肾病综合征初发激素耐药患儿免疫功能特征

The Characteristics of Lymphocyte Subsets and Immunoglobulin Levels in Children with Steroid-Resistant Nephrotic Syndrome

目的:了解激素耐药型肾病综合征(NS)患儿临床特征,并探讨免疫功能(淋巴细胞亚群与免疫球蛋白水平)与激素抵抗性肾病综合征的相关性。方法:纳入2018年9月1日—2022年6月30日115例NS患儿,根据是否初发分为初发组(PNS)和复发组(RNS),根据PNS组患儿对激素治疗反应分为激素敏感型组(SSNS)和激素耐药型组(SRNS)。分别评估临床特征、淋巴细胞亚群和免疫球蛋白水平,并分析PNS组SRNS的影响因素。结果:(1)115例NS患儿中PNS 67例,SRNS 21例(31.34%)。(2)和RNS组相比,PNS组病程更长(P<0.05),水肿程度更重(P<0.05),CD4+/CD8+更大(P=0.03),IgG/IgM更小(P<0.05),而PNS与RNS组间CD3+、CD4+、CD8+、CD19+、CD56+以及IgG、IgM、IgA水平均无显著差异(均P>0.05)。(3)和SSNS组相比,SRNS组胆固醇、尿蛋白水平更高(P<0.05),CD3+更低(P<0.05),其余指标SSNS与SRNS间比较差异无统计学意义(P>0.05)。多因素Logistic回归示尿蛋白增加会增加激素耐药的风险(P=0.034),CD3+增加可降低激素耐药的风险(P=0.001)。结论:PNS患儿高尿蛋白水平和低CD3+水平是发生SRNS的高危因素。

Objective:Define the characteristics at initial diagnosis and investigate the association of both lymphocyte subsets and immunoglobulin levels with steroid-resistant nephrotic syndrome in children.Methods:115 children with NS were included from September 1st,2018 to June 30 th,2022.They were divided into primary group(PNS)and recurrent group(RNS)according to whether they were primary.Children in PNS group were divided into steroid sensitivity group(SSNS)and steroid resistance group(SRNS).Evaluated clinical features,lymphocyte subsets and immunoglobulin levels of these patients,and analyzed their potential impacts on steroid resistance.Results:(1)Of 67 evaluated children who were initial diagnosis as primary nephrotic syndrome(PNS),21(31.34%)showed steroid resistance.(2)Compared with the RNS group,the PNS group had a longer course and a severer degree of edema,the IgG/IgM ratio was significantly lower,while the CD4+/CD8+ratio was significantly higher(all P<0.05).There were no significant differences between the two groups in both the lymphocyte subsets of CD3+,CD4+,CD8+,CD19+,CD56+(P>0.05)and the immunoglobulin levels of IgG,IgM,IgA(all P>0.05).(3)Compared with SSNS group,SRNS group showed statistically significantly higher cholesterol and urine protein levels,and lower CD3+(all P<0.05).The multivariate logistic regression equation found that an increase in urine protein increased the risk of hormone resistance and was statistically significant(P=0.034).An increase in CD3+reduced the risk of hormone resistance(P=0.001).Conclusion:Higher level of urine protein and lower level of CD3+suggest a high potential for SRNS in PNS group.