摘要
目的 总结近11年中国沈阳儿童急性链球菌感染后肾小球肾炎（APSGN）的发病情况、临床表现特点、治疗和随访情况,阐明本地区儿童APSGN近11年的特点.方法 单中心回顾性分析2002年1月至2012年12月11年间,中国东北典型城市沈阳市儿童每年诊断APSGN的患儿数量、发病季节的特点、感染诱因的类型、肉眼血尿、非肾病范围内蛋白尿、肾病范围内蛋白尿、急性肾损伤（AKI）患儿分别所占比例.同时比较AKI和肾功正常患儿抗链球菌溶血素O（ASO）和补体的改变情况.长期随访患儿镜下血尿消失时间、肾病范围内蛋白尿患儿和AKI患儿的治疗情况.结果 2002-2012年沈阳市中国医科大学附属盛京医院儿肾科共收治APSGN患儿376例,发病季节全部为秋冬季节,发病诱因80％以上为化脓性扁桃体炎.11年间,APSGN发病人数呈现逐年下降的趋势,AKI和肾病范围内蛋白尿的患儿比例有升高趋势,肉眼血尿患儿所占比例无明显改变.肉眼血尿2～3周内消失;非肾病范围内蛋白尿患儿1～3周内尿蛋白恢复正常;APSGN肾病范围内蛋白尿患儿治疗同儿童原发性肾病综合征,3～4个月停用激素治疗,所有患儿尿蛋白转阴后均有镜下血尿,镜下血尿持续时间较长者大多为此类患儿.AKI在APSGN患儿中所占比例逐年升高,AKI患儿随访时间最长5年,无慢性肾功能不全发生.结论 APSGN发病人数逐年下降,AKI和肾病范围内蛋白尿的患儿比例有升高趋势.APSGN患儿预后良好,少数患儿持续镜下血尿.
Objective To define the incidence,clinical features,treatment and prognostic characteristics of acute post-streptcoccal glomerulonephritis （APSGN） in Shenyang,a typical city of north-eastern China.Methods A total of 376 patients,all were 〈 14 years old,had been admitted to Shengjing Hospital of China Medical University for APSGN between January 2002 and December 2012,and were retrospectively enrolled in the study.Microscopic hematuria,decreased C3 and evidence of recent streptococcal infection were adopted as diagnostic criteria.Data were collected from hospital records on admission,progression notes and outpatient follow up.Results Among 376 patients,56.1% were male and 43.9% were female.Mean age of patients was 8.6±3.5 years old.Signs of suppurative tonsillitis were clearly evident in more than 80% of the children,and most of the patients were diagnosed during autumn and winter.The incidence of APSGN showed a trend of decreasing in the past 11 years in Shenyang,but the proportion of the patients with acute kidney injury （AKI） or nephrotic-range proteinuria was increasing.There was no significant change in the proportion of children with macroscopic hematuria during these years.Macroscopic hematuria usually disappeared in 2-3 weeks and non-nephroticproteinuria can be resolved in 1-3 weeks.The treatment of APSGN patients with nephrotic-proteinuria was same with the children with primary nephrotic syndrome,the prednisone was withdrawn in 3-4 months.Some AKI patients have been followed up for 5 years and no chronic renal failure was observed.Conclusion The incidence of APSGN was decreased during recent years.The proportion of APSGN patients with AKI or nephroticrange proteinuria was increased.The short-term prognosis of APSGN was good,minority patients persisted with microscopic hematuria.
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2013年第10期878-881,共4页
Journal of China Medical University
基金
辽宁省自然科学基金(201102288)
关键词
链球菌
肾小球肾炎
儿童
streptcoccal
glomenlonephritis
child
