儿童激素敏感型肾病综合征频复发因素分析  

Analysis of frequent relapse factors of steroid-sensitive nephrotic syndrome in children

作　　者：张嘉琦 吴玉秀 张倩 王振升 马浩杰 张永峰[2] ZHANG Jiaqi;WU Yuxiu;ZHANG Qian;WANG Zhensheng;MA Haojie;ZHANG Yongfeng(school of Clinical Medicine,Weifang Medical University,Shandong Weifang 261000,China;The Affiliated Hospital of Weifang Medical University,Shandong Weifang 261000,China)

机构地区：[1]潍坊医学院临床医学院,山东潍坊261000 [2]潍坊医学院附属医院,山东潍坊261000

出　　处：《中国妇幼健康研究》2023年第5期73-80,共8页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨儿童激素敏感型肾病综合征(SSNS)频复发的早期相关因素,为临床对患儿的预后评估提供参考依据。方法选取2017年2月至2021年2月在潍坊医学院附属医院住院并初次确诊为原发性肾病综合征(PNS)73例患儿的临床资料进行回顾性研究。按照疾病复发情况将其分为频复发组30例,非频复发组43例;对患儿的基本信息及实验室指标进行组间对比,分析SSNS患儿频复发的相关因素。结果单因素分析显示,频复发组与非频复发组的疾病临床类型分布差异有统计学意义(χ^(2)=3.954,P<0.05);频复发组初次激素治疗尿蛋白转阴时间明显长于非频复发组,而缓解后初次复发时间明显短于非频复发组,差异均有统计学意义(t值分别为5.779、-6.822,P<0.05);频复发组的IgE明显高于非频复发组(Z=-2.148,P<0.05),而频复发组的CD4+T细胞水平、CD4^(+)/CD8^(+)、NK细胞水平均明显低于非频复发组,差异均有统计学意义(t值分别为-2.211、-2.776、-4.294,P<0.05)。多因素Logistic回归分析显示,初次激素治疗尿蛋白转阴时间为SSNS患儿频复发的危险因素(OR=9.067,95%CI:1.623~50.644,P<0.05),缓解后初次复发时间、CD4^(+)/CD8^(+)、NK细胞水平均为SSNS患儿频复发的保护因素(OR=0.180,95%CI:0.049~0.658,P<0.05;OR=0.000,95%CI:0.000~0.343,P<0.05;OR=0.116,95%CI:0.017~0.811,P<0.05)。受试者工作特征(ROC)曲线分析显示,SSNS患儿初次激素治疗尿蛋白转阴时间>11.5天、缓解后初次复发时间<5.5个月、CD4^(+)/CD8^(+)<1.115、NK细胞水平<9.465%均为SSNS患儿频复发的危险因素(P<0.05)。结论初次激素治疗尿蛋白转阴时间、缓解后初次复发时间、CD4^(+)/CD8^(+)、NK细胞水平均是SSNS患儿频复发的影响因素。Objective To analyse early related factors of frequent relapse of steroid-sensitive nephrotic syndrome(SSNS) in children so as to provide reference for clinicians to evaluate prognosis of the children.Methods The clinical data of 73 children who admitted to The Affiliated Hospital of Weifang Medical University and were initially diagnosed as primary nephrotic syndrome(PNS) and followed up for one year from February 2017 to February 2021 were analyzed retrospectively.According to whether the disease relapse, the children were divided into frequent relapse group(n=30) and non-frequent relapse group(n=43).The basic information and laboratory indexes of the children were compared between the two groups and the related factors of frequent relapse of the children with SSNS were analyzed.Results Single factor analysis shown that there was significant difference in distribution of clinical types of the disease between the two groups(χ^(2)=3.954,P<0.05).The time of urine protein turning negative after initial hormone therapy of the children in the frequent relapse group was longer than that in the non-frequent relapse group, while their time of first relapse after remission was shorter than that in the non-frequent relapse group, and the differences were significant(t=5.779 and-6.822 respectively, both P<0.05).The serum level of IgE of the children in the frequent relapse group was higher than that in the non-frequent relapse group(Z=-2.148,P<0.05),while their levels of CD4^(+) T cells, CD4^(+)/CD8^(+) and NK cells were significantly lower than those in the non-frequent relapse group(t=-2.211,-2.766 and-4.294 respectively, all P<0.05).Multi-factor logistic regression analysis showed that the time of urine protein turning negative after initial hormone therapy was a risk factor for frequent relapse of SSNS in children(OR=9.067,95%CI:1.623-50.644,P<0.05),while the time of first relapse after remission, CD4^(+)/CD8^(+),and NK cell levels were all protective factors for frequent relapse of SSNS in children(OR=0.180,95%CI:0.0

关 键 词：激素敏感型肾病综合征 儿童 频复发 早期相关因素 

分 类 号：R179[医药卫生—妇幼卫生保健]