中国医科大学学报

中国医科大学学报

中国医科大学学报 ›› 2013, Vol. 42 ›› Issue (10): 878–881.

• 论著 • 上一篇    下一篇

儿童急性链球菌感染后肾小球肾炎回顾性分析

杜悦,侯玲,王秀丽,黄晓金,赵成广,吴玉斌   

  1. 中国医科大学附属盛京医院儿肾科,沈阳 110004
  • 收稿日期:2013-05-30 修回日期:2013-11-26 出版日期:2013-10-18 发布日期:2013-11-26
  • 作者简介:杜悦(1971-),女,教授,博士.

A Retrospective Analysis of Acute Post-Streptcoccal Glomerulonephritis in Children of Shenyang City in North-eastern China

DU Yue, HOU Ling, HUANG Xiao-jin, WANG Xiu-li, WU Yu-bin   

  1. Department of Pediatric Nephrology, Shengjing Hospital, China Medical University, Shenyang 110004, China
  • Received:2013-05-30 Revised:2013-11-26 Online:2013-10-18 Published:2013-11-26

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年至2012年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。

关键词: 链球菌, 肾小球肾炎, 儿童

Abstract: Objectives 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#x000b1;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-nephrotic-proteinuria 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 nephrotic-range proteinuria was increased. The short-term prognosis of APSGN was good, minority patients persisted with microscopic hematuria.

Key words: Streptcoccal, glomerulonephritis, child

中图分类号: 

  • R725
[1] Rodriguez-Iturbe B, Musser JM. The current state of post-streptococcal glomerulonephritis [J]. J Am Soc Nephrol, 2008, 19(10):1855-1864.
[2] Berrios X, Lagomarsino E, Solar E, et al. Post-streptococcal acute glomerulonephritis in Chile-20 years of experience [J]. Pediatr Nephrol, 2004, 19(3):306-312.
[3] Yap HK, Chia KS, Murugasu B, et al. Acute glomerulonephritis-changing patterns in Singapore children [J]. Pediatr Nephrol, 1990, 4(5): 482-484.
[4] Zhang Y, Shen Y, Feld LG, et al. Changing pattern of glomerular disease at Beijing Children#x02019;s Hospital[J]. Clin Pediatr(Phila), 1994, 33(5):542-547.
[5] Coppo R, Gianoglio B, Porcellini MG, et al. Frequency of renal disease and clinical indications for renal biopsy in children(report of the Italian National Registry of Renal Biopsies in Children). Group of Renal Immunopathology of the Italian Society of Pediatric Nephrology and Group of Renal Immunopathology of the Italian Society of Nephrology [J]. Nephrol Dial Transplant, 1998,13(2):293-297.
[6] Carapetis JR, Steer AC, Mulholland EK, et al. The global burden of group A streptococcal diseases [J]. Lancet Infect Dis, 2005, 5(11):685-694.
[7] Madaio MP, Harrington JT. Current concepts. The diagnosis of acute glomerulonephritis[J]. N Engl J Med, 1983, 309(21):1299-1302.
[8] Clark G, White RH, Glasgow EF, et al. Post-streptococcal glomerulonephritis in children: Clinicopathological correlations and long term prognosis[J]. Pediatr Nephrol, 1988, 2(4): 381-388.
[9] Herthelius M, Berg U. Renal function reserve after APSGN[J]. Pediatr Nephrol, 1999, 13(9):907-911.
[10] Kasahara T, Hukyakawa H, Okubo S, et al. Prognosis of APSGN is excellent in children, when adequately diagnosed[J]. Pediatr Int, 2001, 43(4):364-367.
[11] Schwartz B, Facklam RR, Breiman RF. Changing epidemiology of group A streptococcal infection in the USA[J]. Lancet, 1990,336(8724):1167-1171.
[12] Roy S 3rd, Pitcock JA, Etteldorf JN. Prognosis of acute poststreptcoccal glomerulonephritis in childhood: prospective study and review of the literature [J]. Adv Pediatr, 1976, 23(1):35-69.
[13] Catherine S. Marshall, Allen C. Cheng, Peter G. Markey, et al. Acute post-streptococcal glomerulonephritis in the northern territory of Australia: a review of 16 years data and comparison with the literature [J]. Am J Trop Med Hyg, 2011,85(4): 703-710.
[14] Akcan-Arikan A, Zappitelli M, Loftis LL, et al. Modified RIFLE criteria in critically ill children with acute kidney injury[J]. Kidney Int, 2007,71(10):1028-1035.
[15] Dodge WF, Spargo BH, Travis LB, et al. Poststreptcoccal glomerulonephritis. A prospective study in children[J]. N Engl J Med, 1972, 286(6):273-278.
[16] Roy S 3rd, Murphy WM, Arant BS Jr. Poststreptcoccal crescenteric glomerulonephritis in children: comparison of quintuple therapy versus supportive care[J]. J Pediatr, 1981,98(3): 403-410.
[17] Wong W, Morris MC, Zwi J. Outcome of severe acute post-streptcoccal glomerulonephritis in New Zealand children [J]. Pediatr Nephrol, 2009, 24(5): 1021-1026.
[1] 路阳. 神经内镜治疗儿童鞍上蛛网膜囊肿21例护理体会[J]. 中国医科大学学报, 2018, 47(6): 572-573.
[2] 宋丹. 儿童肺炎支原体肺炎并发肺栓塞的风险评估与护理干预[J]. 中国医科大学学报, 2018, 47(5): 466-469.
[3] 帖黎明, 刘果, 王旭梅. 中文版儿童父母养育方式量表的修订与信效度评价[J]. 中国医科大学学报, 2018, 47(10): 886-890.
[4] 傅桐, 杜悦, 赵成广, 侯玲, 王秀丽. 256例儿童白天尿频相关因素分析[J]. 中国医科大学学报, 2018, 47(10): 914-916,920.
[5] 刘冰阳 ,姜冉华 ,厉平 ,刘聪 ,李玲. 应用腰围身高比、腰臀比预测儿童青少年代谢综合征的最佳 切点值的研究[J]. 中国医科大学学报, 2017, 46(5): 434-438.
[6] 王凤英,黄路圣,徐康,叶林华,黄云,肖飞. 正五聚蛋白 3 在儿童过敏性紫癜中的表达[J]. 中国医科大学学报, 2017, 46(2): 156-159.
[7] 董改琴, 吕翔, 陈敏华. 82例儿童传染性单核细胞增多症临床分析[J]. 中国医科大学学报, 2017, 46(12): 1147-1149.
[8] 沈力,盛楠,张莹. 学龄前期哮喘患儿照护者焦虑对疾病照护能力的影响[J]. 中国医科大学学报, 2017, 46(1): 41-44.
[9] 黄晓芳 ,,毛建华 ,沈辉君 ,傅海东 ,王晶晶. 原发性肾病综合征患儿血尿酸水平及其影响因素分析[J]. 中国医科大学学报, 2017, 46(1): 55-58.
[10] 丁宁,田霞,孟晨鑫,马玉梅,张明香. 辽宁、黑龙江省1 342例婴幼儿与成人麻疹临床特征分析[J]. 中国医科大学学报, 2016, 45(3): 214-217.
[11] 陈春艳,张力,鲍海宏,董志伟. 数字化导板和三维模型在儿童髁状突骨折重建中的应用[J]. 中国医科大学学报, 2016, 45(2): 171-173.
[12] 苏荣坤,豆立宁,王旭梅,刘果,刘浩,CLONINGER Claude Robert. 学龄前儿童气质性格量表的信效度研究[J]. 中国医科大学学报, 2016, 45(12): 1072-1076.
[13] 李真,金宁,万静洁,李阳,万玉骁,朱俊超. 脑电双频指数监测小儿丙泊酚复合瑞芬太尼静脉麻醉维持剂量的临床研究[J]. 中国医科大学学报, 2016, 45(1): 17-20.
[14] 高光洁,乔娇,宋丹丹. 儿童全凭静脉麻醉在脑电双频指数指导下气管拔管的临床观察[J]. 中国医科大学学报, 2015, 44(7): 614-617.
[15] 王瑶,罗钢. 不同年龄组紫癜性肾炎患者临床表现、病理分级及预后的比较[J]. 中国医科大学学报, 2015, 44(3): 247-251.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA