紫癜性肾炎患儿复发因素研究  

Study on Factors of Recurrence in Children with Henoch-Sch?nlein Purpura Nephritis

作　　者：高敏[1,2] 丁樱[1,2] 吴瑞红 代彦林 徐炎 韩姗姗[2] 陈玉琴 GAO Min;DING Ying;WU Rui-hong;DAI Yan-lin;XU Yan;HAN Shan-shan;CHEN Yu-qin(Pediatric Hospital of the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450003;School of Pediatrics of Henan University of Chinese Medicine,Zhengzhou 450046;Information Department of the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450003;Department of Pediatrics,Xingyang Hospital of Traditional Chinese Medicine,Zhengzhou 450199)

机构地区：[1]河南中医药大学第一附属医院儿科医院,郑州450003 [2]河南中医药大学儿科医学院,郑州450046 [3]河南中医药大学第一附属医院信息科,郑州450003 [4]荥阳市中医院儿科,郑州450199

出　　处：《中国中西医结合杂志》2025年第2期169-175,共7页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金青年科学基金项目(No.82305311,No.82305310);国医大师工作室建设项目(No.国中医药人教发[2022]245号);河南省特色骨干学科中医学第二批学科建设项目(No.STG-ZYX05-202140)。

摘　　要：目的 分析影响河南地区紫癜性肾炎(HSPN)患儿预后的危险因素。方法 筛选河南中医药大学第一附属医院儿科3 774例尿蛋白异常的HSPN患儿,随访2 115例,统计1年内、1~3年、3~6年、6年以上(11年)HSPN患儿尿蛋白的复发情况、是否转化为终末期肾病(ESRD)及其他不良事件。结果 随访1年,患儿治疗前24 h尿蛋白值偏高、IgE偏高是导致HSPN复发的危险因素(P<0.001,P<0.05),受试者工作特征曲线(ROC曲线)分析显示:复发的24 h尿蛋白临界值为13.1605 mg/kg;发病季节在夏季和秋季是减轻HSPN患儿复发的保护因素(P<0.001,P<0.05)。随访1~3年,HSPN患儿复发危险因素为年龄、1年内曾经复发、尿检异常时间>3个月、冬季发病(P<0.05)。随访3~6年复发危险因素为尿检异常时间>3个月、1年内复发、1~3年复发、冬季发病(P<0.05)。随访6年复发危险因素为尿检异常时间>3个月、1年内复发、1~3年复发以及年龄和性别为女性(P<0.05)。远期安全性随访中出现2例环磷酰胺冲击后呕吐,28例服中药后腹泻,7例青春期女性患儿服雷公藤多苷片期间月经异常(延迟、不规律)、停药后恢复正常,1例改服用昆仙胶囊后出现胃肠不适,服用激素后1例出现股骨头坏死、2例骨折、6例向心性肥胖。发生终点事件共12例,9例ESRD,1例急性肾衰竭后转为ESRD,2例患儿死亡(P<0.05)。根据Cox回归分析确定年龄及高水平凝血酶原时间、纤维蛋白原是HSPN患儿发展为ESRD、死亡的独立危险因素。结论 治疗前高水平24 h尿蛋白(50 mg/kg)以及IgE是辅助监测HSPN患儿的短期复发的重要因素,年龄、冬季发病、尿检异常时间>3个月以及早期复发频次是辅助监测远期复发的主要因素。HSPN患儿的发病年龄偏大及血液高凝状态或是导致其预后不佳的重要因素。Objective To analyze the risk factors affecting the long-term prognosis of children with Henoch-Sch?nlein purpura nephritis(HSPN)in Henan region. Methods A total of 3 774 HSPN children with abnormal urine protein were screened from the Department of Pediatrics of the First Affiliated Hospital of Henan University of Chinese Medicine. A total of 2 115 patients were followed up,and the recurrence of urinary protein, whether it progresses to end stage renal disease(ESRD), and other adverse events in children with HSPN within 1 year, 1-3 years, 3-6 years, and more than 6 years( 11 years) of the follow-up period were counted.Results For children with a disease cycle of within 1 year during the follow-up, a high 24 h urinary protein value and a high IgE level at baseline were risk factors(P<0.001,P<0.05)for the recurrence of HSPN, while onset during summer and autumn were seasonal protective factors against relapse in children with HSPN(P<0.001, P<0.05). The ROC curve analysis showed that the critical value of 24 h urinary protein for recurrence was 13.1605 mg/kg. The onset seasons of summer and autumn were protective factors for reducing the recurrence of HSPN in children. For children with a disease cycle of 1-3 years, the risk factors for recurrence were age, recurrence within 1 year, abnormal urine test for more than 3 months, and onset in winter(P<0.05). For the 3-6-year disease cycle, the risk factors for recurrence were abnormal urine test for more than 3 months, recurrence within 1 year, recurrence within 1-3 years, and onset in winter(P<0.05). Risk factors for recurrence at 6 years of follow-up were abnormal urine test for more than 3 months, recurrence within 1 year, recurrence within 1-3 years,as well as age and female gender(P<0.05). In the long-term safety follow-up, there were 2 cases of vomiting after cyclophosphamide shock, 28 cases of diarrhea after taking Chinese medicine, 7 cases of abnormal menstruation(delayed and irregular) during taking tretinoin tablets for adolescent female children, which retur

关 键 词：儿童 紫癜性肾炎 复发因素 远期随访 

分 类 号：R72[医药卫生—儿科]