本文選題：兒童 + 狼瘡性腎炎　； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:研究并分析兒童狼瘡性腎炎腎轉(zhuǎn)歸的影響因素。方法:回顧性分析吉林大學(xué)第一醫(yī)院兒腎科確診狼瘡性腎炎并有完整隨訪資料的患兒56例,根據(jù)治療結(jié)果分為完全緩解和治療失敗兩組,應(yīng)用統(tǒng)計(jì)學(xué)方法對(duì)患兒一般資料、實(shí)驗(yàn)室檢查、治療反應(yīng)及治療方案進(jìn)行單因素及多因素分析,明確患兒腎轉(zhuǎn)歸的影響因素。結(jié)果:1.本研究共收集56例狼瘡性腎炎患兒,其中男性8例,占14.29%,女性48例,占85.71%。研究對(duì)象中年齡最小者為5歲,年齡最大者為16歲,平均年齡為11.38±2.46歲。出現(xiàn)腎臟表現(xiàn)或尿檢查異常至腎活檢的時(shí)間最長(zhǎng)者為6個(gè)月,最短者為3天。經(jīng)過(guò)治療56名患者中40人得到完全緩解,有16人治療失敗。2.根據(jù)56名患兒的治療效果將患兒分為完全緩解組和治療失敗組,比較兩組患者的一般資料和治療期間的相關(guān)指標(biāo)情況,結(jié)果顯示貧血患者的治療失敗率高于無(wú)貧血患者,差異比較有統(tǒng)計(jì)學(xué)意義(p0.05)。肌酐升高患者的治療失敗率高于肌酐正常的患者,差異比較有統(tǒng)計(jì)學(xué)意義(p0.05)。24h尿蛋白定量≥50mg/kg的患者治療失敗率明顯高于24h尿蛋白定量50mg/kg的患者,差異比較有統(tǒng)計(jì)學(xué)意義(p0.05)。ds-DNA陽(yáng)性的患者治療失敗率高于ds-DNA陰性的患者,差異比較有統(tǒng)計(jì)學(xué)意義(p0.05)。誘導(dǎo)治療非完全反應(yīng)患者治療失敗率高于誘導(dǎo)治療完全反應(yīng)的患者,差異比較有統(tǒng)計(jì)學(xué)意義(p0.05)。維持期治療方案霉酚酸酯+激素+環(huán)磷酰胺治療的患者治療失敗率低于霉酚酸酯+激素治療的患者,差異比較有統(tǒng)計(jì)學(xué)意義(p0.05)。其他相關(guān)獨(dú)立因素在完全緩解組與治療失敗組間的差異無(wú)明顯統(tǒng)計(jì)學(xué)意義(p0.05)。3.采用Logistic回歸多因素分析結(jié)果顯示尿蛋白、誘導(dǎo)治療反應(yīng)、維持期治療方案為影響最終腎轉(zhuǎn)歸的獨(dú)立影響因素。24h尿蛋白定量≥50mg/kg的患者發(fā)生治療失敗的風(fēng)險(xiǎn)遠(yuǎn)遠(yuǎn)高于24h尿蛋白定量50mg/kg的患者,OR為10.433,95%CI為1.445~75.301。對(duì)于誘導(dǎo)治療反應(yīng),完全反應(yīng)的患者發(fā)生治療失敗的風(fēng)險(xiǎn)低于非完全反應(yīng)的患者,OR為0.251,95%CI為0.073~0.856。對(duì)于維持治療方法,采用霉酚酸酯+激素+環(huán)磷酰胺治療的患者發(fā)生治療失敗的風(fēng)險(xiǎn)低于采用霉酚酸酯+激素的患者,OR為0.122,95%CI為0.018~0.837。結(jié)論1.病初貧血、肌酐升高、腎病水平蛋白尿、ds-DNA滴度升高為患兒腎轉(zhuǎn)歸不良的危險(xiǎn)因素。2.腎病水平蛋白尿、誘導(dǎo)治療呈非完全反應(yīng)為患兒腎轉(zhuǎn)歸不良的獨(dú)立危險(xiǎn)因素。3.維持期多種免疫抑制劑聯(lián)合治療對(duì)患兒腎轉(zhuǎn)歸有積極意義。
[Abstract]:Objective: to study and analyze the influencing factors of renal outcome in children with lupus nephritis. Methods: 56 cases of lupus nephritis diagnosed in Department of Pediatrics and Kidney, first Hospital of Jilin University were analyzed retrospectively. According to the results of treatment, 56 cases were divided into two groups: complete remission group and failed treatment group. The general data of the children were analyzed by statistical method. Laboratory examination, treatment response and treatment regimen were analyzed by single factor and multivariate analysis to determine the influencing factors of renal outcome in children. The result is 1: 1. In this study, 56 children with lupus nephritis were collected, including 8 males (14.29%) and 48 females (85.71%). The youngest group was 5 years old, the oldest was 16 years old, the average age was 11.38 鹵2.46 years. The longest time to renal biopsy was 6 months, and the shortest was 3 days. Of the 56 patients treated, 40 had complete remission and 16 failed. 2. 56 children were divided into complete remission group and failed treatment group according to the effect of treatment. The results showed that the treatment failure rate of anemia patients was higher than that of non-anemia patients. The difference was statistically significant (p 0.05). The treatment failure rate of patients with creatinine elevation was higher than that of patients with normal creatinine. The difference was statistically significant (p0.05). The failure rate of patients with 24 hours urinary protein 鈮，

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