成人原发性肾病综合征激素疗效差异的相关因素

Influential factors for theraputic effect of steroid on adult primary nephrotic syndrome

目的:通过分析经肾活检确诊的成人原发性肾病综合征(primary nephrotic syndrome,PNS)的临床资料,以了解影响该病激素疗效的相关因素。方法:回顾性分析2013年1月至2014年1月间中南大学湘雅二医院肾脏科425例经肾活检确诊的PNS患者的一般资料、实验室检查及肾病理类型。结果:轻微病变、局灶节段肾小球硬化、Ig A肾病对激素治疗敏感(P<0.05);14~24岁患者较其他年龄组的患者对激素的敏感性要高(P<0.05)。激素抵抗组与非激素抵抗型肾病综合征组比较Ig A水平明显下降(P<0.05),激素抵抗型肾病综合征组治疗前后24 h尿蛋白定量的比较,差异无统计学意义(P>0.05),非激素抵抗型肾病综合征组治疗前后24 h尿蛋白定量的比较,差异有统计学意义(P<0.05)。结论:肾疾病的病理类型及患者的年龄与激素疗效存在一定的关系。Ig A水平的相对降低可能与PNS激素疗效有关。

Objective: To determine the factors associated with the ef fect of steroid on adult primary nephrotic syndrome.Methods: The general information, laboratory examination and renal pathological type of 425 patients with primary nephrotic syndrome were retrospectively analyzed.Results: There were signif icant dif ferences in the response to steroid among the pathological types of minimal change disease, focal segmental glomerulosclerosis and Ig A nephropathy. The patients in the age of 14–24 years old showed the strongest response to steroid(P<0.05). The Ig A level in the steroid resistance group was lower than that in the non-steroid resistance group(P<0.05). There was no signif icant dif ference in urine protein in 24 hour quantitation in the steroid resistance group between pre-and post-treatment(P>0.05), while there was signif icant dif ference in urine protein in 24 hour quantitation in the non-steroid resistance group between pre-and post-treatment(P<0.05).Conclusion: Pathological types and ages of the patients are related to the steroid curative effect. The decrease in IgA probably affects the effect of steroid on primary nephrotic syndrome.