成人原发性肾病综合征激素疗效差异的相关因素

目的：通过分析经肾活检确诊的成人原发性肾病综合征(primary nephrotic syndrome，PNS)的临床资料，以 了解影响该病激素疗效的相关因素。方法：回顾性分析2013年1月至2014年1月间中南大学湘雅二医院肾脏科425例经 肾活检确诊的PNS患者的一般资料、实验室检查及肾病理类型。结果：轻微病变、局灶节段肾小球硬化、IgA肾病对 激素治疗敏感(P<0.05)；14~24岁患者较其他年龄组的患者对激素的敏感性要高(P<0.05)。激素抵抗组与非激素抵抗型 肾病综合征组比较IgA水平明显下降(P<0.05)，激素抵抗型肾病综合征组治疗前后24 h尿蛋白定量的比较，差异无统计 学意义(P>0.05)，非激素抵抗型肾病综合征组治疗前后24 h尿蛋白定量的比较，差异有统计学意义(P<0.05)。结论：肾 疾病的病理类型及患者的年龄与激素疗效存在一定的关系。IgA水平的相对降低可能与PNS激素疗效有关。

Influential factors for theraputic effect of steroid on adult primary nephrotic syndrome

Objective: To determine the factors associated with the eff ect of steroid on adult primary nephrotic syndrome. Methods: The general information, laboratory examination and renal pathological type of 425 patients with primary nephrotic syndrome were retrospectively analyzed. Results: Th ere were signifi cant diff erences in the response to steroid among the pathological types of minimal change disease, focal segmental glomerulosclerosis and IgA nephropathy. Th e patients in the age of 14–24 years old showed the strongest response to steroid (P<0.05). Th e IgA level in the steroid resistance group was lower than that in the non-steroid resistance group (P<0.05). There was no signifi cant diff erence in urine protein in 24 hour quantitation in the steroid resistance group between pre- and post-treatment (P>0.05), while there was signifi cant diff erence in urine protein in 24 hour quantitation in the non-steroid resistance group between pre- and post-treatment (P<0.05). Conclusion: Pathological types and ages of the patients are related to the steroid curative effect. The decrease in IgA probably affects the effect of steroid on primary nephrotic syndrome.