中国循证儿科杂志
中國循證兒科雜誌
중국순증인과잡지
CHINESE JOURNAL OF EVIDENCE-BASED PEDIATRICS
2014年
3期
201-205
,共5页
梁慧开%周建华%仇丽茹%程黎明%鲍春%李辉军
樑慧開%週建華%仇麗茹%程黎明%鮑春%李輝軍
량혜개%주건화%구려여%정려명%포춘%리휘군
儿童%肾病综合征%25-羟维生素D%阿法骨化醇%蛋白尿
兒童%腎病綜閤徵%25-羥維生素D%阿法骨化醇%蛋白尿
인동%신병종합정%25-간유생소D%아법골화순%단백뇨
Children%Nephrotic syndrome%25-hydroxyvitamin D%Alfacalcidol%Proteinuria
目的:了解肾病综合征( NS)患儿维生素D营养状况,并分析其影响因素。方法以2012年1月1日至12月31日华中科技大学同济医学院附属同济医院儿科收治的初诊或复诊NS患儿为NS组,体检儿童为对照组。根据血清25-羟维生素D[25(OH)D]水平判断维生素D营养状态,≤20 ng·mL-1为维生素D缺乏。从NS患儿病史中截取可能影响25( OH)D的因素行维生素D缺乏的单因素分析和Logistic回归分析;同时对25( OH)D的影响因素行多元线性回归分析。结果 NS组139例,男103例,女36例,年龄(6.1±3.7)岁;对照组83例,男49例,女34例,年龄(3.1±2.0)岁。①NS组和对照组血清25(OH)D水平分别为(10.3±7.5)和(29.4±9.9)ng·mL-1,差异有统计学意义(P<0.0001)。维生素D缺乏检出率NS组和对照组分别为86.3%和19.3%,差异有统计学意义( P<0.0001)。②单因素分析结果显示,NS病程、24 h尿蛋白定量、糖皮质激素累积剂量和使用时间、血清钙在维生素 D缺乏和不缺乏 NS 患儿间差异有统计学意义;Logistic回归分析显示,体重Z评分(OR=0.151,95%CI:0.035~0.649)、NS病程(OR=0.143,95%CI:0.035~0.592)和大量24 h蛋白尿( OR=28.177,95%CI:3.295~240.970)与维生素D缺乏相关。③多元线性回归显示,男性、24 h尿蛋白定量、血清钙和每公斤体重糖皮质激素累积剂量与血清25(OH)D水平相关(P<0.05)。④27例NS患儿服用阿法骨化醇前和3个月后均行血清25(OH)D水平检测,治疗前和治疗后分别为(7.2±5.0)和(14.9±11.0)ng·mL-1,差异有统计学意义(P=0.001)。结论 NS患儿血清25(OH)D低于健康儿童,有部分可能与蛋白尿水平、NS病程和糖皮质激素累积剂量等因素相关,口服阿法骨化醇可提高血清25( OH)D水平。
目的:瞭解腎病綜閤徵( NS)患兒維生素D營養狀況,併分析其影響因素。方法以2012年1月1日至12月31日華中科技大學同濟醫學院附屬同濟醫院兒科收治的初診或複診NS患兒為NS組,體檢兒童為對照組。根據血清25-羥維生素D[25(OH)D]水平判斷維生素D營養狀態,≤20 ng·mL-1為維生素D缺乏。從NS患兒病史中截取可能影響25( OH)D的因素行維生素D缺乏的單因素分析和Logistic迴歸分析;同時對25( OH)D的影響因素行多元線性迴歸分析。結果 NS組139例,男103例,女36例,年齡(6.1±3.7)歲;對照組83例,男49例,女34例,年齡(3.1±2.0)歲。①NS組和對照組血清25(OH)D水平分彆為(10.3±7.5)和(29.4±9.9)ng·mL-1,差異有統計學意義(P<0.0001)。維生素D缺乏檢齣率NS組和對照組分彆為86.3%和19.3%,差異有統計學意義( P<0.0001)。②單因素分析結果顯示,NS病程、24 h尿蛋白定量、糖皮質激素纍積劑量和使用時間、血清鈣在維生素 D缺乏和不缺乏 NS 患兒間差異有統計學意義;Logistic迴歸分析顯示,體重Z評分(OR=0.151,95%CI:0.035~0.649)、NS病程(OR=0.143,95%CI:0.035~0.592)和大量24 h蛋白尿( OR=28.177,95%CI:3.295~240.970)與維生素D缺乏相關。③多元線性迴歸顯示,男性、24 h尿蛋白定量、血清鈣和每公斤體重糖皮質激素纍積劑量與血清25(OH)D水平相關(P<0.05)。④27例NS患兒服用阿法骨化醇前和3箇月後均行血清25(OH)D水平檢測,治療前和治療後分彆為(7.2±5.0)和(14.9±11.0)ng·mL-1,差異有統計學意義(P=0.001)。結論 NS患兒血清25(OH)D低于健康兒童,有部分可能與蛋白尿水平、NS病程和糖皮質激素纍積劑量等因素相關,口服阿法骨化醇可提高血清25( OH)D水平。
목적:료해신병종합정( NS)환인유생소D영양상황,병분석기영향인소。방법이2012년1월1일지12월31일화중과기대학동제의학원부속동제의원인과수치적초진혹복진NS환인위NS조,체검인동위대조조。근거혈청25-간유생소D[25(OH)D]수평판단유생소D영양상태,≤20 ng·mL-1위유생소D결핍。종NS환인병사중절취가능영향25( OH)D적인소행유생소D결핍적단인소분석화Logistic회귀분석;동시대25( OH)D적영향인소행다원선성회귀분석。결과 NS조139례,남103례,녀36례,년령(6.1±3.7)세;대조조83례,남49례,녀34례,년령(3.1±2.0)세。①NS조화대조조혈청25(OH)D수평분별위(10.3±7.5)화(29.4±9.9)ng·mL-1,차이유통계학의의(P<0.0001)。유생소D결핍검출솔NS조화대조조분별위86.3%화19.3%,차이유통계학의의( P<0.0001)。②단인소분석결과현시,NS병정、24 h뇨단백정량、당피질격소루적제량화사용시간、혈청개재유생소 D결핍화불결핍 NS 환인간차이유통계학의의;Logistic회귀분석현시,체중Z평분(OR=0.151,95%CI:0.035~0.649)、NS병정(OR=0.143,95%CI:0.035~0.592)화대량24 h단백뇨( OR=28.177,95%CI:3.295~240.970)여유생소D결핍상관。③다원선성회귀현시,남성、24 h뇨단백정량、혈청개화매공근체중당피질격소루적제량여혈청25(OH)D수평상관(P<0.05)。④27례NS환인복용아법골화순전화3개월후균행혈청25(OH)D수평검측,치료전화치료후분별위(7.2±5.0)화(14.9±11.0)ng·mL-1,차이유통계학의의(P=0.001)。결론 NS환인혈청25(OH)D저우건강인동,유부분가능여단백뇨수평、NS병정화당피질격소루적제량등인소상관,구복아법골화순가제고혈청25( OH)D수평。
Objective To analyze the serum levels of 25-hydroxy vitamin D[25(OH)D]in children with nephrotic syndrome (NS)and relevant factors. Methods Clinical data of NS paitients hospitalized at Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science & Technology from January 2012 to December 2012 were retrospectively collected,and healthy children coming for physical examination were enrolled as normal control group. The serum levels of 25( OH )D were defined as deficiency(≤20 ng · mL-1 ). Univariate analysis and multivariable logistic regression analysis were performed to explore the possible influencing factors related to vitamin D deficiency. Meanwhile,multi-regression analysis was used to investigate the potential factors affecting serum 25( OH)D level. Results A total of 222 subjects were enrolled,including 139 patients with NS and 83 healthy children. The serum 25(OH)D level of NS group was siginificantly higher than control group,(10. 3 ± 7. 5)vs (29. 42 ± 9. 85)ng·mL-1 ,P<0. 000 1. The prevalence rates of vitamin D deficiency of NS and control groups were 86. 3% and 19. 3%(P<0. 000 1). The multivariate logistic regression showed that patients with higher weight Z-score(0. 151,95%CI:0. 035-0. 649),longer duation of NS(0. 143,95%CI:0. 035-0. 592),greater 24 h protein amount(28. 177,95%CI:3. 295-240. 970)were significantly assocaited with vitamin D deficiency. Multiple linear regression determined that serum 25( OH)D levels were associated with male,24 h urinary protein amount,cumulative glucocorticoid dosage and serum calcium level( P<0. 05). Serum levels of 25(OH)D were significantly increased after treatment with alfacalcidol for 3 months,(7. 2 ± 5. 0)to (14. 9 ± 11. 0)ng·mL-1 ,P=0. 001. Conclusion Vitamin D deficiency was significantly associated with urine protein amount. Alfacalcidol supplements may improve vitamin D deficiency in nephritic patients.