儿童紫癜性肾炎肾脏预后不良危险因素分析

doi:10.12372/jcp.2023.22e1553

摘要/Abstract

摘要：

目的探讨儿童紫癜性肾炎（HSPN）肾脏预后不良[估算肾小球滤过率（eGFR）<90 mL/(min·1.73 m²)]的独立危险因素。方法回顾性分析2000年1月到2019年12月完善肾脏活检并诊断为HSPN患儿的临床资料，通过多因素logistic回归分析导致肾脏预后不良的独立危险因素。结果共纳入476例HSPN患儿，男278例、女198例，发病年龄10.7（8.1~13.2）岁，中位随访时间为33.8（20.9~54.2）月，其中31例（6.5%）肾脏预后不良。与预后良好组相比，预后不良组患儿发病年龄较大，肾脏受累到肾穿刺时间较长，高尿酸、高胆固醇、eGFR<90 mL/(min·1.73m²)、大量蛋白尿、高尿视黄醇结合蛋白（RBP）的比例较高，差异均有统计学意义（P<0.05）。预后良好组与预后不良组之间节段性肾小球硬化/粘连、>25%肾小管萎缩/间质纤维化比例及新月体形成程度差异有统计学意义（P<0.05）。多因素logistic回归分析显示，节段性肾小球硬化/粘连、>25%肾小管萎缩/间质纤维化和高尿RBP是导致肾脏预后不佳的独立危险因素（P<0.05）。结论本研究发现3个影响HSPN患儿肾脏预后不良的危险因素，有待在临床上进一步的探索和验证。

关键词: 紫癜性肾炎, IgA血管炎, 新月体, 儿童

Abstract:

Objective To explore independent risk factors for poor renal outcome defined as an estimated glomerular filtration rate (eGFR)<90 mL/(min·1.73m²) in children with Henoch-Schönlein purpura nephritis (HSPN). Methods The clinical data of children diagnosed with HSPN after completing renal biopsy from January 2000 to December 2019 were retrospectively analyzed, and the independent risk factors leading to poor renal prognosis were analyzed by multivariate logistic regression. Results A total of 476 children with HSPN were included, of whom 31(6.5%) had poor renal outcomes. There were 278 boys and 198 girls, and the age of onset was 10.7 (8.1-13.2) years. The median follow-up time was 33.8 (20.9-54.2) months. Compared with the good prognosis group, the poor prognosis group had older age of onset, longer time from renal involvement to renal aspiration, higher proportions of high uric acid, high cholesterol, eGFR<90 mL/(min·1.73m²), large albuminuria and high urinary retinol binding protein (RBP), and the differences were statistically significant (P<0.05). There were significant differences in segmental glomerulosclerosis/adhesion, >25% renal tubular atrophy/interstitial fibrosis, and the degree of crescent formation between the good and poor prognosis groups (P<0.05). Multivariate logistic regression analysis showed that segmental glomerulosclerosis/adhesion, >25% renal tubular atrophy/interstitial fibrosis and high urinary RBP were independent risk factors for poor renal prognosis (P<0.05). Conclusions This study found three risk factors for poor renal prognosis in children with HSPN, which are worthy of further clinical exploration and verification.

Key words: Henoch-Schönlein purpura nephritis, IgA vasculitis, crescent, child

王美秋, 何旭, 王忍, 贾丽丽, 高春林, 夏正坤. 儿童紫癜性肾炎肾脏预后不良危险因素分析[J]. 临床儿科杂志, 2023, 41(12): 903-907.

WANG Meiqiu, HE Xu, WANG Ren, JIA Lili, GAO Chunlin, XIA Zhengkun. Risk factors of poor renal prognosis in children with Henoch-Schönlein purpura nephritis[J]. Journal of Clinical Pediatrics, 2023, 41(12): 903-907.

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项目	预后良好组(n=445)	预后不良组(n=31)	统计量	P
男性[n(%)]	258(58.0)	20(60.5)	χ²=0.51	0.475
发病年龄[M(P₂₅~P₇₅)]/岁	10.5(8.0~13.2)	12.6(11.5~13.3)	Z=2.29	0.022
皮疹到肾脏受累时间[M(P₂₅~P₇₅)]/d	11.0(0.0~31.0)	0.0(0.0~31.0)	Z=1.02	0.307
肾脏受累到肾穿时间[M(P₂₅~P₇₅)]/d	36.0(19.0~101.5)	86.0(37.0~531.0)	Z=3.22	0.001
肉眼血尿[n(%)]	67(15.1)	4(12.9)	-	1.000¹⁾
腹痛[n(%)]	185(41.6)	12(38.7)	χ²=0.10	0.754
关节痛[n(%)]	153(34.4)	7(22.6)	χ²=1.81	0.179
随访时间[M(P₂₅~P₇₅)]/月	33.8(20.9~53.8)	34.5(21.2~89.8)	Z=1.07	0.284
贫血[n(%)]	77(17.3)	7(22.6)	χ²=0.56	0.456
低血清白蛋白[n(%)]	19(4.3)	2(6.5)	-	0.639¹⁾
高胆固醇[n(%)]	132(29.7)	15(48.4)	χ²=4.76	0.029
高尿酸血症[n(%)]	51(11.5)	10(32.3)	-	0.003¹⁾
eGFR<90 mL/(min·1.73 m²)[n(%)]	9(2.0)	4(12.9)	-	0.007¹⁾
大量蛋白尿[n(%)]	50(11.2)	9(29.0)	-	0.008¹⁾
高尿NAG酶[n(%)]	293(65.8)	24(77.4)	χ²=1.75	0.186
高尿RBP[n(%)]	68(15.3)	13(41.9)	χ²=14.58	<0.001
高尿C3[n(%)]	158(35.5)	11(35.5)	χ²=0.00	0.998
高尿α₂-M[n(%)]	57(12.8)	7(22.6)	-	0.166¹⁾
RAS阻滞剂[n(%)]	177(39.8)	12(38.7)	χ²=0.01	0.907
应用泼尼松[n(%)]	401(90.1)	29(93.6)	-	0.756¹⁾
甲泼尼龙冲击治疗[n(%)]	158(35.5)	12(38.7)	χ²=0.13	0.719
应用免疫抑制剂[n(%)]	175(39.3)	8(25.8)	χ²=2.24	0.135

项目	预后良好组(n=445)	预后不佳组(n=31)	χ²值	P
系膜细胞增生≥50%	157(35.3)	14(45.2)	1.23	0.268
毛细血管内皮细胞增生	163(36.6)	8(25.8)	1.48	0.225
节段性肾小球硬化/粘连	120(27.0)	18(58.1)	13.62	<0.001
>25%肾小管萎缩或间质纤维化	3(0.7)	4(12.9)	-	<0.001¹⁾
新月体			8.37	0.015
C0	206(46.3)	10(32.6)
C1	204(45.8)	14(45.2)
C2	35(7.9)	7(22.6)

变量	偏回归系数	标准误	χ²值	OR(95%CI)	P
高尿RBP	1.29	0.41	9.79	3.62(1.62~8.09)	0.002
节段性肾小球硬化/粘连	1.12	0.40	7.97	3.06(1.41~6.67)	0.005
>25%肾小管萎缩或间质纤维化	2.58	0.88	8.52	13.15(2.33~74.19)	0.004
常量	－3.58	0.33	121.46	-	<0.001