒張壓呈正相關(guān)。結(jié)論:依據(jù)PNS患兒血脂代謝特點(diǎn)及不同類型血壓特點(diǎn),臨床上有必要對(duì)PNS患兒血壓進(jìn)行動(dòng)態(tài)監(jiān)測(cè),并且對(duì)血壓高的患兒進(jìn)行分型診治有一定的臨床價(jià)值,將PNS患兒高血壓診斷標(biāo)準(zhǔn)細(xì)化,從而提高兒童PNS的診療水平,為國內(nèi)兒童PNS的基礎(chǔ)診療提供理論基礎(chǔ)。
[Abstract]:Objective: to investigate the differences of blood lipid, urine protein and blood pressure in children with primary nephrotic syndrome (PNSs) with different blood pressure types. To provide theoretical basis for the basic diagnosis and treatment of children with PNS. Methods: children with primary nephrotic syndrome (aged from 1 to 14 years) who were hospitalized in our hospital from March 2014 to March 2016 were selected. 101 cases. At the same time, 61 children with upper respiratory tract infection in the same period were selected to record the history, measure body weight and blood pressure, and use Cobas-8000 automatic biochemical analyzer to measure biochemical indexes. These include cholesterol Cho, triglyceride (TGG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and apolipoprotein (ApoA). Apolipoprotein (ApoB) was measured by BECKMAN COULTER-AU5800 automatic biochemical analyzer and divided into 4 groups according to blood pressure. Normal blood pressure group (n = 21), systolic hypertension group (n = 18), diastolic hypertension group (n = 18), double-phase hypertension group (n = 44). The relative factors affecting blood pressure were obtained by correlation analysis. Results: the experimental group was tested by t test, and the experimental group was tested with CHOTGG HD-ApoA. Compared with the control group, the systolic blood pressure and diastolic blood pressure were significantly higher than that of the control group (P 0.05). The results of independent sample rank sum test showed that the LDL of the experimental group was higher than that of the control group. ApoB was significantly higher than that of the control group (P 0.05). According to the blood pressure, the children with PNS were divided into four groups. The results of univariate ANOVA showed that there was no significant difference in the sex and age composition of the children in each group, and the LDL-C levels in CHOU TGN in the bipolar hypertension group were higher than those in the other three groups (P 0.05). ApoA in the simple systolic hypertension group was significantly higher than that in the other three groups (P 0.05). There was no significant difference between the four groups in the comparison of HDL-Con ApoB between the four groups (P 0.05). The 24-hour urinary protein in the two phase hypertension group was significantly higher than that in the other three groups (P 0.05). The 24 hour urine protein quantity in simple systolic hypertension group was higher than that in normal blood pressure group (P0.05). However, there was no significant difference between the simple diastolic hypertension group and the normal blood pressure group (P 0.05). The LDL-C value of the bipolar hypertension group was higher than that of the other three groups by nonparametric rank sum test. However, there was no significant difference between the other groups (P 0.05). There was no significant difference in ApoB value among the four groups (P 0.05). Correlation analysis: systolic blood pressure and diastolic blood pressure were regarded as dependent variables respectively. 24 hours urine protein was quantified as independent variable. Pearson and spearman correlation analysis were used. The results showed that Cho TG. ApoA and 24h urinary protein were positively correlated with systolic blood pressure (SBP). Conclusion: according to the characteristics of blood lipid metabolism and different types of blood pressure in children with PNS, it is necessary to dynamically monitor blood pressure in children with PNS. And the diagnosis and treatment of high blood pressure of children with certain clinical value, PNS children with hypertension diagnosis criteria refined, thereby improving the level of diagnosis and treatment of children with PNS. To provide a theoretical basis for the basic diagnosis and treatment of PNS in children in China.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.9

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