儿童原发性肾病综合征激素敏感型与特应性疾病的关系  

Relationship between primary steroid-sensitive nephrotic syndrome and atopic diseases in children

作　　者：何学慧 傅桐 王秀丽[1] 赵成广[1] 杜悦[1] HE Xue-hui;FU Tong;WANG Xiu-li;ZHAO Cheng-guang;Du Yue(Department of Pediatric Nephrology,Rheumatology and Immunology,Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿肾脏风湿免疫内科,沈阳110001

出　　处：《中华临床免疫和变态反应杂志》2021年第5期521-527,共7页Chinese Journal of Allergy & Clinical Immunology

摘　　要：目的探讨儿童原发性肾病综合征激素敏感型(steroid-sensitive nephrotic syndrome,SSNS)与特应性疾病的关系,研究IgE、组胺、缓激肽在儿童原发性肾病综合征初发、缓解及复发中的改变及临床意义。方法选取2018年1月—2019年12月234例SSNS患儿,收集临床资料,分析特应性疾病共病、复发诱因及季节特点,比较SSNS患儿初发、缓解及复发时期血清总IgE、血组胺及缓激肽变化。结果纳入234例SSNS患儿中,特应性疾病共病143例(61.11%),包括呼吸道共病67例(28.63%)及皮肤共病76例(32.48%),细胞因子IL-2、IL-4、IL-10、TNF-α明显升高,复发患儿中过敏人数(100例)高于感染人数(36例)(P<0.05),春季(27.21%)和秋季(30.15%)复发人数高于夏季(22.79%)和冬季(19.85%)(P<0.05)。总IgE及缓激肽,初发组[分别为(688.38±815.90)IU/mL和(1234.21±1247.31)ng/mL]和复发组[分别为(699.71±894.27)IU/mL和(973.95±469.9)ng/mL]较缓解组[分别为(250.27±411.15)IU/mL和(595.69±387.47)ng/mL]明显升高(P<0.05);而组胺,初发组(28.61±28.79)ng/mL显著高于缓解组(9.02±5.28)ng/mL(P<0.05),缓解组和复发组趋于正常范围。结论儿童SSNS与特应性疾病呈现高共病特点,复发诱因过敏因素明显高于感染因素,过敏性炎症介质IgE、组胺、缓激肽可能参与了儿童肾病综合征的发病机制。Objective To study the relationship between steroid-sensitive nephrotic syndrome(SSNS)and atopic disease in children and investigate the function of IgE,histamine,and bradykinin in pathogenesis of SSNS.Methods Clinical data,laboratory results,and followed-up of 234 pediatric patients with SSNS admitted to the Department of Pediatric Nephrology of Shengjing Hospital,China Medical University from January 1st 2018 to December 31st 2019 were collected.The incidence of comorbidities with allergic diseases,associated symptoms,and recurrence season were analyzed.Serum samples were collected from children with recurrent SSNS at the initial stage,remission stage,and recurrence stage.The changes of total IgE,histamine,and bradykinin in serum were compared.Results For 234 children with SSNS,67 cases(28.63%)had respiratory tract allergy and 76 cases(32.48%)had skin allergy.IL-2,IL-4,IL-10,and TNF-αwere significantly increased in initial group(P<0.05).For recurrent groups,children with allergy(100 cases)were significantly more than ones with infection(36 cases)(P<0.05).As the recurrence rate in spring(27.21%)and autumn(30.15%)was higher than those in summer(22.79%)and winter(19.85%)(P<0.05),which was consistent with the high incidence season of allergy.For children with SSNS at different stages,the levels of IgE and bradykinin in initial group[(688.38±815.90)IU/mL and(1234.21±1247.31)ng/mL,respectively]and recurrent group[(699.71±894.27)IU/mL and(973.95±469.9)ng/mL,respectively]were significantly higher than those in remission group[(250.27±411.15)IU/mL and(595.69±387.47)ng/mL,respectively](P<0.05).For histamine,the levels of initial group(28.61±28.79)ng/mL were significantly higher than those of remission group(9.02±5.28)ng/mL(P<0.05),while remission group and recurrent group were close to the normal range.Conclusions SSNS children were related with atopic diseases as the high comorbidity.As the predisposing factor of relapse,allergy has higher incidence than infection.It is suggested that IgE,histamine,and bradykin

关 键 词：激素敏感型肾病综合征 特应性疾病 儿童 组胺 缓激肽 免疫球蛋白E 

分 类 号：R726.9[医药卫生—儿科]