EB病毒感染对儿童原发性肾病综合征激素疗效及复发的影响

发布时间：2018-02-28 05:03

本文关键词： 原发性肾病综合征 EB病毒儿童糖皮质激素　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的原发性肾病综合征(primary nephrotic syndrome,PNS)是中国儿童常见的肾小球疾病,年患病率为16/10万。EB病毒(Epstein-Barr virus,EBV)是全人类普遍存在的一种病毒,超过90%以上的成人EBV血清抗体阳性。儿童主要通过唾液传播,也可经过血液传播,亦可通过造血干细胞移植或实体器官移植进行传播,一旦感染便会在宿主体内终生存在。EBV感染可引起T细胞和B细胞免疫功能异常,而肾病综合征患儿容易合并EBV感染。但EBV感染对儿童PNS激素疗效及频复发/激素依赖的影响尚不清楚。本研究旨在探讨儿童PNS患儿的EBV感染率、EBV感染对儿童单纯型PNS激素反应性的影响、EBV感染与儿童单纯型激素敏感型肾病综合征(steroid-sensitive nephrotic syndrome,SSNS)频复发/激素依赖的关系。方法对650例PNS患儿进行回顾性分析,应用实时荧光定量PCR检测650例患儿的外周血单个核细胞EBV DNA,并采用统计学方法统计EBV感染率及分析其流行病学特征;将可对比的EBV感染组的单纯型PNS初发患儿与非EBV感染组的单纯型PNS初发患儿应用足量糖皮质激素(glueocorticosteroid,GC)4周、8周内对GC的反应性进行对比;将可对比的EBV感染的单纯型SSNS患儿中1年内频复发/激素依赖百分比与非EBV感染组进行比较。数据处理应用SPSS19.0统计软件包,采用p0.05作为检验显著性标准。结果 1、650例原发性肾病综合征患儿293例感染EBV,感染率为45.08%,高于健康患儿;10月~2岁PNS患儿中EBV感染率最高(60.25%),PNS患儿中EBV感染率无季节差异性。2、EBV感染组101例单纯型PNS初发患儿足量GC治疗4周内尿蛋白转阴92例,占91.09%;8周内转阴者97例,占96.4%;非EBV感染组共107例单纯型PNS初发患儿,足量GC治疗4周内转阴99例,占92.52%;8周内转阴者102例,占96.26%;两组比较差异无统计学意义。3、EBV感染的单纯型SSNS患儿中1年内频复发/激素依赖比例与非EBV感染组比较结果如下:EBV感染组频复发/激素依赖占15.5%(11/71),非EBV感染组频复发/激素依赖占15.7%(14/89),差异无统计学意义。结论本回顾性研究显示尽管儿童原发性肾病综合征患儿EBV感染率比健康人群高,但是EBV感染既不影响单纯型PNS患儿对GC的反应性,也不是单纯型SSNS患儿频复发/激素依赖的因素。该结论有待于多中心、前瞻性、随机对照试验以进一步证实。
[Abstract]:Objective Primary nephrotic syndrome (PNS) is a common glomerular disease in Chinese children. The annual prevalence rate of Epstein-Barr virus (EBV) is 16/10 000. More than 90% adults are positive for EBV seroantibodies. Children are mainly transmitted through saliva, blood, hematopoietic stem cell transplants or solid organ transplants. Once infected, the presence of EBV in the host for life may lead to abnormal immune function of T and B cells. However, the effect of EBV infection on the effect of PNS hormone and frequent recurrence / hormone dependence in children with PNS was not clear. The purpose of this study was to investigate the prevalence of EBV infection in children with PNS. The relationship between PNS infection and frequent recurrence / hormone dependence of steroid-sensitive nephrotic syndromes in children with steroid-sensitive nephrotic syndrome were retrospectively analyzed. The EBV DNA of peripheral blood mononuclear cells (PBMC) of 650 children was detected by real-time fluorescence quantitative PCR. The infection rate of EBV and its epidemiological characteristics were analyzed by statistical method. The reactivity of glucocorticoid glueocorticoid to GC was compared in the primary EBV group and the simple PNS group within 4 weeks and 8 weeks respectively. The 1-year recurrent / hormone dependent percentage of simple SSNS patients with EBV infection was compared with that of non-#en2# infected children. The data was processed with SPSS19.0 statistical software package. Results 1,650 children with primary nephrotic syndrome were infected with EBV, the infection rate was 45.08, which was higher than that of healthy children, and in October, the highest rate of EBV infection was 60.25% in children with PNS. There was no seasonal difference in the infection rate of EBV in 1,650 children with primary nephrotic syndrome. In the group of heterosexual. 2EBV infection, 92 cases of urine protein turned negative in 4 weeks after full GC treatment of simple PNS. 97 cases (96.4%) turned negative in 91.09 weeks, 107 cases in non-#en0# infection group, 99 cases in 4 weeks after full GC treatment, 102 cases in 92.52 weeks. There was no significant difference between the two groups in the frequency of recurrence / hormone dependence in children with simple SSNS infection in one year. The results were as follows: 1% EBV infection group had frequent recurrence / hormone dependence rate of 15.55% / 71%, and non-EBV infection group had frequency of 15. 5% / 71%, while that of non-EBV infection group was higher than that of non-EBV group. Recurrence / hormone dependence accounted for 15.7 / 89% of the total. Conclusion this retrospective study showed that EBV infection rate in children with primary nephrotic syndrome was higher than that in healthy persons. However, EBV infection does not affect the reactivity to GC in children with simple PNS, nor is it a factor of frequent recurrence / hormone dependence in children with simple SSNS. This conclusion needs to be further confirmed by multicenter, prospective and randomized controlled trials.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R726.9

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