儿童原发性肾病综合征并发感染的临床分析

Clinical Analysis of Primary Nephrotic Syndrome Complicated with Infections in Children

目的:分析儿童原发性肾病综合征(PNS)并发感染的相关影响因素。方法:选取2015年1月-2018年12月广西医科大学第一附属医院儿科一区住院患者中合并感染的PNS患儿342例为感染组,选取同期收治的无感染原发性肾病综合征患儿91例为非感染组。回顾性分析两组患儿临床资料,总结PNS患儿并发感染的危险因素。结果:两组患儿IgA、IgM、总T细胞、CD4^(+)、CD8^(+)、NK细胞、补体C4、24 h尿蛋白定量、血肌酐比较,差异无统计学意义(P>0.05);感染组IgG、白蛋白、补体C3低于非感染组,差异有统计学意义(P<0.05);感染组尿素氮、总胆固醇水平高于非感染组,差异有统计学意(P<0.05)。单独激素治疗患儿的白蛋白、IgG、IgA、IgM、CD4^(+)水平与激素联合其他免疫抑制剂治疗的患儿比较,差异无统计学意义(P>0.05)。单独激素治疗患儿的总T细胞、CD8^(+)细胞均低于激素联合免疫抑制剂治疗的患儿,差异有统计学意义(P<0.05)。单因素分析结果显示,PNS并发感染与低白蛋白血症、低IgG血症、低补体C3血症、高尿素氮血症、高胆固醇血症相关。通过二元logistic回归分析进一步提示,低白蛋白血症为PNS并发感染的高危因素。结论:低白蛋白血症是PNS并发感染的高危因素,激素对T淋巴细胞的免疫抑制效果优于免疫抑制剂环磷酰胺、霉酚酸酯、他克莫司。

Objective:To analyze the related influencing factors of primary nephrotic syndrome(PNS)complicated with infection in children.Methods:A total of 342 PNS children complicated with infection who were hospitalized in First Ward of Department of Pediatrics at the First Affiliated Hospital of Guangxi Medical University from January 2015 to December 2018 were selected as the infection group.During the same period,91 PNS children without infection were selected as non-infection group.The clinical and laboratory data were retrospectively analyzed.The risk factors of PNS children complicated with infection were analyzed.Re⁃sults:There were no statistically significant differences in the quantitation of IgA,IgM,total T cells,CD4^(+),CD8^(+),NK cell levels,complement C4,and 24-h urine protein between the two groups(P>0.05).The IgG,albumin and complement C3 in the infection group were lower than those in the non-infection group,and the difference was statistically significant(P<0.05);the levels of urea nitrogen and total cholesterol in the infection group were higher than those in the non-infection group,and the difference was sta⁃tistically significant(P<0.05).There were no statistically significant differences in the levels of albumin,IgG,IgA,IgM and CD4^(+)between the children treated with hormone alone and the children treated with hormone and immunosuppressants(P>0.05).The total T cells and CD8 cells of the children treated with hormone alone were lower than those of the children treated with hor⁃mone and immunosuppressants,and the differences were statistically significant(P<0.05).Univariate analysis showed that PNS complicated infection was associated with hypoalbuminemia,hypoimmunoglobulinemia,hypocomplementemia,hyperuricacidemia and hypercholesterolemia,and binary logistic regression analysis further suggested that hypoalbuminemia was the high-risk factor for PNS complicated with infection.Conclusion:Hypoalbuminemia is a high-risk factor for PNS complicated with infection.The immunosuppressive effect of hormone on T lymphocytes is better than that of immunosuppressive agents(cyclophosphamide,myco⁃phenolate mofetil,、tacrolimus).