本文關(guān)鍵詞： 原發(fā)性腎病綜合征 EB病毒 兒童 糖皮質(zhì)激素　出處：《福建醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 原發(fā)性腎病綜合征(primary nephrotic syndrome,PNS)是中國兒童常見的腎小球疾病,年患病率為16/10萬。EB病毒(Epstein-Barr virus,EBV)是全人類普遍存在的一種病毒,超過90%以上的成人EBV血清抗體陽性。兒童主要通過唾液傳播,也可經(jīng)過血液傳播,亦可通過造血干細胞移植或?qū)嶓w器官移植進行傳播,一旦感染便會在宿主體內(nèi)終生存在。EBV感染可引起T細胞和B細胞免疫功能異常,而腎病綜合征患兒容易合并EBV感染。但EBV感染對兒童PNS激素療效及頻復(fù)發(fā)/激素依賴的影響尚不清楚。本研究旨在探討兒童PNS患兒的EBV感染率、EBV感染對兒童單純型PNS激素反應(yīng)性的影響、EBV感染與兒童單純型激素敏感型腎病綜合征(steroid-sensitive nephrotic syndrome,SSNS)頻復(fù)發(fā)/激素依賴的關(guān)系。方法 對650例PNS患兒進行回顧性分析,應(yīng)用實時熒光定量PCR檢測650例患兒的外周血單個核細胞EBV DNA,并采用統(tǒng)計學(xué)方法統(tǒng)計EBV感染率及分析其流行病學(xué)特征;將可對比的EBV感染組的單純型PNS初發(fā)患兒與非EBV感染組的單純型PNS初發(fā)患兒應(yīng)用足量糖皮質(zhì)激素(glueocorticosteroid,GC)4周、8周內(nèi)對GC的反應(yīng)性進行對比;將可對比的EBV感染的單純型SSNS患兒中1年內(nèi)頻復(fù)發(fā)/激素依賴百分比與非EBV感染組進行比較。數(shù)據(jù)處理應(yīng)用SPSS19.0統(tǒng)計軟件包,采用p0.05作為檢驗顯著性標準。結(jié)果 1、650例原發(fā)性腎病綜合征患兒293例感染EBV,感染率為45.08%,高于健康患兒;10月~2歲PNS患兒中EBV感染率最高(60.25%),PNS患兒中EBV感染率無季節(jié)差異性。2、EBV感染組101例單純型PNS初發(fā)患兒足量GC治療4周內(nèi)尿蛋白轉(zhuǎn)陰92例,占91.09%;8周內(nèi)轉(zhuǎn)陰者97例,占96.4%;非EBV感染組共107例單純型PNS初發(fā)患兒,足量GC治療4周內(nèi)轉(zhuǎn)陰99例,占92.52%;8周內(nèi)轉(zhuǎn)陰者102例,占96.26%;兩組比較差異無統(tǒng)計學(xué)意義。3、EBV感染的單純型SSNS患兒中1年內(nèi)頻復(fù)發(fā)/激素依賴比例與非EBV感染組比較結(jié)果如下:EBV感染組頻復(fù)發(fā)/激素依賴占15.5%(11/71),非EBV感染組頻復(fù)發(fā)/激素依賴占15.7%(14/89),差異無統(tǒng)計學(xué)意義。結(jié)論 本回顧性研究顯示盡管兒童原發(fā)性腎病綜合征患兒EBV感染率比健康人群高,但是EBV感染既不影響單純型PNS患兒對GC的反應(yīng)性,也不是單純型SSNS患兒頻復(fù)發(fā)/激素依賴的因素。該結(jié)論有待于多中心、前瞻性、隨機對照試驗以進一步證實。
[Abstract]:Objective Primary nephrotic syndrome (PNS) is a common glomerular disease in Chinese children. The annual prevalence rate of Epstein-Barr virus (EBV) is 16/10 000. More than 90% adults are positive for EBV seroantibodies. Children are mainly transmitted through saliva, blood, hematopoietic stem cell transplants or solid organ transplants. Once infected, the presence of EBV in the host for life may lead to abnormal immune function of T and B cells. However, the effect of EBV infection on the effect of PNS hormone and frequent recurrence / hormone dependence in children with PNS was not clear. The purpose of this study was to investigate the prevalence of EBV infection in children with PNS. The relationship between PNS infection and frequent recurrence / hormone dependence of steroid-sensitive nephrotic syndromes in children with steroid-sensitive nephrotic syndrome were retrospectively analyzed. The EBV DNA of peripheral blood mononuclear cells (PBMC) of 650 children was detected by real-time fluorescence quantitative PCR. The infection rate of EBV and its epidemiological characteristics were analyzed by statistical method. The reactivity of glucocorticoid glueocorticoid to GC was compared in the primary EBV group and the simple PNS group within 4 weeks and 8 weeks respectively. The 1-year recurrent / hormone dependent percentage of simple SSNS patients with EBV infection was compared with that of non-#en2# infected children. The data was processed with SPSS19.0 statistical software package. Results 1,650 children with primary nephrotic syndrome were infected with EBV, the infection rate was 45.08, which was higher than that of healthy children, and in October, the highest rate of EBV infection was 60.25% in children with PNS. There was no seasonal difference in the infection rate of EBV in 1,650 children with primary nephrotic syndrome. In the group of heterosexual. 2EBV infection, 92 cases of urine protein turned negative in 4 weeks after full GC treatment of simple PNS. 97 cases (96.4%) turned negative in 91.09 weeks, 107 cases in non-#en0# infection group, 99 cases in 4 weeks after full GC treatment, 102 cases in 92.52 weeks. There was no significant difference between the two groups in the frequency of recurrence / hormone dependence in children with simple SSNS infection in one year. The results were as follows: 1% EBV infection group had frequent recurrence / hormone dependence rate of 15.55% / 71%, and non-EBV infection group had frequency of 15. 5% / 71%, while that of non-EBV infection group was higher than that of non-EBV group. Recurrence / hormone dependence accounted for 15.7 / 89% of the total. Conclusion this retrospective study showed that EBV infection rate in children with primary nephrotic syndrome was higher than that in healthy persons. However, EBV infection does not affect the reactivity to GC in children with simple PNS, nor is it a factor of frequent recurrence / hormone dependence in children with simple SSNS. This conclusion needs to be further confirmed by multicenter, prospective and randomized controlled trials.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R726.9

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本文編號：1545867