儿童激素敏感性肾病综合征复发的原因和相关因素分析

目的分析儿童激素敏感性肾病综合征复发的原因，为合理治疗肾病综合征复发提供依据。方法对激素敏感性肾病综合征患儿进行定期随访检查，复发时进行详细病史询问、体检和血尿常规、血生化、血皮质醇测定，分析肾病复发的原因。结果纳入儿童激素敏感性肾病综合征93例，未复发28例（未复发组）；复发65例，共计116例次复发，其中频复发31例（频复发组），非频复发34例（非频复发组）。复发原因最多为激素依赖和（或）免疫抑制剂依赖（占49．1％），之后依次为感染（占36．2％），激素停用（占1．7％），过敏和接种（占1．7％），外伤（占1．7％），10．3％原因不明。血清皮质醇水平减低在频复发组中的比例显著高于非频复发组和未复发组（P〈0．05和P〈0．01），而严重低血清白蛋白血症和低IgG血症在各组中无显著差别。结论糖皮质激素依赖和感染是儿童激素敏感性肾病综合征复发的主要原因，而血皮质醇水平低下可能是儿童激素敏感性肾病综合征出现频繁复发和激素依赖的重要机制。

Analysis of relapse causes and related factors of steroid-sensitive nephrotic syndrome in children

Objective To analyze relapse causes and related factors of steroid-sensitive nephrotic syndrome in children and provide information for rational treatment of relapse of nephrotie syndrome. Methods Children with steroid-sensitive nephrotic syndrome were regularly followed-up, detailed medical history inquiry and physical examinations, urine test, plasma biochemistry and cortisol detec- tion were performed to analyze the causes of relapse. Results Totally 93 children with steroid-sensitive nephrotic syndrome were included in the study. Among them, 28 cases of them showed no relapse, 65 cases had at least one relapse and a total of 116 relapses were recorded, frequent relapses in 31 cases and infrequent relapses in 34 cases. The most common cause of relapse was steroid-dependent and/or immunosuppressive drugs dependent（49. 1%）, followed by infection（36. 2%）, stop of glucocorticoste- roid （ 1.7% ）, allergy and vaccination（ 1.7 % ）, trauma（ 1.7%）, unknown causes （ 10. 3 % ）. Reduced serum cortisol levels were much more eonunon in frequent relapse group than in infrequent relapse group （P〈0. 05） and no replapse group （P〈0. 01） ,while severe hypoalbuminemia and hypo-IgG levels were not statistically significant between these groups. Conclusions Steroid-dependent and infection is the leading causes of relapse steroid-sensitive nephrotic syndrome in children, low serum cortisol levels may play important role in frequent relapse and steroid-dependent in children with steroid-sensitive hephrotic syndrome.