CAJ | 학술논문

目的通过对原发性肾病综合征(PNS)患儿临床资料统计分析,探讨小儿PNS频反复的影响因素.方法收集2007年1月至2010年2月于我科诊断为PNS的患儿住院及门诊随访病历,对获得的完整临床资料进行分析.结果 245例激素敏感型肾病综合征患儿中,非频反复202例(82.4%),频反复43例(17.6%).单因素分析结果中,首次反复距初治缓解时间＜3个月、起病时血总蛋白、胆固醇水平、血清IgE水平在频反复及非频反复两组间差异有统计学意义(P＜0.05).多因素非条件logistic回归分析中,首次反复距初治缓解时间＜3个月及血清IgE水平升高(＞358IU/ml)为频反复的危险因素(P＜0.05).引起反复的诱因中,以上呼吸道感染最多见,共194次(65.1%),有诱因的反复发生在1～3月份最多,占30.4%.结论频反复在正规激素治疗的PNS中所占比例达17.6%,存在冬春季复发高峰的季节性特点.起病时血总蛋白＜40g/L、血胆固醇水平＞10mmol/L可作为预测PNS易出现频反复的指标.感染是肾病综合征反复的主要诱因,不规则治疗、特应性体质导致反复亦应引起重视.
목적 통과대원발성신병종합정(PNS)환인림상자료통계분석,탐토소인PNS빈반복적영향인소.방법 수집2007년1월지2010년2월우아과진단위PNS적환인주원급문진수방병력,대획득적완정림상자료진행분석.결과 245례격소민감형신병종합정환인중,비빈반복202례(82.4%),빈반복43례(17.6%).단인소분석결과중,수차반복거초치완해시간＜3개월、기병시혈총단백、담고순수평、혈청IgE수평재빈반복급비빈반복량조간차이유통계학의의(P＜0.05).다인소비조건logistic회귀분석중,수차반복거초치완해시간＜3개월급혈청IgE수평승고(＞358IU/ml)위빈반복적위험인소(P＜0.05).인기반복적유인중,이상호흡도감염최다견,공194차(65.1%),유유인적반복발생재1～3월빈최다,점30.4%.결론 빈반복재정규격소치료적PNS중소점비례체17.6%,존재동춘계복발고봉적계절성특점.기병시혈총단백＜40g/L、혈담고순수평＞10mmol/L가작위예측PNS역출현빈반복적지표.감염시신병종합정반복적주요유인,불규칙치료、특응성체질도치반복역응인기중시.
Objective To explore the influencing factors of frequent relapse primary nephritic syndrome (PNS) in children according to the statistical analysis of their clinical data and laboratory examinations. Method We collected in-hospital and out-patient medical records of children who were diagnosed PNS from Jan. 2007 to Feb. 2010 and whole clinical data were analyzed. Results In 245 cases of children with steroid sensitine nephrotic syndrome, non-frequent replapse (NFR) accounted for 82.4% and frequent relapse (FR) accounted for 17.6%. In univariate analysis, period of first relapse between initial treatment remission within 3 months , level of serum total protein and cholesterol and IgE at onset had statistical significance in FR children and NFR children, which were significant predictors of FR. The logistic regression analysis revealed that the first relapse after initial treatment remission within 3 months and increasing of serum IgE level (more than 358 IU/ml)were risk factors of FR. Among frequent relapses factors, infection, especially upper respiratory tract infection was the first (65. 1%). The relapse with motivation mainly in January to March, accounted for 30. 4%. Conclusion FR had a proportion of 17. 6% in children with PNS under regular glucocorticoid treatment. It showed seasonality feature that relapse. peak in winter and spring. Level of the serum total protein less than 40g/L and cholesterol more than 10mmol/L at onset can be predictive index of FR. Infections are the main motivation of relapse, but the relapse by irregular treatment and specific constitutions should be pay more attentions too.