| With the social and economic development, improved people's living standards and changed lifestyle, incidence of dyslipidemia has increased year by year among the population. Dyslipidemia refers to the lipid abnormalities in both quantity and quality of plasma. Long-term dyslipidemia can lead to atherosclerosis, increased cardiovascular and cerebrovascular disease morbidity and mortality, lower quality of life of patients and survival of endurance. Our cohort study showed that increased TC or LDL-C is one of independent risk factors of coronary heart disease and ischemic stroke. For this reason the prevention and treatment of dyslipidemia should be early emphasized.Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease. Lupus nephritis (LN) is the most common and severe SLE clinical manifestations. SLE patients with renal biopsy of renal involvement account for almost 100%, of which 45% ~ 85% have clinical manifestations of renal injury. Abnormal lipid metabolism in patients with systemic lupus erythematosus is not uncommon. Some SLE patients with hyperlipidemia due to myocardial infarction and sudden death led to increased mortality in patients with SLE. PNS is a group of cause's glomerular filtration caused by increased membrane permeability, resulting in plasma protein from the urine in substantial loss of the clinical syndrome, secondary to proteinuria dyslipidemia is to accelerate the progress of nephropathy against one of the factors. Research has shown that hyperlipidemia can affect the cell signal transduction, intrinsic renal cells, extracellular matrix synthesis and release and the promotion of fibroblast growth factor secretion, and so on kidney structure of the sexual changes, accelerated glomerulosclerosis process. And as a result of the use of hormones and renal glomerular damage, the inflammatory state can lead to abnormal lipid metabolism and increase the probability that it does in the PNS of patients with LN. In the course of clinical treatment, to understand the changes in blood lipids and characteristics, and master rational application of fat-reducing drugs is very important.This article presents a retrospective clinical study, through PNS comparison, observation and analysis of 59 cases and 50 cases of patients with inpatient rheumatoid immune LN between January 2007 and December 2008 in China and Japan Friendship hospital attached to Jilin University and to get a comprehensive and systematic understanding of the two groups of patients with LN and NS lipid medication before and after treatment in different dynamics of change, depth of disease, drugs (glucocorticoids, lipid-lowering station drugs), disease prognosis of lipid significant influence on the clinical doctor's diagnosis and treatment. First we observed the dyslipidemia morbidity of 59 cases of LN patients (33 cases of them didn't receive in the past hormone therapy, while 26 cases had previous application of hormone therapy). Also 43 cases who stayed in hospital for more than two weeks according to whether treatment with lipid-lowering drugs are divided into A, B group, A group of 27 cases, B group 16 cases were observed before and after medication in patients with serum albumin and blood lipid changes situation. Finally, 50 cases of PNS patients, according to the effectiveness of short-term hormone therapy (two weeks after hospitalization than serum albumin on admission increase, reduce or change) into C (hormonal treatment group 34 cases), D group (hormone 16 cases of ineffective treatment group), C group and D group were given lipid-lowering medication; we observed within and between the hormone groups after station lipid-lowering drug treatment the characteristics and relevance of serum albumin, blood lipid changes.Results: 1.59 cases of LN patients with dyslipidemia incidence rate of 72.9%, of which the past use of hormone therapy is not the incidence of dyslipidemia was 60.6%, retroactive application of the incidence of hormone therapy for 88.5%. And "China's nutrition and health status of residents (2004)" report, China's adult prevalence rate of dyslipidemia compared to 18.5% is significantly higher incidence of the two groups Hyperlipemia byχ2 test,χ2 = 0.6044 <3.84, P > 0.05, indicates whether or not the application of LN in patients with hormone therapy there are obvious abnormalities of lipid metabolism, glucocorticoid treatment of patients with LN is one of the reasons for dyslipidemia. 2. LN patients with glucocorticoid treatment, TC, HDL-C, LDL-C with the extension of treatment time showed a gradual increase in the trend of drug use after treatment one week, two weeks compared with those before treatment, were significantly different. And the difference in TG before treatment and after treatment was not significant statistically. 3. LN patients with glucocorticoid at the same time plus atorvastatin after treatment, TC, LDL-C with the extension of treatment time showed a gradual downward trend in drug use after treatment one week, two weeks before treatment compared are significantly different. And the difference in TG before treatment and after treatment was of no significance in terms of statistical view. 4. LN Group and the PNS group of two different diseases before treatment are not obviously different in aspects like age, height, weight, BMI and blood pressure. ALB in patients with PNS is lower than in patients with LN group, there was a significant difference in aspects like TC, HDL-C, LDL-C, ApoA1, ApoB, which were high in patients with LN group. 5. PNS patients with hormone-sensitive group in the application of corticosteroid at the same time plus atorvastatin 20 mg, one day after oral treatment at bedtime, the blood ALB increased, compared before and after treatment were significantly different; TC, LDL-C with the condition improvement and extension of treatment time showed a gradual downward trend in drug use after treatment one week, two weeks compared with those before treatment, there is significant difference; HDL-C gradually increased after 2 weeks before treatment, they were significantly different, and ALB blood level of TC, LDL-C, ApoB were highly negatively correlated, TC and LDL-C correlation coefficient r = 0.969, p <0.01, both highly positively correlated. And the difference in TG before treatment and after treatment was not significant statistically. 6. PNS group(Hormone therapy fails to apply)were given glucocorticoid plus atorvastatin treatment at the same time, after two weeks ALB in the blood further decreased, while TC, LDL-C increased. There was a significant difference(P <0.05), TC and LDL-C correlation coefficient r = 0.932 (p <0.01), a high positive correlation between the two. An increase in HDL-C, treatment of 1 week, 2 weeks compared with before treatment there was a significant difference, ALB level of blood TC, LDL-C, ApoB was highly negatively correlated. And the difference in TG before treatment and after treatment was not significant statistically.Conclusion: 1.LN application in patients with hormone therapy regardless of whether there are obvious dyslipidemia, hormone therapy after the application of TC, LDL-C increased on LN hormone involved in the treatment of dyslipidemia in the course of the mechanism, reveals that hormone is one of the reasons for dyslipidemia, and provides guidance for clinicians in the treatment of choosing lipid-lowering drugs. 2. Although PNS patients and LN patients may differ in etiology and pathogenesis, there are varying degrees of dyslipidemia, particularly in the PNS patients. Patients LN with nephrotic syndrome also include six different types, including the clinical classification. Consequently, for those newly diagnosed kidney patients, especially those with edema, hypoproteinemia, massive proteinuria, associated with hyperlipidemia in patients with suspected NS should be checked whether there is the possible of LN, in order to avoid misdiagnosis. 3. Since PNS groups (Hormone therapy applies and the groups it fails) are given different drugs, there was a significant difference between the two groups after treatment. So in the course of clinical treatment, the indirect response to the disease prognosis of TC, LDL-C level in patients with PNS can be supporting indicators in clinical observation. 4. Because of the potential risk of hyperlipidemia, elevated blood lipids in patients with LN and PNS plus patients treated with lipid-lowering drugs is necessary, LN hormone station treatment group and effective group PNS hormone therapy plus atorvastatin treatment after the blood TC and LDL-C significantly reduced, and patients in the PNS increased the role of HDL-C, but the LN in patients with elevated HDL-C had no effect, it applies to PNS in patients with LN and TC, LDL-C elevated, PNS in patients with reduced HDL-C can also use. 5. TG within the group and among the groups had no significant statistical significance, so the index can not be used for an indicator of the influence hormone therapy during hospitalization in patients with dyslipidemia and for the impact on the evaluation of lipid-lowering station drugs on the efficacy of dyslipidemia in the patients. |
