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中国循证儿科杂志

中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (2): 131-134.

• 论著 • 上一篇    下一篇

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

管娜，丁洁，杨霁云，肖慧捷，姚勇，刘景城，钟旭辉，王芳，朱赛楠   

  1. 北京大学第一医院儿科 北京，100034
  • 收稿日期:2017-02-27 修回日期:2017-04-25 出版日期:2017-04-25 发布日期:2017-04-25
  • 通讯作者: 丁洁，E-mail: djnc_5855@126.com·论著·

Retrospective case control study on the creteria of hypoalbuminemia in the diagnosis of nephrotic syndrome in children

GUAN Na, DING Jie, YANG Ji-yun, XIAO Hui-jie, YAO Yong, LIU Jing-cheng, ZHONG Xu-hui, WANG Fang, ZHU Sai-nan   

  1. Department of Pediatrics, Peking University First Hospital, Beijing  100034  ,China
  • Received:2017-02-27 Revised:2017-04-25 Online:2017-04-25 Published:2017-04-25
  • Contact: DING Jie, E-mail: djnc_5855@126.com

PDF

1562

被引次数

5

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%；②2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:

Abstract objective: To investigate the diagnostic criteria of hypoalbuminemia in nephrotic syndrome in children. Methods: Data from children with idiopathic nephrotic syndrome hospitalized in Peking University First Hospital during January of 1993 to December of 2012 were collected and analyzed retrospectively. Children were divided into 2 groups, including a group with serum albumin 25 to 30 g·L-1 and another group with serum albumin < 25 g·L-1at onset. Data on children's general information, renal pathology, clinical presentations, treatment, steroid response, serious complications and prognosis were compared between two groups. Results: Data from 458 children were analyzed including 28 cases in group with serum albumin 25 to 30 g·L-1 and 430 cases in group with serum albumin less than 25 g·L-1. No significant differences were found in gender and onset age between two groups. ①Twelve children from group with serum albumin <25 g·L-1 and 141 children from group with serum albumin 25 to 30 g·L-1 underwent renal biopsy. There was no significant difference in the renal pathological diagnosis type between two groups. Focal segmental glomerulosclerosis was the most common pathological change in both groups. Minimal change disease or minor change disease accounted for 21.9% in group with serum albumin < 25 g·L-1 and 8.3% in group with serum albumin 25 to 30 g·L-1. ② There were no significant differences between two groups in the clinical phenotype, the kinds of immunosuppressant, the occurrence of severe complications and the incidence of steroid related adverse events. There was a significant difference in steroid response between the two groups . The steroid response rate was 68.4%（294/430）in group with serum albumin < 25 g·L-1 and 50.0%（14/28）in group with serum albumin 25 to 30 g·L-1. ③The occurrence of serious prognosis in group with serum albumin 25 to 30 g·L-1 was significantly higher than in group with serum albumin < 25 g·L-1（14.3% vs 4.4%，P=0.04）. Conclusion: Children with heavy proteinuria and serum albumin 25 to 30 g·L-1 manifested mainly with non minimal /minor change disease and more serious prognosis. Early renal biopsy should be performed on them.