CAJ | 학술논문

目的：探讨微小病变性肾病综合征激素抵抗的相关危险因素．方法：回顾性调查68例经肾组织活检确诊为微小病变性肾小球肾炎患者临床资料，实验室检查结果及随访情况，将患者分为激素抵抗组（30例）及非抵抗组（38例），采用 SPSS17.0软件，进行单因素分析，对有意义的单因素采用二分类 Logistic 回归进行多因素分析，绘制受试者工作特性曲线（ROC）评价检验指标在预测微小病变性肾病综合征激素抵抗时的敏感度，特异度和最佳临界值．结果：单因素分析显示合并感染、尿镜下红细胞水平、总胆固醇、24h 尿蛋白定量、高尿酸，血清白蛋白及补体 C4下降是激素抵抗型微小病变性肾病综合征的相关因素（P≤0.05），有统计学差异．多因素分析显示感染、尿镜下红细胞水平、24 h 尿蛋白定量是激素抵抗型微小病变性肾病综合征的独立危险因素，OR（95％IC）分别为4.265（1.033～17.609，P ＝0.045）、2.468（1.124～5.420，P ＝0.024）、1.001（1.000～1.002，P ＝0.039）．ROC 曲线分析显示当尿镜下红细胞≥3.5／HP，24 h 尿蛋白定量超过5.57 g／d，总胆固醇高于9.49 mmol／L 是判断激素抵抗型微小病变性肾病综合征的最佳诊断临界值．结论：（1）感染、血尿、24 h 尿蛋白定量是激素抵抗型微小病变性肾病综合征的独立危险因素．（2）当出现血尿，24 h 尿蛋白定量≥5.57 g／d，总胆固醇≥9.49 mmol／L 时应警惕激素抵抗型微小病变性肾病综合征的发生．
목적：탐토미소병변성신병종합정격소저항적상관위험인소．방법：회고성조사68례경신조직활검학진위미소병변성신소구신염환자림상자료，실험실검사결과급수방정황，장환자분위격소저항조（30례）급비저항조（38례），채용 SPSS17.0연건，진행단인소분석，대유의의적단인소채용이분류 Logistic 회귀진행다인소분석，회제수시자공작특성곡선（ROC）평개검험지표재예측미소병변성신병종합정격소저항시적민감도，특이도화최가림계치．결과：단인소분석현시합병감염、뇨경하홍세포수평、총담고순、24h 뇨단백정량、고뇨산，혈청백단백급보체 C4하강시격소저항형미소병변성신병종합정적상관인소（P≤0.05），유통계학차이．다인소분석현시감염、뇨경하홍세포수평、24 h 뇨단백정량시격소저항형미소병변성신병종합정적독립위험인소，OR（95％IC）분별위4.265（1.033～17.609，P ＝0.045）、2.468（1.124～5.420，P ＝0.024）、1.001（1.000～1.002，P ＝0.039）．ROC 곡선분석현시당뇨경하홍세포≥3.5／HP，24 h 뇨단백정량초과5.57 g／d，총담고순고우9.49 mmol／L 시판단격소저항형미소병변성신병종합정적최가진단림계치．결론：（1）감염、혈뇨、24 h 뇨단백정량시격소저항형미소병변성신병종합정적독립위험인소．（2）당출현혈뇨，24 h 뇨단백정량≥5.57 g／d，총담고순≥9.49 mmol／L 시응경척격소저항형미소병변성신병종합정적발생．
Aim:To evaluate risk factors of steroid-resistant minimal change nephrotic syndrome. Methods:retrospectively analysed 68 patients who were confirmed as minimal-change nephritic syndrome by renal biopsies,and divided as group steroid-resistant group(n =30)and non steroid-resistant group(n=38).A univariate analysis was performed firstly.Then the significant ones were performed a multivari-ate analysis by using binary Logistic regression model.Lastly,the sensitivity,the specificity,and the best threshold value of the indexes,which as indicating the steroid-resistant minimal change disease,was testi-fied by drawing a receiver operating characteristic curve(ROC).Results:(1)combined infection(P =0.014),red blood cell count(P =0.005 ),total cholesterol (P =0.015 ),24 h urinary protein (P = <br> 0.000),serum albumin(P =0.011),high urine uric acid(P =0.045),C4 decrease(P =0.028)were all the risk factors of steroid-resistant minimal change disease(P <0.05).(2)And infection(OR 4.265, 95%IC =1.033 ~17.609 P =0.045),red blood cell count(OR 2.468,95%IC =1.124 ~5.420 P =0.024),24 h urinary protein(OR =1.001,95%IC =1.000 ~1.002,P =0.039),were independent risk factors of steroid-resistant minimal change disease.(4)Red blood cell count in urine >3.5 /HP,24 h u-rinary protein >5.57 g/d total cholesterol >9.49 mmol /L were the best threshold value indicating ster-oid-resistant minimal change disease.Conclusion:(1)infection,hematuria,24 h urinary protein quanti-tative is independent risk factors of Steroid-resistant minimal change nephrotic syndrome.(2)when Oc-cur hematuria,24 h urinary proteind≥5.57 g/d,total cholesterol≥9.49 mmol /L,,Should be alert to the occurrence of Steroid-resistant minimal change nephrotic syndrome.