【作者】 王丽丽；

【导师】 赵凯姝；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2017， 硕士

【摘要】 目的:研究并分析儿童狼疮性肾炎肾转归的影响因素。方法:回顾性分析吉林大学第一医院儿肾科确诊狼疮性肾炎并有完整随访资料的患儿56例,根据治疗结果分为完全缓解和治疗失败两组,应用统计学方法对患儿一般资料、实验室检查、治疗反应及治疗方案进行单因素及多因素分析,明确患儿肾转归的影响因素。结果:1.本研究共收集56例狼疮性肾炎患儿,其中男性8例,占14.29%,女性48例,占85.71%。研究对象中年龄最小者为5岁,年龄最大者为16岁,平均年龄为11.38±2.46岁。出现肾脏表现或尿检查异常至肾活检的时间最长者为6个月,最短者为3天。经过治疗56名患者中40人得到完全缓解,有16人治疗失败。2.根据56名患儿的治疗效果将患儿分为完全缓解组和治疗失败组,比较两组患者的一般资料和治疗期间的相关指标情况,结果显示贫血患者的治疗失败率高于无贫血患者,差异比较有统计学意义(p<0.05)。肌酐升高患者的治疗失败率高于肌酐正常的患者,差异比较有统计学意义(p<0.05)。24h尿蛋白定量≥50mg/kg的患者治疗失败率明显高于24h尿蛋白定量<50mg/kg的患者,差异比较有统计学意义(p<0.05)。ds-DNA阳性的患者治疗失败率高于ds-DNA阴性的患者,差异比较有统计学意义(p<0.05)。诱导治疗非完全反应患者治疗失败率高于诱导治疗完全反应的患者,差异比较有统计学意义(p<0.05)。维持期治疗方案霉酚酸酯+激素+环磷酰胺治疗的患者治疗失败率低于霉酚酸酯+激素治疗的患者,差异比较有统计学意义(p<0.05)。其他相关独立因素在完全缓解组与治疗失败组间的差异无明显统计学意义(p>0.05)。3.采用Logistic回归多因素分析结果显示尿蛋白、诱导治疗反应、维持期治疗方案为影响最终肾转归的独立影响因素。24h尿蛋白定量≥50mg/kg的患者发生治疗失败的风险远远高于24h尿蛋白定量<50mg/kg的患者,OR为10.433,95%CI为1.445~75.301。对于诱导治疗反应,完全反应的患者发生治疗失败的风险低于非完全反应的患者,OR为0.251,95%CI为0.073~0.856。对于维持治疗方法,采用霉酚酸酯+激素+环磷酰胺治疗的患者发生治疗失败的风险低于采用霉酚酸酯+激素的患者,OR为0.122,95%CI为0.018~0.837。结论1.病初贫血、肌酐升高、肾病水平蛋白尿、ds-DNA滴度升高为患儿肾转归不良的危险因素。2.肾病水平蛋白尿、诱导治疗呈非完全反应为患儿肾转归不良的独立危险因素。3.维持期多种免疫抑制剂联合治疗对患儿肾转归有积极意义。更多还原

【Abstract】 Objective:To investigate relevant factors affecting curative effect in childhood lupus nephritis.Methods:A retrospective analysis was done on 56 inpatient with first diagnosed as LN and had complete follow-up data in the first Hospital of Jilin University.All cases were divided into groups according to therapy results:complete remission group and treatment failure group.History of cases,indicators of laboratory,treatment plan and therapy results were recorded.Various factors between different groups were compared by analysis of T-test,chi-square test and Logistic regression analysis.Result:1.This study collected 56 cases of patients,there are 8male(14.29%),48female(85.71%).The youngest one is 5 years old,the oldest one is 16 years old.The average age was 11.38 ± 2.46 years.Time from kidney or urinary abnormalities to renal biopsy range from 3 days to6 months.After treatment,40 patients were complete remission,while 16 failed.2.Patients with anemia had higher treatment failure rate than those without anemia.The difference was statistically significant(p<0.05).Patients with elevated creatinine had higher treatment failure rate than those with normal creatinine(p<0.05).Whose 24 h Urinary protein≥50mg/kg had higher treatment failure ratethan those with the 24 h urinary protein<50mg/kg(p<0.05).The treatment failure rate in patients with ds-DNA negative was lower than those with ds-DNA positive(p<0.05).Incomplete response patients after induction therapy had higher treatment failurerate than complete response patients(p < 0.05).In the maintenance phase,those accepted MMF+prednisolone+ CTX therapy had lower treatment failure rate than those who were treated with MMF+prednisolone(p<0.05).Other related indicators did not havestatistical difference betweengroups(p>0.05).3.The result of multi factor analysis showed that urinary protein,the way of maintenance treatment,the reaction induced by treatment were independent risk factors.Patients whose 24 h urine protein ≥50mg/kg had higher treatment failure rate than the those with 24 h urinary protein< 50mg/kg[Or=10.433,95%CI: 1.445~75.301].Patients with complete response after induction therapy had lower treatment failure ratethan the incomplete response patients [Or= 0.251,95%CI 0.073~0.856].For maintenance treatment,the risk of treatment failure in patients withMMF+prednisolone+CTX was lower than that of the MMF+prednisolone patients[ Or= 0.122,95%CI :0.018~0.837].Conclusion:1.Anemia,elevated creatinine,massive proteinuria,ds-DNA positive were risk factors of renal failure.2.Massive proteinuria,incomplete response of induction treatment were independent risk factors for renal failure Multiple immunosuppressive agents combined therapy has positive effect in maintenance of renal outcome.更多还原