急性链球菌感染后肾小球肾炎患儿的流行概况及危险因素分析  

Prevalence and risk factors analysis of children with glomerulonephritis after acute streptococcal infection

作　　者：孙玲 谢兴元 周杜鹃 肖菲[1] 王瑞雪[1] SUN Ling;XIE Xing-yuan;ZHOU Du-juan;XIAO Fei;WANG Rui-xue(Department of Pediatric Nephrology,Chenzhou First People′s Hospital,Chenzhou 423000,Hunan,China)

机构地区：[1]郴州市第一人民医院儿童肾内科,湖南郴州423000

出　　处：《广东医学》2023年第7期888-893,共6页Guangdong Medical Journal

基　　金：郴州市科技发展计划项目(ZDYF2020045)。

摘　　要：目的探究急性链球菌感染后肾小球肾炎(acute post streptococcal glomerulonephritis,APSGN)患儿的流行概况及危险因素分析。方法回顾性分析2017年3月至2019年5月肾内科收治的186例APSGN患儿作为研究对象。收集患儿住院资料以及门诊资料,记录患者相关临床检查治疗检查结果,通过电话进行回访。结果2017—2019年APSGN患儿发病率较高;男性APSGN患儿居多;冬季为发病高峰期。家族史、预防接种、龋齿、居住环境、前驱感染、丘疹性荨麻疹等与儿童APSGN发病有关。肉眼血尿、血清C4水平及肾病性范围蛋白尿、尿蛋白、尿微量白蛋白、BNP水平是影响重症APSGN发生的相关因素(P<0.05)。肾病性范围蛋白尿、肉眼血尿持续时间、尿蛋白、尿微量白蛋白水平、血清C4下降程度及合并支原体、EB病毒感染是影响APSGN长期预后的相关因素(P<0.05)。Logistic分析表明肾病性范围蛋白尿、肉眼血尿持续时间、尿蛋白升高、尿微量白蛋白升高是影响APSGN出院转归以及长期预后的独立危险因素(P<0.05)。大量蛋白尿及肉眼血尿持续时间长的患儿长期预后较差。结论冬季是APSGN发病高峰期,影响APSGN发病及预后的因素较多。Objective To investigate the prevalence and risk factors of children with acute streptococcal glomerulonephritis(APSGN).Methods In this retrospective analysis,186 children with APSGN admitted to the Department of Nephrology from March 2017 to May 2019 were enrolled.The hospitalization data,outpatient data,relevant clinical examination and treatment results were recorded.The follow-up was conducted with telephone.Results The incidence of children with APSGN gradually decreased.Most of the children with APSGN were male.Winter was the peak season for APSGN.Family history,vaccination,dental caries,living environment,preinfection and papular urticaria were correlated to APSGN in children.Gross hematuria,decreased serum C4,nephrotic range proteinuria,urinary protein,urinary microalbumin and BNP levels were significant risk factors of severe APSGN(P<0.05).Nephrotidc range proteinuria,gross hematuria duration,ASO,urinary protein,urinary microalbumin levels,the degree of serum C4 decline and mycoplasma and EBV infection were the related factors affecting the long-term prognosis of APSGN(P<0.05).Logistic analysis showed that nephrotic range proteinuria,gross hematuria duration,elevated urinary protein,elevated urinary microalbumin were independent risk factors for discharge outcome and long-term prognosis of APSGN(P<0.05).The long-term prognosis of children with massive proteinuria and long duration of gross hematuria was poor.Conclusion Winter is the peak period of APSGN incidence,and there are many factors affecting the incidence and prognosis of APSGN.

关 键 词：患儿 肾小球肾炎 急性链球菌感染 预后 危险因素 

分 类 号：R692.31[医药卫生—泌尿科学] R181.22[医药卫生—外科学]