摘要
目的探究青少年肾病综合征合并急性肾损伤患者的病理与临床特征。方法选取2015年2月-2019年2月海南医学院第二附属医院肾内科收治的203例青少年肾病综合征患者为研究对象,根据是否合并有急性肾损伤将其分为合并急性肾损伤组与未合并急性肾损伤组,比较两组患者临床特征与病理特征,采用Logistic回归分析研究青少年肾病综合征患者合并急性肾损伤的影响因素。结果203例青少年肾病综合征患者中合并急性肾损伤56例(27.58%),其中原发性肾病综合征50例(89.29%),继发性肾病综合征6例(10.71%);两组患者在年龄、性别、血压、使用中药、合并高血压情况差异无统计学意义(P>0.05)。与非急性肾损伤组比较,急性肾损伤组患者住院时间长,利尿剂和糖皮质激素的使用以及基线eGFR<60 mL的患者比例升高,患者血液中白细胞计数、中性粒细胞计数、尿素氮、肌酐、尿酸、胱抑素C、C反应蛋白升高,白蛋白降低,患者尿液指标中镜下血尿阳性率和镜下白细胞阳性率升高,24 h尿量降低,差异均有统计学意义(P<0.05)。两组患者病理特征存在差异(χ^2=41.307,P=0.000),合并急性肾损伤的肾病综合征患者病理特征以急性肾小管-间质损伤为主(28例,占50.00%),非合并急性肾损伤的肾病综合征患者病理特征以微小病变型肾病为主(63例,占45.57%)。Logistic回归分析表明中性细胞升高、血尿素氮升高、利尿剂使用率升高以及镜下血尿阳性是青少年肾病综合征患者并发急性肾损伤的危险因素(OR=2.03、1.94、3.02、2.13,P<0.05)。结论青少年肾病综合征患者合并急性肾损伤的发病率较高,影响因素以中性细胞升高、血尿素氮升高、利尿剂使用率升高以及镜下血尿阳性为主。
Objective To investigate the pathological and clinical characteristics of adolescent nephrotic syndrome complicated with acute renal injury(ARI).Methods A total of 203 adolescent patients with nephrotic syndrome admitted to Department of Nephrology,the Second Affiliated Hospital of Hainan Medical College from February 2015 to February 2019 were selected as the study subjects.According to whether the selected patients had ARI or not,the patients were divided into two groups:the group with ARI and the group without ARI.The clinical and pathological characteristics of the two groups were compared.Logistic regression analysis was used to analyze the influencing factors of ARI in patients with nephrotic syndrome.Results In 203 cases of juvenile nephrotic syndrome,there were 56 cases of ARI(27.58%),50 cases of primary nephrotic syndrome(89.29%)and 6 cases of secondary nephrotic syndrome(10.71%);there was no significant difference between the two groups in age,gender,blood pressure,use of traditional Chinese Medicine and hypertension(P>0.05).Compared with the non-ARI group,the patients in the ARI group had longer hospital stay,increasing use of diuretics and glucocorticoids,and elevating percentage of patients with baseline of eGFR<60(P<0.05);the leukocyte count,neutrophil count,urea nitrogen,creatinine,uric acid,Cystatin C,C reactive protein increased,albumin decreased,the positive rate of microscopic hematuria and microscopic leukocyte increased,the urine volume decreased in 24 hours,of which the differences were statistically significant(P<0.05).The pathological characteristics of the two groups were different(χ^2=41.307,P=0.000).The pathological characteristics of nephrotic syndrome patients with ARI were mainly acute tubulointerstitial injury(28 cases,accounting for 50.00%).The pathological characteristics of nephrotic syndrome patients without ARI were mainly micro pathological nephropathy(63 cases,accounting for 45.57%).Logistic regression analysis showed that the increase of neutrophil,urea nitrogen,diuretic use rate and positive hematuria under microscope were the risk factors of ARI(OR=2.03,1.94,3.02,2.13,P<0.05).Conclusion The incidence of ARI in the adolescent patients with nephrotic syndrome is high,and the main factors affecting adolescent nephrotic syndrome complicated with ARI were neutrophil elevation,blood urea nitrogen elevation,diuretic use rate elevation and positive microscopic hematuria.
作者
庄乙君
陈文
王名法
李佳
林叶
汪水连
ZHUANG Yijun;CHEN Wen;WANG Mingfa;LI Jia;LIN Ye;WANG Shuilian(Department of Kidney,the Second Affiliated Hospital of Hainan Medical College,Haikou 570311,China;Department of Pathology,the Second Affiliated Hospital of Hainan Medical College,Haikou 570311,China;Hainan Medical College,Haikou 571199,China)
出处
《新疆医科大学学报》
CAS
2020年第6期763-767,共5页
Journal of Xinjiang Medical University
基金
海南省卫生计生行业科研项目(18A200052)。
关键词
肾病综合征
急性肾损伤
病理特征
临床特征
影响因素
肾功能
nephrotic syndrome
acute renal injury(ARI)
pathological characteristics
clinical characteristics
influencing factors
renal function
