儿童紫癜性肾炎肾脏预后不良危险因素分析  

Risk factors of poor renal prognosis in children with Henoch-Schönlein purpura nephritis

作　　者：王美秋 何旭 王忍 贾丽丽 高春林 夏正坤 WANG Meiqiu;HE Xu;WANG Ren;JIA Lili;GAO Chunlin;XIA Zhengkun(Department of Pediatrics,Nanjing Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,Jiangsu,China;Department of Pediatrics,Jinling Hospital,Nanjing 210002,Jiangsu,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)儿科,江苏南京210002 [2]东部战区总医院儿科,江苏南京210002

出　　处：《临床儿科杂志》2023年第12期903-907,924,共6页Journal of Clinical Pediatrics

基　　金：江苏省儿科医学创新团队项目(No.CXTDA2017022);江苏省自然基金-青年项目(No.BK20190251)。

摘　　要：目的探讨儿童紫癜性肾炎(HSPN)肾脏预后不良[估算肾小球滤过率(eGFR)<90 mL/(min·1.73 m^(2))]的独立危险因素。方法回顾性分析2000年1月到2019年12月完善肾脏活检并诊断为HSPN患儿的临床资料,通过多因素logistic回归分析导致肾脏预后不良的独立危险因素。结果共纳入476例HSPN患儿,男278例、女198例,发病年龄10.7(8.1~13.2)岁,中位随访时间为33.8(20.9~54.2)月,其中31例(6.5%)肾脏预后不良。与预后良好组相比,预后不良组患儿发病年龄较大,肾脏受累到肾穿刺时间较长,高尿酸、高胆固醇、eGFR<90 mL/(min·1.73m^(2))、大量蛋白尿、高尿视黄醇结合蛋白(RBP)的比例较高,差异均有统计学意义(P<0.05)。预后良好组与预后不良组之间节段性肾小球硬化/粘连、>25%肾小管萎缩/间质纤维化比例及新月体形成程度差异有统计学意义(P<0.05)。多因素logistic回归分析显示,节段性肾小球硬化/粘连、>25%肾小管萎缩/间质纤维化和高尿RBP是导致肾脏预后不佳的独立危险因素(P<0.05)。结论本研究发现3个影响HSPN患儿肾脏预后不良的危险因素,有待在临床上进一步的探索和验证。Objective To explore independent risk factors for poor renal outcome defined as an estimated glomerular filtration rate(eGFR)<90 mL/(min‧1.73m^(2))in children with Henoch-Schönlein purpura nephritis(HSPN).Methods The clinical data of children diagnosed with HSPN after completing renal biopsy from January 2000 to December 2019 were retrospectively analyzed,and the independent risk factors leading to poor renal prognosis were analyzed by multivariate logistic regression.Results A total of 476 children with HSPN were included,of whom 31(6.5%)had poor renal outcomes.There were 278 boys and 198 girls,and the age of onset was 10.7(8.1-13.2)years.The median follow-up time was 33.8(20.9-54.2)months.Compared with the good prognosis group,the poor prognosis group had older age of onset,longer time from renal involvement to renal aspiration,higher proportions of high uric acid,high cholesterol,eGFR<90 mL/(min‧1.73m^(2)),large albuminuria and high urinary retinol binding protein(RBP),and the differences were statistically significant(P<0.05).There were significant differences in segmental glomerulosclerosis/adhesion,>25%renal tubular atrophy/interstitial fibrosis,and the degree of crescent formation between the good and poor prognosis groups(P<0.05).Multivariate logistic regression analysis showed that segmental glomerulosclerosis/adhesion,>25%renal tubular atrophy/interstitial fibrosis and high urinary RBP were independent risk factors for poor renal prognosis(P<0.05).Conclusions This study found three risk factors for poor renal prognosis in children with HSPN,which are worthy of further clinical exploration and verification.

关 键 词：紫癜性肾炎 IgA血管炎 新月体 儿童 

分 类 号：R726.9[医药卫生—儿科]