基于病例对照研究的儿童肾病综合征低白蛋白血症诊断标准探讨

发布时间：2018-07-05 11:42

本文选题：儿童 + 肾病综合征　；参考：《中国循证儿科杂志》2017年02期

【摘要】：目的探讨儿童原发性肾病综合征低白蛋白血症诊断标准。方法收集1993年1月至2012年12月在北京大学第一医院住院的原发性肾病综合征患儿的临床资料,根据初次诊断肾病综合征时的最低血浆白蛋白水平将患儿分为25 g·L~(-1)组和25~30 g·L~(-1)组。比较两组的肾脏病理类型、临床表型、激素效应、合并症和预后。结果进入本文分析患儿458例,白蛋白25~30 g·L~(-1)组28例,白蛋白25 g·L~(-1)组430例,两组性别和年龄差异无统计学意义。(1)血浆白蛋白水平25 g·L~(-1)组和25~30 g·L~(-1)组分别有12例和141例行肾脏病理分析,两组肾脏病理类型分布差异无统计学意义,均以局灶节段性肾小球硬化症为主,两组微小病变或轻微病变分别占21.9%和8.3%;(2)2组临床表型、免疫抑制剂的应用种类、严重合并症的发生情况和激素相关不良反应的发生情况差异均无统计学意义,2组激素效应分布差异有统计学意义,血浆白蛋白水平25 g·L~(-1)组和25~30 g·L~(-1)组激素敏感比例分别为68.4%(294/430)和50.0%(14/28);(3)血浆白蛋白水平25~30 g·L~(-1)组严重预后发生率(14.3%,4/28)高于25 g·L~(-1)组(4.4%,19/430)。结论具有大量蛋白尿伴有血浆白蛋白25~30 g·L~(-1)的患儿肾脏病理类型以非微小病变为主,其预后较血浆白蛋白25 g·L~(-1)者更为严重,建议早期行肾活检。
[Abstract]:Objective to investigate the diagnostic criteria of hypoalbuminemia in children with primary nephrotic syndrome. Methods the clinical data of children with primary nephrotic syndrome were collected from January 1993 to December 2012 in the first Hospital of Peking University. The children were divided into 25 g L ~ (-1) group and 25 ~ (30 g L ~ (-1) group according to the minimum plasma albumin level in the initial diagnosis of nephrotic syndrome. Renal pathological types, clinical phenotypes, hormone effects, complications and prognosis were compared between the two groups. Results there were 458 cases of children with albumin 2530 g L ~ (-1), 28 cases of albumin 2530 g L ~ (-1) and 430 cases of albumin 25 g L ~ (-1). There was no significant difference in sex and age between the two groups. (1) there were 12 cases and 141 cases of renal pathology in 25g L ~ (-1) group and 2530 g L ~ (-1) group, respectively. There was no significant difference in the distribution of renal pathological types between the two groups. Focal segmental glomerulosclerosis was the main type of glomerulosclerosis, with minimal or slight changes accounting for 21.9% and 8.3% respectively. (2) the clinical phenotypes of the two groups and the types of immunosuppressants were used. There was no significant difference in the occurrence of serious complications and the occurrence of steroid related adverse reactions. The sensitive rates of hormone in 25g / L ~ (-1) group and 25g / L ~ (-1) group were 68.4% (294 / 430) and 50.0% (14 / 28 /); (~ (3), respectively. The incidence of severe prognosis in 2530 g / L ~ (-1) group was higher than that in 25 g / L ~ (-1) group (4.44 / 430). Conclusion the renal pathological types of children with massive proteinuria and plasma albumin 2530g L ~ (-1) are mainly non-minimal change, and the prognosis is more serious than that of plasma albumin 25g L ~ (-1). Early renal biopsy is recommended.
【作者单位】：北京大学第一医院儿科;
【分类号】：R726.9

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