中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
5期
351-354
,共4页
张建江%王娜%王淼%付书琴%窦文杰%史佩佩
張建江%王娜%王淼%付書琴%竇文傑%史珮珮
장건강%왕나%왕묘%부서금%두문걸%사패패
激素敏感型肾病综合征%儿童%皮质醇%促皮质素%复发
激素敏感型腎病綜閤徵%兒童%皮質醇%促皮質素%複髮
격소민감형신병종합정%인동%피질순%촉피질소%복발
Steroid-sensitive nephritic syndrome%Child%Cortisol%Adrenocorticotrophic hormone%Relapse
目的 研究激素敏感型肾病综合征(SSNS)患儿血清皮质醇和促皮质素(ACTH)的变化及对其干预的临床意义.方法 将48例SSNS患儿根据其在病程中有无复发分为未复发组(例数=19)及复发组(例数=29),同时选取同龄健康儿童作为健康对照组(例数=14).采用电化学发光法测定SSNS患儿血清皮质醇和ACTH的水平,并对复发组中血清皮质醇、ACTH降低的15例患儿调整治疗方案为甲泼尼龙片或甲泼尼龙片联合ACTH针静脉滴注.结果 糖皮质激素治疗前,复发组、未复发组及健康对照组血清皮质醇、ACTH水平差异均无统计学意义(P均＞0.05);糖皮质激素诱导缓解治疗后,复发组血清皮质醇、ACTH水平均显著低于未复发组,差异均有统计学意义[(113.03±80.02) μg/L比(251.54±185.05) μg,/L,t=-2.925,P＜0.05;(12.81±10.14) ng/L比(23.53±12.05) ng/L,t=-0.885,P＜0.05];其中复发组15例患儿血清皮质醇、ACTH出现降低,调整治疗方案治疗8～12周后,血清皮质醇水平较调整治疗方案前升高,差异有统计学意义[(168.90±133.43) μg/L比(73.62-±58.04) μg/L,t =3.016,P＜0.05];血清ACTH水平调整治疗方案前后比较差异无统计学意义[(14.05±10.99) ng/L比(8.72±4.11) ng/L,t=1.991,P＞0.05];月平均复发次数较调整治疗方案前降低,差异有统计学意义[(0.09±0.08)次比(0.35±0.11)次,t=-7.560,P＜0.05].结论 血清皮质醇、ACTH的水平在一定程度上可评估SSNS患儿复发的风险,对其进行有效干预可减少其复发率.
目的 研究激素敏感型腎病綜閤徵(SSNS)患兒血清皮質醇和促皮質素(ACTH)的變化及對其榦預的臨床意義.方法 將48例SSNS患兒根據其在病程中有無複髮分為未複髮組(例數=19)及複髮組(例數=29),同時選取同齡健康兒童作為健康對照組(例數=14).採用電化學髮光法測定SSNS患兒血清皮質醇和ACTH的水平,併對複髮組中血清皮質醇、ACTH降低的15例患兒調整治療方案為甲潑尼龍片或甲潑尼龍片聯閤ACTH針靜脈滴註.結果 糖皮質激素治療前,複髮組、未複髮組及健康對照組血清皮質醇、ACTH水平差異均無統計學意義(P均＞0.05);糖皮質激素誘導緩解治療後,複髮組血清皮質醇、ACTH水平均顯著低于未複髮組,差異均有統計學意義[(113.03±80.02) μg/L比(251.54±185.05) μg,/L,t=-2.925,P＜0.05;(12.81±10.14) ng/L比(23.53±12.05) ng/L,t=-0.885,P＜0.05];其中複髮組15例患兒血清皮質醇、ACTH齣現降低,調整治療方案治療8～12週後,血清皮質醇水平較調整治療方案前升高,差異有統計學意義[(168.90±133.43) μg/L比(73.62-±58.04) μg/L,t =3.016,P＜0.05];血清ACTH水平調整治療方案前後比較差異無統計學意義[(14.05±10.99) ng/L比(8.72±4.11) ng/L,t=1.991,P＞0.05];月平均複髮次數較調整治療方案前降低,差異有統計學意義[(0.09±0.08)次比(0.35±0.11)次,t=-7.560,P＜0.05].結論 血清皮質醇、ACTH的水平在一定程度上可評估SSNS患兒複髮的風險,對其進行有效榦預可減少其複髮率.
목적 연구격소민감형신병종합정(SSNS)환인혈청피질순화촉피질소(ACTH)적변화급대기간예적림상의의.방법 장48례SSNS환인근거기재병정중유무복발분위미복발조(례수=19)급복발조(례수=29),동시선취동령건강인동작위건강대조조(례수=14).채용전화학발광법측정SSNS환인혈청피질순화ACTH적수평,병대복발조중혈청피질순、ACTH강저적15례환인조정치료방안위갑발니룡편혹갑발니룡편연합ACTH침정맥적주.결과 당피질격소치료전,복발조、미복발조급건강대조조혈청피질순、ACTH수평차이균무통계학의의(P균＞0.05);당피질격소유도완해치료후,복발조혈청피질순、ACTH수평균현저저우미복발조,차이균유통계학의의[(113.03±80.02) μg/L비(251.54±185.05) μg,/L,t=-2.925,P＜0.05;(12.81±10.14) ng/L비(23.53±12.05) ng/L,t=-0.885,P＜0.05];기중복발조15례환인혈청피질순、ACTH출현강저,조정치료방안치료8～12주후,혈청피질순수평교조정치료방안전승고,차이유통계학의의[(168.90±133.43) μg/L비(73.62-±58.04) μg/L,t =3.016,P＜0.05];혈청ACTH수평조정치료방안전후비교차이무통계학의의[(14.05±10.99) ng/L비(8.72±4.11) ng/L,t=1.991,P＞0.05];월평균복발차수교조정치료방안전강저,차이유통계학의의[(0.09±0.08)차비(0.35±0.11)차,t=-7.560,P＜0.05].결론 혈청피질순、ACTH적수평재일정정도상가평고SSNS환인복발적풍험,대기진행유효간예가감소기복발솔.
Objective To investigate the changes in serum cortisol and adrenocorticotrophic hormone(ACTH) levels in children with steroid-sensitive nephritic syndrome (SSNS) and the clinical significance of intervention.Methods According to whether a child with SSNS would relapse,48 children with SSNS were divided into non-recurrence group(n =19) and recurrence group(n =29),at the same time 14 age-matched healthy children were enrolled as the healthy control group.Serum cortisol and ACTH were measured in patients with SSNS by using electrochemiluminesence methods.In recurrence group,methylpredisolone or methylprednisolone combined with ACTH injection therapy was used on 15 patients with their serum cortisol and ACTH below normal.Results Before standard glucocorticoid treatment,the serum levels of cortisol and ACTH had no difference among 3 groups (all P ＞ 0.05).By the end of remission phase,the serum levels of cortisol and ACTH in recurrence group were statistically lower than those of the non-recurrence group[(113.03 ± 80.02) μg/L vs (251.54 ± 185.05) μg/L,t =-2.925,P ＜ 0.05 ; (12.81 ± 10.14) ng/L vs (23.53 ± 12.05) ng/L,t =-0.885,P ＜ 0.05].Eight to 12 weeks after being adjusted,the serum level of cortisol and the average monthly time of recurrent were both significantly improved in 15 abnormal children in recurrence group [(168.90 ± 133.43) μg/L vs (73.62 ± 58.04) μg/L,t =3.016,P ＜ 0.05 ; (0.09 ± 0.08) times vs (0.35 ± 0.11) times,t =-7.560,P ＜0.05],but as to the serum level of ACTH,there was no significant difference in abnormal children in recurrence group [(14.05 ± 10.99) ng/L vs (8.72 ± 4.11) ng/L,t =1.991,P ＞ 0.05].Conclusions The concentrations of serum cortisol and ACTH can reveal the risk of recurrence for children with SSNS to some extent,and effective intervention can reduce the recurrence rate and shorten the course of disease.
