儿童原发性肾病综合征尿蛋白转阴时间的多因素分析

Multiple-factor analysis of proteinuria elimination time in children with primary nephrotic syndrome

目的分析儿童原发性肾病综合征激素治疗后尿蛋白转阴时间的影响因素。方法 146例原发性肾病综合征患儿行激素治疗后,可评价疗效136例。按照尿蛋白转阴时间分为A组(尿蛋白转阴时间≤1周)和B组(1周<尿蛋白转阴时间≤2周)。其中A组男44例,女4例;B组男74例,女14例。对患儿各种常规情况、生化指标行单因素分析及多因素Logistic回归分析。结果单因素分析显示,父母认知情况、水肿程度、水肿至口服激素时间、是否存在合并感染、入院时血浆IgM水平、血浆白蛋白水平、胶体渗透压等指标在A、B组间差异有统计学意义(P<0.05)。多因素Logistic回归分析提示:父母认知情况差(P=0.004,OR=0.087)、水肿至口服激素时间长(P=0.000,OR=20.676)、胶体渗透压低(P=0.025,OR=0.649)与尿蛋白转阴时间有关。结论父母认知情况差、水肿至口服激素时间长、胶体渗透压低为原发性肾病综合征患儿尿蛋白转阴时间>1周的危险因素,与患儿的不良预后相关,临床应予以高度重视。

Objective To analyze the influencing factors of proteinuria elimination time after hormone therapy in children with primary nephrotic syndrome（PNS）. Methods 146 cases of children with PNS were treated by hormone, and among them 136 patients were evaluated for efficacy and tolerability. The patients were divided into two groups according to proteinuria elimination time. The proteinuria elimination time ≤1 week of patients were in group A, while 1 week proteinuria elimination time ≤2 weeks of patients were in group B. There were 44 male and 4 female in group A,and 74 male and 14 female in group B respectively.Children＇s characteristics and laboratory indicators were collected,and then the univariate analysis and multiple-factor Logistic regression analysis were performed. Results Univariate analysis showed that indicators of awareness of parents, degree of swelling, time from edema to oral hormone, with or without infection, plasma IgM level, level of albumin, colloid osmotic pressure were significant differences between group A and group B（P〈0.05）. Multiple-factor Logistic regression analysis showed that poor awareness level of parents（P=0.004, OR=0.087）, long time from edema to oral hormone（P=0.000, OR=20.676）, low plasma colloid osmotic pressure（P=0.025, OR=0.649） were related to proteinuria elimination time. Conclusion Poor awareness level of parents, long time from edema to oral hormone, low plasma colloid osmotic pressure are the risk factors of proteinuria elimination time〉1 week in children with PNS, which also relate to the worse prognosis and need to be paid more attention in clinic.