微小病变性肾病综合征激素抵抗的多因素分析

Multiple factors analysis of steroid resistance of minimal change nephrotic syndrome

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．

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.