肾病综合征患儿频复发相关因素分析及预后

Analysis of Related Factors and Prognosis of Frequent Relapses Nephrotic Syndrome in Children

目的探讨影响小儿肾病综合征(NS)频复发的临床相关因素及预后。方法对35例NS患儿进行门诊或电话、短信随访,随访时间1～15a,了解患儿疾病转归及生活质量,并对获得的完整临床资料进行分析。结果35例患儿中单纯型肾病33例,肾炎型肾病2例。其中6例做过肾活检,病理类型为微小病变4例,系膜增生性肾炎、局灶性节段性肾小球硬化各1例。在频复发的因素中,感染尤其是呼吸道感染比例最高(91.4%),其次为不正规激素治疗(22.8%),再次为持续的高脂血症,尤其是脂蛋白(a)增高(14.8%);精神因素和特应性体质也受到重视。其中不同发病年龄的复发率无显著性差异(P>0.05);激素初治疗程(以6个月为标准)频复发与少复发组比较差异显著(P<0.05)。随访过程中,5例临床治愈,28例完全缓解,2例部分缓解。34例能正常生活,1例出现生长发育迟缓。结论正确使用糖皮质激素,积极控制感染,合理应用免疫抑制剂可减少复发;建立长期随访管理制度对改善小儿NS的预后非常重要。

ObjectiveTo explore the clinical correlative factor and prognosis of frequent relapses nephrotic syndrome（NS） in children.MethodsThirty-five children with NS were followed up（in the out-patient,by telephone and messages） 1-15 years and the whole clinical data including outcome of the diseases and quality of life were analyzed.ResultsAmong the 35 cases,33 cases were simple nephrosis and 2 cases were nephritic nephrosis.And 6 cases had done renal biopsy and got the pathologic types,minimal change nephrotic syndrome 4 cases,mesangial proliferative glomerulonephritis 1 case,focal segmental glomerulosclerosis 1 case.Among frequent relapses factors,infection,especially respiratory tracts infection was the first（91.4%）;the second was treated irregularly with steroids（22.8%）;the third was persistent hyperlipidemia especially lipoprotein（a）（14.8%）;lastly,spirit factors and specific constitutions should be pay more attentions too.After the statistics analysis,there were no evident differences between the children＇s age when the disease came on and frequent relapses（P〉0.05）,period of treatment with steroids when the disease came on（adopting 6 months as criterion） were evidently differences between the frequent relapses group and the few relapses group（P〈0.05）.In follow-up,5 cases were cured,28 cases were completely remission,2 cases were part remission.Thirty-four cases could live normal life,1 case had slow growth and development.ConclusionsTaking steroids correctly,treating infection actively and using immunosuppressant reasonably could reduce times of relapses;at the same time,building long following-up management is very important to improve the prognosis in children with NS.