儿童肾病综合征合并自发性腹膜炎临床特征分析  

Clinical characteristic of primary nephrotic syndrome complicated with spontaneous bacterial peritonitis in children

作　　者：管娜[1] 丁洁[1] 姚勇[1] 肖慧捷[1] 王芳[1] 钟旭辉[1] 刘晓宇[1] Guan Na;Ding Jie;Yao Yong;Xiao Huijie;Wang Fang;Zhong Xuhui;Liu Xiaoyu(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院儿科,100034

出　　处：《北京医学》2020年第11期1089-1092,共4页Beijing Medical Journal

摘　　要：目的总结儿童原发性肾病综合征(nephrotic syndrome,NS)合并自发性细菌性腹膜炎(spontaneous bacterial peritonitis,SBP)的临床特征。方法选取1993年1月至2019年3月北京大学第一医院儿科肾脏病房收治的原发性NS合并SBP患儿,描述性分析一般情况、SBP时NS状态、SBP表现、相关不良事件、治疗及转归。结果1995例NS患儿中确诊SBP 6例(0.3%),均为男童,包括3例激素耐药型NS和3例激素敏感频复发型NS。血ALB均值为(11.2±2.8)g/L。患儿主要表现为发热和腹痛。2例腹水培养阳性者分别为肺炎链球菌和唾液链球菌。4例发生不良事件包括脓毒症、感染性休克、血栓栓塞和急性肾损伤等。经积极治疗后所有患儿均恢复。结论SBP虽不常见,但可伴随或诱发脓毒症、急性肾损伤和血栓栓塞等危及生命的不良事件。避免应用有诱发急性肾损伤风险的药物,预防性抗凝治疗有助于防治不良事件。Objective To summarize the clinical characteristic of spontaneous bacterial peritonitis(SBP)complicated with primary nephrotic syndrome(NS)in children.Methods The medical records of NS complicated with SBP in children in Peking University First Hospital were reviewed from January 1993 to March 2019.Data on demographic information,manifestations,associated adverse events,treatment and outcome of SBP were collected and described.Results Among 1995 children with primary NS,six cases(0.3%)were diagnosed with SBP.All of them were boys.Three cases were steroid resistant NS and three cases were frequent relapse steroid sensitive NS.The average serum albumin level was(11.2±2.8)g/L.All cases mainly presented with fever and abdominal pain.Two cases had positive results of peritoneal fluid culture including one streptococcus pneumoniae and one streptococcus salivarius.Four cases experienced adverse events associated with SBP including sepsis,septic shock,thrombosis and acute kidney injury.All of them recovered completely after aggressive treatment.Conclusions Although SBP was not a common complication in the children with primary NS,it associated with serious adverse events including sepsis,thrombosis and acute kidney injury.Avoidance of nephrotoxic drugs,prophylactic anticoagulation therapy may be helpful to prevent and treat adverse events.

关 键 词：肾病综合征 腹膜炎 不良事件 

分 类 号：R726.9[医药卫生—儿科] R725.7[医药卫生—临床医学]