摘要： 目的 比较血浆、低分子右旋糖苷和白蛋白对儿童原发性肾病综合征（PNS）重度水肿的临床疗效。方法 回顾性分析2017年1月至2019年12月在中国医科大学附属盛京医院小儿肾脏风湿免疫内科住院的60例PNS重度水肿患儿治疗前后的临床资料，比较血浆治疗组、白蛋白治疗组及低分子右旋糖酐治疗组的临床疗效。结果 与治疗前相比，3组患儿治疗后尿量均增多，体质量及血肌酐均降低。血浆治疗组患儿尿量在治疗第3、7、10天明显多于其他2组（P<0.001），体质量在血浆治疗第7和10天较其他2组明显下降（P<0.001），血肌酐在治疗第7天较其他2组降低更为显著（P=0.005）。60例患儿中，PNS重度水肿并发急性肾损伤（AKI）35例，其中，白蛋白治疗组和血浆治疗组患儿治疗后尿量均较治疗前增多，体质量及血肌酐明显降低；与白蛋白治疗组相比，血浆治疗组患儿的尿量在血浆治疗第3、7、10天明显增多（P<0.001），体质量在治疗第7和10天明显下降（P<0.005），血肌酐在治疗第7天亦有大幅度降低（P<0.001）。PNS重度水肿应用白蛋白后并发AKI患儿12例，在呋塞米及糖皮质激素等治疗基础上，与单纯输注血浆治疗相比，血浆联合甘露醇治疗的患儿在治疗第5和10天的尿量明显增加（P<0.005），体质量在治疗第5天后明显下降（P<0.05），血肌酐在治疗第7天明显降低（P<0.05）。结论 血浆治疗儿童PNS重度水肿的疗效明显优于白蛋白和低分子右旋糖酐。血浆输注对PNS重度水肿并发AKI患儿的疗效显著优于白蛋白治疗。在治疗PNS重度水肿应用白蛋白后并发AKI患儿的过程中，血浆输注后应用甘露醇更利于水肿的消退和肾功能的改善，缓解病情作用更快、更显著。

血浆治疗儿童原发性肾病综合征重度水肿的临床疗效

赵成广, 傅桐, 侯玲, 王秀丽, 杜悦

中国医科大学附属盛京医院小儿肾脏风湿免疫内科, 沈阳 110004

收稿日期:2021-01-05出版日期:2021-09-30发布日期:2021-09-18
通讯作者:杜悦E-mail:duy@sj-hospital.org
作者简介:赵成广(1974-),男,副主任医师,博士.



关键词: 血浆, 儿童, 原发性肾病综合征, 重度水肿
Abstract: Objective To compare the clinical effects of plasma,low-molecular-weight dextran,and albumin on children with severe edema of primary nephrotic syndrome (PNS). Methods The clinical data of 60 patients with a diagnosis of PNS with severe edema admitted to the Department of Pediatric Nephrology of the Shengjing Hospital of China Medical University from January 2017 to December 2019,were retrospectively analyzed to compare the clinical efficacy of the plasma group,albumin group,and low-molecular-weight dextran group. Results Compared with data before treatment,the urine output (UOP) was increased in three groups as body weight (BW) and serum creatinine (Scr) were decreased. For the plasma group,the UOP was significantly higher than that of other groups on the 3rd,7th,and 10th day of treatment (D3,D7,and D10) (P<0.001),while the BW was significantly lower on D3 and D10 (P<0.001),and the Scr was obviously decreased on D7 (P=0.005). Thirty-five cases were of severe edema of PNS complicated with acute kidney injury (AKI). The UOP increased in the albumin group and plasma group after treatment as BW and Scr decreased significantly. Compared with the albumin group,the UOP of the plasma group increased significantly on D3,D7,and D10 (P<0.001),the BW decreased on D7 and D10 (P<0.005),and the Scr decreased significantly on D7 (P<0.001). Twelve cases of severe edema of PNS with AKI after albumin application treated by basic therapy such as furosemide and glucocorticoids were divided into two groups. Compared with simple plasma infusion,the UOP of the children treated with plasma combined with mannitol increased significantly on D5 and D10 (P<0.005),the BW decreased on D5 (P<0.05),and the Scr decreased significantly on D7 (P<0.05). Conclusion The therapeutic effect of plasma on severe edema of PNS in children is better than that of albumin and low-molecular-weight dextran. The effect of plasma infusion on severe edema of PNS with AKI is significantly better than that of albumin. In severe edema of PNS with AKI after albumin application,mannitol after plasma infusion is more conducive to reduce edema and improve renal function,while remission is faster and more significant.
Key words: plasma, children, primary nephrotic syndrome, severe edema
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