儿童原发性肾病综合征激素耐药危险因素分析及预测模型建立  

Analysis of risk factors for steroid resistance in children with primary nephritic syndrome and discussion on the prediction model of steroid resistance

作　　者：张碧丽[1] 刘涛[1] 林书祥[1] 王文红[1] 刘妍[1] 刘艳[1] 吴瑕[1] 王欣[1] 刘喆[1] 

机构地区：[1]天津市儿童医院肾内科,300074

出　　处：《中华肾脏病杂志》2015年第6期414-418,共5页Chinese Journal of Nephrology

基　　金：天津市卫生行业重点攻关项目（12KG117）

摘　　要：目的 寻找原发性肾病综合征（PNS）患儿发生激素耐药的危险因素,建立预测激素耐药的积分法模型.方法 病例来自2011年10月至2013年10月在天津市儿童医院肾内科住院的初发PNS患儿185例.收集患儿临床指标、实验室检查及影像学检查等资料.采用单因素相关分析、受试者工作特征曲线（ROC）及logistic回归分析方法筛选PNS发生激素耐药的危险因素,进而对危险因素进行积分,初步建立预测激素耐药的模型,并对模型的预测作用进行检验.结果 （1）单因素分析、ROC曲线及logistic回归分析结果提示,PNS患儿年龄≥6.5岁（X1）、镜下血尿（X2）和尿蛋白量≥177.49 mg· kg^-1·d^-1（X3）是发生激素耐药的高危因素,logistic回归预测模型为Y=6.761-2.947X1-3.336X2-2.669X3.（2）回归模型的拟合效果分析结果提示：根据预测模型分别计算激素敏感型肾病综合征（SSNS）组及激素耐药型肾病综合征（SRNS）组患儿所得分值,绘制ROC曲线得出,当危险因素总分值≤0.95时,诊断的灵敏度为56.56％、特异度为96.62％,ROC曲线下面积为0.86（P＜ 0.05）.结论 年龄≥6.5岁,镜下血尿及尿蛋白量≥177.49 mg· kg^-1·d^-1为PNS患儿发生激素耐药的危险因素.Objective To seek the risk factors of steroid resistance in children with primary nephritic syndrome,and construct the predicting model of steroid resistance.Methods The clinical indicators of 185 patients with primary nephrotic syndrome （PNS） were collected,including clinical data,laboratory and imaging examination.The risk factors of steroid resistance were found using single factor analysis,receiver operator characteristic （ROC） and logistic regression test.The predicting model of steroid resistance was constructed based on integral method model.Results The results of single factor analysis,receiver operating characteristic curve （ROC） and logistic regression analysis showed that the age more than 6.5 years old,having microscopic hematuria and the 24 h urine protein content （24 hUP） more than 177.49 mg· kg^-1 · d^-1 were the significant risk factors of steroid resistant nephrotic syndrome （SRNS）.Logistic regression prediction model was Y=6.761-2.947X1-3.336X2-2.669X3.The result of receiver operator characteristic showed that when the score was 0.95,the sensitivity and specificity was 56.56%,96.62% respectively and the area under ROC was 0.86,P〈0.05）.Conclusions The age more than 6.5 years old,having microscopic hematuria and 24 h urine protein content more than 177.49 mg· kg^-1· d^-1 are the significant risk factors of SRNS.

关 键 词：肾病综合征 原发性 抗药性 激素 儿童 预测 

分 类 号：R726.9[医药卫生—儿科]