儿童原发性肾病综合征合并肾上腺危象临床特点及相关因素分析  

Clinical characteristics and related factors analysis of adrenal crisis occurred in children with primary nephrotic syndrome

作　　者：管娜[1] 肖慧捷[1] 苏白鸽[1] 钟旭辉[1] 王芳[1] 朱赛楠[2] Guan Na;Xiao Huijie;Su Baige;Zhong Xuhui;Wang Fang;Zhu Sainan(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;Department of Medical Statistics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院儿科,北京100034 [2]北京大学第一医院医学统计室,北京100034

出　　处：《中华儿科杂志》2023年第9期805-810,共6页Chinese Journal of Pediatrics

摘　　要：目的探讨儿童原发性肾病综合征(NS)合并糖皮质激素相关肾上腺危象(AC)的临床特点及相关因素。方法病例对照研究。选取2016年1月至2021年5月在北京大学第一医院儿科确诊的1~18岁全部原发性NS合并AC患儿7例为病例组(AC组)。按病例组∶对照组1∶4比例匹配同期住院同年龄原发性NS不合并AC 28例患儿为对照组(非AC组)。收集并分析两组患儿临床资料,组间比较采用t检验、Mann-Whitney U检验或Fisher确切概率法。采用受试者工作特征(ROC)曲线分析AC的预测指标截断值。结果AC组男4例、女3例,年龄6.9(4.6,10.8)岁;非AC组男20例、女8例,年龄5.2(3.3,8.4)岁。AC均发生在NS复发后未缓解期,存在感染诱因。7例均有胃肠道症状如恶心、呕吐、腹痛,6例有精神差或意识障碍。两组间NS病程、激素疗程、剂型、剂量、服药间隔方式、胃肠炎和发热的比例差异均无统计学意义(均P>0.05)。与非AC组比较,AC组患儿从NS复发距入院时间短[0.2(0.1,0.6)比1.0(0.4,5.0)个月,U=25.50,P=0.005],24 h尿蛋白定量(UTP)高[193(135,429)比81(17,200)mg/kg,U=27.00,P=0.036],血白蛋白水平低[(13.1±2.1)比(24.5±8.7)g/L,t=-6.22,P<0.001],外周血白细胞计数高[(26±9)×109比(11±5)×109/L,t=4.26,P=0.004],中性粒细胞比值高(0.71±0.08比0.60±0.19,t=2.56,P=0.017),C反应蛋白≥8 mg/L患儿比例高(3/7比0,P=0.005)。ROC曲线分析示24 h UTP预测AC的截断值为122 mg/(kg·d),灵敏度100.0%,特异度70.4%;血白蛋白截断值为17.0 g/L,灵敏度100.0%,特异度82.1%。结论胃肠道症状和精神差是NS患儿合并AC突出表现。NS复发早期24 h UTP高、血白蛋白水平低、外周血白细胞计数高、中性粒细胞比值高及C反应蛋白高可能与AC发生有关。Objective To investigate the clinical characteristics and related factors of corticosteroid induced adrenal crisis(AC)in children with primary nephrotic syndrome(NS).Methods Case control study.The case group included 7 children aged 1 to 18 years with NS combined with AC hospitalized in Peking University First Hospital from January 2016 to May 2021(AC group).According to the ratio of case group:control group 1:4,28 children aged 1 to 18 years who were diagnosed with NS without AC during the same period were matched as controls(non-AC group).Clinical data were collected.The clinical characteristics of AC were described.The clinical parameters were compared between the 2 groups by t test,Mann-Whitney U test or Fisher′s test.Receiver operating characteristic(ROC)curve was used to analyze the cutoff values of clinical parameters for prediction of AC.Results The AC group included 4 boys and 3 girls aged 6.9(4.6,10.8)years.The non-AC group included 20 boys and 8 girls aged 5.2(3.3,8.4)years.All AC events occurred during the relapse of NS with infection.Seven children had gastrointestinal symptoms such as nausea,vomiting and abdominal pain.Six children had poor mental state or impaired consciousness.No significant differences in NS course,corticosteroid treatment course,corticosteroid type,steroid dosage,steroid medication interval,the proportion of gastroenteritis and fever existed between the two groups(all P>0.05).Compared with the non-AC group,the duration from the onset of the relapse of NS until hospitalization in the AC group was significantly shorter(0.2(0.1,0.6)vs.1.0(0.4,5.0)month,U=25.50,P=0.005).The 24 h urinary total protein(UTP)level was significantly higher in the AC group(193(135,429)vs.81(17,200)mg/kg,U=27.00,P=0.036)than the non-AC group.The serum albumin level in the AC group was significantly lower((13.1±2.1)vs.(24.5±8.7)g/L,t=-6.22,P<0.001)than the non-AC group.There were significantly higher total white blood cell counts((26±9)×109vs.(11±5)×109/L,t=4.26,P=0.004),percentage of neutrophils(0.

关 键 词：肾病综合征 肾上腺功能减退 疾病特征 

分 类 号：R726.9[医药卫生—儿科]