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目的 探讨肾病综合征患儿蛋白尿的发生机制及其影响因素。方法 以红细胞 (RBC)膜Alcian蓝 (AB)结合量为指标观测 36例肾病综合征 (NS)患儿 RBC膜电荷量 ,并测定其血液流变学各指标。结果 (1 )患儿 RBC膜 AB结合量明显降低 ,但其 RBC表面主要阴离子涎酸含量并未减少 ,提示 NS患儿 RBC膜电荷量呈“功能性”降低。 (2 )患儿全血粘度 (高切及低切 )、血浆粘度、血沉、红细胞压积、红细胞电泳时间、血沉方程 K值、红细胞聚集指数、全血还原比粘度等指标均明显增高 ,提示 NS患儿血液呈现高粘滞、高聚集、高浓缩状态。 (3)多元逐步回归分析结果提示 NS患儿尿蛋白量受 RBC膜电荷及血粘度的影响。结论 恢复肾小球电荷屏障功能、纠正血流变异常对于减少蛋白尿、改善血流状态、减少并发症、恢复肾功能具有重要意义
Objective To investigate the mechanism of proteinuria in children with nephrotic syndrome and its influencing factors. Methods The amount of RBC membrane charge in 36 children with nephrotic syndrome (NS) was measured with the combination of Alcian Blue (AB) in erythrocyte membrane (RBC) and the indexes of hemorheology were measured. Results (1) The binding capacity of AB in RBC membrane was significantly decreased, but the main anionic sialic acid content on RBC surface did not decrease, suggesting that the RBC membrane charge decreased in patients with NS. (2) The indexes of whole blood viscosity (high and low cut), plasma viscosity, erythrocyte sedimentation rate, hematocrit, hematocrit, erythrocyte electrophoresis time, erythrocyte sedimentation rate K value, erythrocyte aggregation index and whole blood reducing viscosity were all higher NS children showed high blood viscosity, high concentration, high concentration state. (3) Multiple stepwise regression analysis showed that urinary protein in children with NS was influenced by RBC membrane charge and blood viscosity. Conclusion It is of great significance to restore the function of the glomerular charge barrier and correct the abnormal blood flow to reduce the proteinuria, improve the blood flow state, reduce the complications and restore the renal function