激素敏感型肾病综合征患儿血清皮质醇和促皮质素水平变化的意义

被引：6

作者：

张建江

王娜

王淼

付书琴

窦文杰

史佩佩

机构：

[1] 郑州大学第一附属医院儿科,河南省儿童肾脏病临床诊疗中心

来源：

中华实用儿科临床杂志 | 2015年 / 30卷 / 05期

关键词：

激素敏感型肾病综合征; 儿童; 皮质醇; 促皮质素; 复发;

D O I：

暂无

中图分类号：

R726.9 [小儿泌尿科学];

学科分类号：

100202 [儿科学];

摘要：

目的研究激素敏感型肾病综合征(SSNS)患儿血清皮质醇和促皮质素(ACTH)的变化及对其干预的临床意义。方法将48例SSNS患儿根据其在病程中有无复发分为未复发组(例数=19)及复发组(例数=29), 同时选取同龄健康儿童作为健康对照组(例数=14)。采用电化学发光法测定SSNS患儿血清皮质醇和ACTH的水平, 并对复发组中血清皮质醇、ACTH降低的15例患儿调整治疗方案为甲泼尼龙片或甲泼尼龙片联合ACTH针静脉滴注。结果糖皮质激素治疗前, 复发组、未复发组及健康对照组血清皮质醇、ACTH水平差异均无统计学意义(P均>0.05);糖皮质激素诱导缓解治疗后, 复发组血清皮质醇、ACTH水平均显著低于未复发组, 差异均有统计学意义[(113.03±80.02) μg/L比(251.54±185.05) μg/L, t=–2.925, P<0.05;(12.81±10.14) ng/L比(23.53±12.05) ng/L, t=–0.885, P<0.05];其中复发组15例患儿血清皮质醇、ACTH出现降低, 调整治疗方案治疗8～12周后, 血清皮质醇水平较调整治疗方案前升高, 差异有统计学意义[(168.90±133.43)μg/L比(73.62±58.04) μg/L, t=3.016, P<0.05 ];血清ACTH水平调整治疗方案前后比较差异无统计学意义[(14.05±10.99) ng/L比(8.72±4.11) ng/L, t=1.991, P>0.05];月平均复发次数较调整治疗方案前降低, 差异有统计学意义[(0.09±0.08)次比(0.35±0.11)次, t=–7.560, P<0.05]。结论血清皮质醇、ACTH的水平在一定程度上可评估SSNS患儿复发的风险, 对其进行有效干预可减少其复发率。

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