肾病综合征合并甲型H1N1流感15例临床研究

Clinical analysis of nephrotic syndrome combined with H1N1 influenza in 15 children

目的探讨肾病综合征合并甲型H1N1流感的临床特点。方法回顾分析15例肾病综合征合并甲型H1N1流感患儿的临床表现、实验室及影像学检查、治疗措施及预后。结果 15例确诊肾病综合征患儿均符合甲型H1N1流感诊断标准。患儿中位年龄4岁8个月(2岁2个月~6岁9个月),均单用激素或联合其他免疫抑制剂治疗;重症患儿3例,危重型患儿5例。4例患儿的肾病综合征全面复发,其中2例并发急性肾功能不全。所有患儿在入院时均给予奥司他韦抗病毒治疗,4例在起病48 h内使用奥司他韦,该4例患儿均表现为普通型甲型H1N1流感。14例患儿的甲型H1N1流感治愈出院,尿蛋白明显好转或转阴,中位住院时间8天(1~25天);1例患儿死亡,死于急性坏死性脑病、脑疝。结论肾病综合征患儿是重症或危重型甲型H1N1流感的高危人群,甲型H1N1流感流行期,应对肾病综合征患儿采取临床预防措施。

ObjectiveTo explore the clinical features of nephrotic syndrome combined with H1N1 infuenza. Methods The clinical manifestations, laboratory and image examinations, treatment, and prognosis of nephrotic syndrome combined H1N1 infuenza were retrospectively analyzed in 15 children with. ResultsAll of 15 children with nephrotic syndrome met the diagnostic criteria of H1N1 infuenza. The median age of all children was 4-year-8-month old （2-year-2-month to 6-year-9-month）. All children were treated with hormone alone or combined with other immunosuppressive drugs. Three cases were severe and another 5 cases were critically ill. Four cases were complicated with recurrence of nephrotic syndrome, 2 of which suffered from acute renal insuffciency. All children were given oseltamivir as antiviral treatment at admission. Four cases took oseltamivir within 48 hours of onset and showed mild symptoms. Fourteen children with H1N1I infuenza were cured, their urinary proteins were signifcantly decreased or converted to negative, and the median hospital stay was 8 days （1 to 25 days）. One child died of acute necrotizing encephalopathy and brain herniation. ConclusionsChildren with nephrotic syndrome are susceptible to severe or critical H1N1 infuenza infections. During the epidemic of H1N1 infuenza, the clinical preventive measures should be taken in children with nephrotic syndrome.