510例小儿肾病综合征激素耐药调查及其影响因素分析

Influencing factors and hormone resistance of 510 children with nephrotic syndrome

目的 调查510例小儿肾病综合征激素耐药情况及分析其影响因素。方法 回顾性收集并分析南京医科大学附属儿童医院2019年1月至2023年8月收治的510例原发性肾病综合征患儿病例资料,经常规足量泼尼松连续治疗8周后行尿蛋白检测,按尿蛋白(+~+++)列为耐药组,尿蛋白(-)列为对照组,比较两组患儿一般资料、病理类型、实验室指标等参数,采用单因素、logistic回归分析筛选造成肾病综合征患儿出现激素耐药的危险因素。结果 (1)8周治疗结束后,510例患儿中,尿蛋白(+)患儿为19例、尿蛋白(++)患儿为22例、尿蛋白(+++)患儿为12例、尿蛋白(-)患儿为457例,总计出现激素耐药患儿(耐药组)人数为53例(10.39%,53/510),激素敏感患儿(对照组)人数为457例(89.61%,457/510);(2)耐药组患儿起病年龄>8岁与局灶阶段性肾小球硬化病理类型占比均高于对照组(P<0.05);(3)单因素分析结果显示,耐药组患儿发病时尿蛋白、红细胞沉降率、白细胞计数、CD_(8)、血肌酐、尿素氮、D-二聚体、β_(2)微球蛋白相较于对照组患儿更高(P<0.05),耐药组患儿发病时CD_(4)、25羟维生素相较于对照组更低(P<0.05);(4)多因素分析结果显示,发病时尿蛋白、红细胞沉降率、CD_(8)、血清肌酐、D-二聚体、β_(2)微球蛋白偏高,25羟维生素、CD_(4)偏低是造成肾病综合征患儿出现激素耐药的危险因素(P<0.05)。结论 对于起病年龄晚于8岁及发病时呈现高尿蛋白、红细胞沉降率、CD_(8)、血清肌酐、D-二聚体、β_(2)微球蛋白,低25羟维生素、CD_(4)的患儿应尽早启动针对性抗凝、免疫调节等治疗,以达到最佳疗效和改善预后。

Objective To investigate the hormone resistance and analyze its influencing factors in 510 children with nephrotic syndrome.Methods The clinical data of 510 children with primary nephrotic syndrome admitted to our hospital from January 2019 to August 2023 were retrospectively collected and analyzed.After 8 weeks of continuous treatment with conventional full-dose prednisone,urine protein detection was performed.Urine protein(+-+++) was listed as drug-resistant group,and urine protein(-) was regarded as control group.The general data,pathological types,and laboratory indicators were compared.Univariate analysis and Logistic regression analysis were used to screen the risk factors for hormone resistance in children with nephrotic syndrome.Results(1) After the end of 8 weeks of treatment,among the 510 children,there were 19 children with urine protein(+),22 children with urine protein(++),12 children with urinary protein(+++) and 457 children with urine protein(-).The total number of children with hormone resistance(drug-resistant group) was 53 cases(10.39%,53/510),and the number of children with hormone sensitivity(control group) was 457 cases(89.61%,457/510).(2) The proportions of children with onset age>8 years old and pathological type of focal stage glomerulosclerosis in drug-resistant group were higher than those in control group(P<0.05).(3) Univariate analysis showed that the urine protein,erythrocyte sedimentation rate,white blood cell count,CD_8,serum creatinine,urea nitrogen,D-dimer and β2-microglobulin at disease onset were higher in drug-resistant group than those in control group(P<0.05) while the CD_(4) and 25-hydroxyvitamin at disease onset were lower than those in control group(P<0.05).(4) Multivariate analysis showed that high urine protein,erythrocyte sedimentation rate,CD_8,serum creatinine,D-dimer and β2-microglobulin,and low 25-hydroxyvitamin and CD4 at disease onset were risk factors for hormone resistance in children with nephrotic syndrome(P<0.05).Conclusion For children with onset age later than 8 years old and high urine protein,erythrocyte sedimentation rate,CD_8,serum creatinine,D-dimer and β2-microglobulin and low 25-hydroxyvitamin and CD_(4) at disease onset,it is necessary to take targeted anticoagulation,immune regulation and other treatments as soon as possible in order to achieve the best efficacy and improve the prognosis.