肾病综合征患者合并无菌性股骨头坏死  

Avascular bone necrosis in patients with primary nephrotic syndrome

作　　者：焦晨峰 许书添[1] 涂远茂[1] 刘志红[1] 李世军[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科,国家肾脏疾病临床医院研究中心,全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2015年第4期307-312,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2013BAI09B04,2015BAI12B05);江苏省临床医学中心项目(BL2012007)

摘　　要：目的:分析原发性肾小球疾病(局灶节段性肾小球硬化、Ig M肾病、微小病变肾病)肾病综合征患者合并无菌性股骨头坏死的临床特点及危险因素。方法:回顾性分析2009年1月至2013年12月原发性肾小球疾病肾病综合征患者激素治疗后合并股骨头坏死的临床资料。结果:3 796例原发性肾小球疾病肾病综合征门诊随访患者中92例(2.4%)并发股骨头坏死。股骨头坏死组在激素治疗3年内发生股骨头坏死比例为80.4%。多因素Logistic回归分析结果显示低白蛋白血症是原发性肾小球疾病肾病综合征患者并发股骨头坏死的危险因素(P<0.05)。股骨头坏死组对激素治疗反应、肾病复发次数及糖皮质激素累积用量与非股骨头坏死组无明显差异(P>0.05)。股骨头坏死组血清白蛋白降低、纤维蛋白原升高及血钙水平降低的患者与非股骨头坏死组有统计学差异(P<0.05)。预防使用维生素D制剂及钙剂不能降低股骨头坏死发生率。股骨头坏死组与非股骨头坏死组之间年龄、性别、24h尿蛋白定量、血红蛋白、血小板、尿酸、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值、血磷无统计学差异(P>0.05)。结论:原发性肾小球疾病肾病综合征并发股骨头坏死在激素治疗3年内高发,部分症状不典型,低白蛋白血症是并发股骨头坏死的高危因素。高危患者应在激素治疗5个月开始定期行影像学检查,以早期诊断骨股头坏死。Objective： To investigate the clinical features of osteonecrosis of the femoral head（ ONFH） in patients with primary nephrotic syndrome. Methodology： The clinical data of 3 796 cases with primary nephrotic syndrome including FSGS,Ig M nephropathy and minimal change nephropathy were retrospectively analyzed in outpatients from January 2009 to December 2013. According to whether or not with ONFH they were divided into two groups; ONFH group and non-ONFH group. Results： A total of 92 cases was diagnozed as ONFH,and incidence of ONFH in idiopathic nephrotic syndrome patients was 2. 4%. 80. 4% of the ONFH occurred within the first 3 years of corticosteroid therapy. Multiple factor logistic regression analysis revealed that hypoproteinemia was the risk factor of ONFH（ P〈0. 05）. ONFH was no correlation with the glucocorticoid therapy response,recurrence frequency of nephropathy and accumulative dosage of glucocorticoid（ P〈0. 05）.Preventive use of vitamin D and calcium can not reduce the occurrence of ONFH. There was no difference in sex,age,24-hour urine albumin excretion,hemoglobin,blood platelet,uric acid,triglyceride,total cholesterol,LDL-C,the ratio LDL-C to HDL-C,blood phosphorus between the two groups（ P〉0. 05）. Conclusion： The incidence of ONFH in patients with idiopathic primary glomerulopathy nephrotic syndrome was high within 3 years glucocorticoid therapy. Some patients were delayed to diagnose of ONFH for its atypical symptoms. Hypoproteinemia is the risk factor with ONFH. They should do MRI test of the hip joint routinely when the time of glucocorticoid treatment for 5 months.

关 键 词：原发性肾小球疾病 肾病综合征 股骨头坏死 糖皮质激素 

分 类 号：R692[医药卫生—泌尿科学] R681.8[医药卫生—外科学]