原发性肾病综合征合并无菌性股骨头坏死的临床研究

发布时间：2018-01-02 16:09

本文关键词：原发性肾病综合征合并无菌性股骨头坏死的临床研究　出处：《南京大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：分析原发性肾病综合征(局灶节段性肾小球硬化、IgM肾病、微小病变性肾病)患者合并无菌性股骨头坏死的临床特点及危险因素。方法：回顾性分析2009年1月至2013年12月随访期间原发性肾病综合征合并股骨头坏死的临床资料。结果：3796例原发性肾病综合征门诊随访患者中并发股骨头坏死人数为92人(2.4%)。股骨头坏死组在激素治疗3年内发生股骨头坏死比例为80.4%。多因素Logistic回归分析结果显示低白蛋白血症是原发病肾病综合征患者并发股骨头坏死的危险因素(P0.05)。股骨头坏死组对激素治疗反应、肾病复发次数及糖皮质累积用量与非股骨头坏死组两者统计学无差异(P0.05)。股骨头坏死组血浆白蛋白降低、纤维蛋白原升高及血钙水平降低的患者与非股骨头坏死组有统计学差异(P0.05)。预防使用维生素D制剂及钙剂不能降低股骨头坏死发生。股骨头坏死组与非股骨头坏死组之间年龄、性别、24小时尿蛋白定量、血色素、血小板、尿酸、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、低密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值、血磷无统计学差异(P0.05)结论：原发性肾病综合征患者合并股骨头坏死的发生率为2.4%,在激素治疗3年内并发股骨头坏死的发生率最高。低蛋白血症是原发性肾病综合征合并股骨头坏死的危险因素。股骨头坏死组与非股骨头坏死组之间对激素治疗反应、肾病复发次数及糖皮质激素累积用量两者无统计学差异。预防使用维生素D制剂及钙剂不能降低股骨头坏死发生。对高危患者在激素治疗5月内定期行影像学检查以早期发现股骨头坏死。
[Abstract]:Objective: to analyze the primary nephrotic syndrome (FSGS, IgM nephropathy, minimal change disease) clinical characteristics and risk factors of patients with aseptic necrosis of femoral head. Methods: a retrospective analysis of clinical data from January 2009 to December 2013 during the follow-up period in primary nephrotic syndrome complicated with avascular necrosis of the femoral head. Results: 3796 cases of primary nephrotic syndrome in the outpatient follow-up of patients with avascular necrosis of femoral head for the number 92 (2.4%). The treatment group of avascular necrosis of femoral head necrosis occurred within 3 years the proportion of the Logistic multi factor 80.4%. regression analysis showed that hypoalbuminemia is associated with femoral head necrosis syndrome in patients with risk factors of primary nephropathy the incidence in hormone (P0.05) treatment group. Femoral head necrosis in response to hormone, nephropathy and glucocorticoid cumulative recurrence times no difference between dosage and non necrosis of femoral head (P0.05). The two groups were shares Head necrosis group serum albumin decreased with elevated fibrinogen and serum calcium levels were significantly decreased and non femoral head necrosis group (P0.05). To prevent the use of vitamin D and calcium preparation can reduce the occurrence of femoral head necrosis. Femoral head necrosis between age group and non femoral head necrosis group sex, 24 hours urine protein quantitative, hemoglobin, platelet, uric acid, triglyceride, total cholesterol, low density lipoprotein cholesterol, low density lipoprotein cholesterol and high density lipoprotein cholesterol ratio, no significant difference in serum phosphorus (P0.05) conclusion: Patients with primary nephrotic syndrome complicated with femoral head necrosis occurred in 2.4%, 3 years of treatment in patients with osteonecrosis of the femoral head in hormone highest incidence. Hypoalbuminemia is primary nephrotic syndrome complicated with femoral head necrosis risk factors. Femoral head necrosis between group and non femoral head necrosis group of hormone There was no difference in treatment response, relapse times of renal disease and cumulative dosage of glucocorticoid. Prevention of vitamin D preparation and calcium can not reduce the occurrence of femoral head necrosis. For high-risk patients, during May, regular imaging examination was performed in early stage of steroid therapy to identify osteonecrosis of the femoral head at early stage.

【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692;R681.8

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