经验治疗与肾穿刺活检术辅助治疗肾病综合征的临床研究

张莉莉 张颖 包斯琴

[摘要] 目的 研究经验治疗与肾穿刺活检术辅助治疗肾病综合症的临床效果。方法 方便收集兴安盟医院2016年1月—2017年2月门诊及住院肾病综合征患者共60例，随机将其分为非肾穿刺组与肾穿刺组，每组均为30例，非肾穿刺组给予经验治疗，肾穿刺组根据病理类型按照KDIGO指南给予治疗，对比两组患者的临床疗效、症状开始缓解时间以及激素减量过程中的复发情况。 结果 非肾穿刺组的缓解率为70.0%，肾穿刺组为90.0%，肾穿刺组高于非肾穿刺组，对比差异有统计学意义（χ2=3.65，P<0.05）。非肾穿刺组的症状开始缓解时间为（20.1±14.2）d，腎穿刺组为（14.5±10.7）d，肾穿刺组明显短于非肾穿刺组，对比差异有统计学意义（t=4.12，P<0.05）。非肾穿刺组激素减量过程中的复发率为13.3%，肾穿刺组为3.3%，肾穿刺组低于非肾穿刺组，对比差异有统计学意义（t=2.86，P<0.05）。 结论 肾穿刺活检术辅助治疗肾病综合征的临床效果明显优于经验治疗，可快速缓解临床症状，显著降低激素减量过程中的复发率，值得推行。

[关键词] 经验治疗;肾穿刺活检术;辅助治疗;肾病综合征

[中图分类号] R692.3          [文献标识码] A          [文章编号] 1674-0742（2018）08（c）-0063-03

Experience in the Treatment of Nephrotic Syndrome with Empiric Therapy and Renal Needle Biopsy

ZHANG Li-li， ZHANG Ying， BAO Si-qin

Department of Nephrology， Xing'anmeng People's Hospital， Wulanhaote， Inner Mongolia， 137400 China

[Abstract] Objective To study the clinical effect of empiric therapy and renal biopsy in the treatment of nephrotic syndrome. Methods A total of 60 outpatients and patients with nephrotic syndrome were convenient from January 2016 to February 2017 in the hospital. They were randomly divided into non-renal puncture group and renal puncture group， 30 cases in each group. Non-kidney puncture group was given empirical treatment. The renal puncture group was treated according to the KDIGO guidelines according to the pathological type. The clinical efficacy， the onset of symptom relief， and the recurrence during hormone reduction were compared between the two groups. Results The remission rate was 70.0% in the non-renal puncture group and 90.0% in the renal puncture group. The renal puncture group was higher than the non-renal puncture group， and the difference was statstically significant （χ2=3.65， P<0.05）. The time of onset of symptom relief in the non-renal puncture group was （20.1±14.2）d， and that in the renal puncture group was （14.5±10.7）d. The renal puncture group was significantly shorter than the non-renal puncture group， the difference was statistically signficant（t=4.12， P<0.05）. The recurrence rate in the non-renal biopsy group was 13.3% in the course of hormone reduction， 3.3% in the renal biopsy group， and lower in the renal biopsy group than in the non-renal biopsy group （t=2.86， P<0.05）. Conclusion The clinical effect of renal biopsy assisted treatment of nephrotic syndrome is significantly better than that of empirical therapy. It can quickly relieve clinical symptoms and significantly reduce the recurrence rate during hormone reduction. It is worthy of implementation.

[Key words] Experience therapy; Renal biopsy; Adjuvant therapy; Nephrotic syndrome

肾病综合征（nephrotic syndrome，NS）是一种临床常见病症，其致病因素较多，肾小球疾病是最主要的危险因素[1]。患者由于诸多蛋白尿的排出，体内一般处于低蛋白血症状态，胶体渗透压变低，极易出现严重的全身性水肿，病情持续恶化的话，甚至会出现肾小球硬化、肾功能不全等不良后果，会严重威胁患者的生命安全，必须及时采取有效措施进行治疗[2]。基于此，該文为了进一步研究经验治疗与肾穿刺活检术辅助治疗肾病综合症的临床效果，方便收集兴安盟医院2016年1月—2017年2月门诊及住院肾病综合症患者共60例，对其治疗情况展开对比分析，现将报道如下。

1  资料与方法

1.1  一般资料

方便收集兴安盟医院门诊及住院肾病综合征患者共60例，纳入标准：①临床资料完整、有效;②经实验室等检查证实，符合国家医学会制定的NS相关诊断标准，临床上均表现出不同程度的水肿、低蛋白血症、高脂血症等症状;③自愿签订知情同意书。……