微小病变型肾病临床治疗疗效分析

发布时间：2019-07-10 16:00

【摘要】：目的：分析研究微小病变型肾病（minimal change disease，MCD）糖皮质激素治疗疗效及可能影响其复发的相关因素，为激素治疗缓解后的MCD患者后续治疗提供理论依据。方法：回顾性分析2010年6月-2013年9月上海交通大学附属第一人民医院肾内科住院的MCD患者，经筛选共65例病人入组。根据激素治疗效果、肾病综合征复发情况分成观察到复发组23例、未观察到复发组34例、其他8例。对无相关禁忌MCD患者，首选糖皮质激素治疗，对复发患者，再次使用和初发相同剂量的激素治疗。对频繁复发和激素依赖患者，根据具体情况予以激素联合环磷酰胺、环孢霉素或他克莫司治疗。观察患者的一般情况及临床、实验室指标，应用SPSS17.0统计软件进行分析。结果：复发组平均年龄小于未观察到复发组，病程大于未复发组，糖尿病、高血压患病率高于未复发组，差异均有统计学意义（P＜0.05）。年龄与MCD复发的相关性有统计学意义（P＜0.05）。促甲状腺激素（thyroid stimulating hormone，TSH）正常组与TSH升高组在MCD转归上无统计学差异（P＞0.05），TSH升高组治疗前后血白蛋白均低于TSH正常组，差异有统计学意义（P＜0.05）。三组细胞毒药物治疗后，组间差异均无统计学意义（P＞0.05）。结论：年龄与MCD复发相关，发病年龄小的MCD患者更倾向于复发。TSH升高的MCD患者治疗前后血白蛋白均低于TSH正常者，，但甲状腺激素水平与MCD复发无关。三种细胞毒药物治疗MCD效果无显著差异，在使用时应注意评估获益与风险。
[Abstract]:Objective: to analyze the curative effect of glucocorticoid therapy and the related factors affecting its recurrence in patients with minimal kidney disease (minimal change disease,MCD), and to provide theoretical basis for the follow-up treatment of MCD patients after remission of hormone therapy. Methods: from June 2010 to September 2013, 65 patients with MCD were selected from the Department of Nephrology, the first people's Hospital affiliated to Shanghai Jiaotong University. According to the effect of hormone therapy, the recurrence of nephrotic syndrome was divided into three groups: recurrent group (n = 23), non-recurrent group (n = 34) and other 8 cases. For patients with MCD without related taboos, glucocorticoid therapy was preferred, and recurrent patients were treated with the same dose of hormone as the initial dose. Patients with frequent recurrence and hormone dependence were treated with hormone combined with cyclophosphamide, cyclosporine or tacrolimus as appropriate. The general situation, clinical and laboratory indexes of the patients were observed and analyzed by SPSS17.0 statistical software. Results: the average age of recurrence group was lower than that of non-recurrence group, the course of disease was higher than that of non-recurrence group, and the prevalence rate of diabetes mellitus and hypertension was significantly higher than that of non-recurrence group (P < 0.05). The correlation between age and recurrence of MCD was statistically significant (P < 0.05). There was no significant difference in the outcome of MCD between the normal group and the group with elevated TSH (P > 0.05). The serum albumin in the group with elevated thyrotropin (thyroid stimulating hormone,TSH was lower than that in the group with normal TSH before and after treatment, and the difference was statistically significant (P < 0.05). There was no significant difference between the three groups after cytotoxicity treatment (P > 0.05). Conclusion: age is associated with recurrence of MCD, and MCD patients with younger onset age are more likely to recur. Serum albumin in patients with elevated MCD is lower than that in patients with normal TSH before and after treatment, but thyroid hormone level is not related to recurrence of MCD. There was no significant difference in the efficacy of the three cytotoxicity drugs in the treatment of MCD, and attention should be paid to evaluating the benefits and risks when using them.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

【共引文献】