儿童紫癜性肾炎10年预后分析

Prognosis of Henoch-Schnlein purpura nephritis in the past decade

目的探讨紫癜性肾炎(HSPN)患儿的预后,评价可能的影响因素。方法随访1999-2008年101例有肾活检资料的HSPN患儿,应用Kaplan-Meier法和Logrank检验分析患儿肾脏损害缓解情况,同时对患儿的诊断和治疗方案进行评估。结果根据就诊时间,前5年组(1999—2003年)包括39例HSPN患儿,后5年组(2004—2008年)62例。两组间性别、年龄和肾外表现差异无统计学意义。后5年组从发现尿常规异常到接受肾脏活检的时间为(6.63±1.24)个月,少于前5年组的(13.47±3.08)个月(P<0.05)。在治疗方案上,前5年组多选择静脉冲击环磷酰胺(30.8%比9.7%,P<0.01),后5年组患儿则多接受霉酚酸酯(10.3%比30.6%,P<0.05)和血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)(51.3%比74.2%,P<0.05)。前5年组患儿肾脏损伤相对较严重(41.0%比22.6%),而后5年组患儿肾脏功能的恢复优于前5年组(χ2=4.709,P<0.05)。结论近10年来HSPN患儿的预后明显改善,其原因可能与早期接受肾脏活检,合理的治疗策略如应用霉酚酸酯和ACEI/ARB药物等有关。

Objective To evaluate the prognosis of children with Henoch-Schnlein purpura nephritis（HSPN）in the past decade,from 1999 to 2008,and to analysis the possible influence effactors.Methods A total of 101 HSPN patients with renal biopsy were followed up.Kaplan-Meier analysis and the Logrank test were applied to study the renal remission.Meanwhile,the diagnosis and management of HSPN were evaluated.Results According to period,there were 39 patients in the first five years（from 1999 to 2003,early group）,and 62 patients in the second five years（from 2004 to 2008,late group）respectively.There were no significant differences in sex,age and extrarenal manifestations between early and late group.The mean elapsed time between abnormal urine routine examination to acceptance of renal biopsy was significantly shorter in later group（6.63 ± 1.24 months）than that in early group（13.47 ± 3.08 months）（P 〈0.05）.Compared the treatment between two groups,in early group,there were more patients having therapy with intravenous cyclophosphamide（30.8% vs.9.7%,P〈 0.01）;and less patients having therapy with new immunosuppressive agents mycophenolate mofetil（MMF）and ACE inhibitor plus angiotensin receptor blocker（ACEI/ARB）（10.3% vs.30.6%,and 51.3% vs.74.2%,all P 〈0.05）.In early group,the patients had more severity and extent of renal lesion than that in late group（41.0% vs.22.6%）.The recovery of renal function was better in late group than that in early group（χ2 = 4.709,P 〈0.05）.Conclusions The prognosis of pediatric HSPN patients was significantly improved from 1999 to 2008,which might be attributed to earlier renal biopsy,rational treatment strategies,e.g.MMF and ACEI/ARB.