原发性肾病综合征患儿复发危险因素及预后分析

Risk factors of recurrence and prognosis in children with primary nephrotic syndrome

目的探讨原发性肾病综合征(PNS)患儿复发的危险因素及预后。方法选择2013年6月至2018年6月南阳市中心医院收治的1042例PNS患儿为研究对象,采集患儿的人口学资料、病情相关指标、复发情况、复发诱因及临床转归等,采用单因素分析和多因素logistic回归分析PNS患儿复发的危险因素。结果1042例PNS患儿中,1028例获得完全缓解,14例始终未获得完全缓解。1028例获得完全缓解患儿中,复发674例(65.56%),未复发354例(34.44%)。674例复发患儿中,具有明确复发诱因者408例(60.53%),主要诱因为呼吸道感染和消化道感染。单因素分析结果显示,患儿的年龄、发病年龄、临床类型、血尿、尿蛋白转阴时间、24 h尿蛋白定量及血清免疫球蛋白M(IgM)水平与PNS复发有关(P<0.05)。多因素logistic回归分析结果显示,临床类型、血尿、尿蛋白转阴时间是PNS患儿复发的危险因素(P<0.05)。674例复发患儿经治疗痊愈164例(24.33%),显效118例(17.51%),有效144例(21.36%),无效248例(36.80%),总有效率为63.20%(426/674)。结论PNS患儿复发率高,多存在明确的复发诱因,且复发患儿临床转归较差;临床类型、血尿、尿蛋白转阴时间是PNS患儿复发的危险因素,应针对这些危险因素采取相应的措施,以降低PNS复发率。

Objective To investigate the risk factors of recurrence and the prognosis in children with primary nephrotic syndrome(PNS).Methods A total of 1042 children with PNS admitted to Nanyang Central Hospital from June 2013 to June 2018 were selected as the research subjects.The demographic data,disease-related indexes,recurrence,recurrence inducements and clinical outcomes of the children were collected.The risk factors for recurrence of PNS were analyzed by univariate and multivariate logistic regression.Results Among the 1042 children with PNS,1028 cases were in complete remission,and 14 cases were not in complete remission.Among the 1028 children with complete remission,674(65.56%)cases relapsed and 354(34.44%)cases did not relapse.Among the 674 cases of recurrent children,408(60.53%)cases had definite causes of recurrence,the main causes were respiratory tract infection and digestive tract infection.The univariate analysis showed that the age,onset age,clinical type,hematuria,the time of urinary protein turning negative,24 h urinary protein quantitation and serum IgM level were related to the recurrence of PNS in children(P<0.05).The multivariate logistic regression analysis showed that the clinical type,hematuria and the time of urinary protein turning negative were the risk factors for recurrence of PNS(P<0.05).There were 164(24.33%)cases in healing,118(17.51%)cases in excellence,144(21.36%)cases in effectiveness and 248(36.80%)cases in inefficiency in the 674 recurrent children after treatment,and the total effective rate was 63.20%(426/674).Conclusion The recurrence rate of PNS children is high,most of them have definite recurrence inducement,and the clinical outcome of recurrent children is poor.The clinical type,hematuria and the time of urinary protein turning negative are the risk factors for the recurrence of PNS in children.Therefore,the corresponding measures should be taken to reduce the recurrence rate of PNS.