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目的探讨影响小儿肾病综合征(NS)频复发的临床相关因素及预后。方法对35例NS患儿进行门诊或电话、短信随访,随访时间1～15a,了解患儿疾病转归及生活质量,并对获得的完整临床资料进行分析。结果35例患儿中单纯型肾病33例,肾炎型肾病2例。其中6例做过肾活检,病理类型为微小病变4例,系膜增生性肾炎、局灶性节段性肾小球硬化各1例。在频复发的因素中,感染尤其是呼吸道感染比例最高(91.4%),其次为不正规激素治疗(22.8%),再次为持续的高脂血症,尤其是脂蛋白(a)增高(14.8%);精神因素和特应性体质也受到重视。其中不同发病年龄的复发率无显著性差异(P>0.05);激素初治疗程(以6个月为标准)频复发与少复发组比较差异显著(P<0.05)。随访过程中,5例临床治愈,28例完全缓解,2例部分缓解。34例能正常生活,1例出现生长发育迟缓。结论正确使用糖皮质激素,积极控制感染,合理应用免疫抑制剂可减少复发;建立长期随访管理制度对改善小儿NS的预后非常重要。
Objective To investigate the clinically relevant factors and prognosis of children with nephrotic syndrome (NS) recurrence. Methods 35 cases of NS children were outpatient or telephone, SMS follow-up, follow-up time of 1 ~ 15a, to understand the outcome of children with disease and quality of life, and to obtain the complete clinical data were analyzed. Results 35 cases of simple nephrotic in 33 cases, nephritis nephropathy in 2 cases. Among them, 6 cases had renal biopsy, pathological type was micro-lesion in 4 cases, mesangial proliferative glomerulonephritis and focal segmental glomerulosclerosis in 1 case. The frequency of recurrence was the highest among infections (91.4%), followed by irregular hormonal therapy (22.8%), followed by persistent hyperlipidemia, especially with increased lipoprotein (a) (14.8% ); Mental factors and atopic fitness have also been valued. There was no significant difference in the relapse rate among different age groups (P> 0.05). There was significant difference between the frequency of recurrence and the less recurrence group (P <0.05). During follow-up, 5 cases were clinically cured, 28 cases completely relieved, and 2 cases partially relieved. 34 cases of normal life, 1 case of growth retardation. Conclusion Correct use of glucocorticoids, positive control of infection, rational use of immunosuppressive agents can reduce recurrence; the establishment of long-term follow-up management system to improve the prognosis of children with NS is very important.