儿童狼疮性肾炎肾转归影响因素分析

发布时间：2018-06-29 09:44

  本文选题：儿童 + 狼疮性肾炎　； 参考：《吉林大学》2017年硕士论文

【摘要】：目的:研究并分析儿童狼疮性肾炎肾转归的影响因素。方法:回顾性分析吉林大学第一医院儿肾科确诊狼疮性肾炎并有完整随访资料的患儿56例,根据治疗结果分为完全缓解和治疗失败两组,应用统计学方法对患儿一般资料、实验室检查、治疗反应及治疗方案进行单因素及多因素分析,明确患儿肾转归的影响因素。结果:1.本研究共收集56例狼疮性肾炎患儿,其中男性8例,占14.29%,女性48例,占85.71%。研究对象中年龄最小者为5岁,年龄最大者为16岁,平均年龄为11.38±2.46岁。出现肾脏表现或尿检查异常至肾活检的时间最长者为6个月,最短者为3天。经过治疗56名患者中40人得到完全缓解,有16人治疗失败。2.根据56名患儿的治疗效果将患儿分为完全缓解组和治疗失败组,比较两组患者的一般资料和治疗期间的相关指标情况,结果显示贫血患者的治疗失败率高于无贫血患者,差异比较有统计学意义(p0.05)。肌酐升高患者的治疗失败率高于肌酐正常的患者,差异比较有统计学意义(p0.05)。24h尿蛋白定量≥50mg/kg的患者治疗失败率明显高于24h尿蛋白定量50mg/kg的患者,差异比较有统计学意义(p0.05)。ds-DNA阳性的患者治疗失败率高于ds-DNA阴性的患者,差异比较有统计学意义(p0.05)。诱导治疗非完全反应患者治疗失败率高于诱导治疗完全反应的患者,差异比较有统计学意义(p0.05)。维持期治疗方案霉酚酸酯+激素+环磷酰胺治疗的患者治疗失败率低于霉酚酸酯+激素治疗的患者,差异比较有统计学意义(p0.05)。其他相关独立因素在完全缓解组与治疗失败组间的差异无明显统计学意义(p0.05)。3.采用Logistic回归多因素分析结果显示尿蛋白、诱导治疗反应、维持期治疗方案为影响最终肾转归的独立影响因素。24h尿蛋白定量≥50mg/kg的患者发生治疗失败的风险远远高于24h尿蛋白定量50mg/kg的患者,OR为10.433,95%CI为1.445~75.301。对于诱导治疗反应,完全反应的患者发生治疗失败的风险低于非完全反应的患者,OR为0.251,95%CI为0.073~0.856。对于维持治疗方法,采用霉酚酸酯+激素+环磷酰胺治疗的患者发生治疗失败的风险低于采用霉酚酸酯+激素的患者,OR为0.122,95%CI为0.018~0.837。结论1.病初贫血、肌酐升高、肾病水平蛋白尿、ds-DNA滴度升高为患儿肾转归不良的危险因素。2.肾病水平蛋白尿、诱导治疗呈非完全反应为患儿肾转归不良的独立危险因素。3.维持期多种免疫抑制剂联合治疗对患儿肾转归有积极意义。
[Abstract]:Objective: to study and analyze the influencing factors of renal outcome in children with lupus nephritis. Methods: 56 cases of lupus nephritis diagnosed in Department of Pediatrics and Kidney, first Hospital of Jilin University were analyzed retrospectively. According to the results of treatment, 56 cases were divided into two groups: complete remission group and failed treatment group. The general data of the children were analyzed by statistical method. Laboratory examination, treatment response and treatment regimen were analyzed by single factor and multivariate analysis to determine the influencing factors of renal outcome in children. The result is 1: 1. In this study, 56 children with lupus nephritis were collected, including 8 males (14.29%) and 48 females (85.71%). The youngest group was 5 years old, the oldest was 16 years old, the average age was 11.38 卤2.46 years. The longest time to renal biopsy was 6 months, and the shortest was 3 days. Of the 56 patients treated, 40 had complete remission and 16 failed. 2. 56 children were divided into complete remission group and failed treatment group according to the effect of treatment. The results showed that the treatment failure rate of anemia patients was higher than that of non-anemia patients. The difference was statistically significant (p 0.05). The treatment failure rate of patients with creatinine elevation was higher than that of patients with normal creatinine. The difference was statistically significant (p0.05). The failure rate of patients with 24 hours urinary protein 鈮，

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