儿童原发性肾病综合征并发医院获得性肺炎的危险因素

Risk Factors of ospital Acquired Pneumonia in Children with the Nephrotic yndrome

摘要:

目的  探讨原发性肾病综合征（ＮＳ）患儿医院获得性肺炎（ＨＡＰ）的危险因素。方法  收集１９９７年１２月至２０００年１２月该院ＮＳ患儿共１９８例进行回顾性分析。结果  １９８例ＮＳ患儿中发生医院感染者共６３例（占３１．８％），其中ＨＡＰ占医院感染中的５２．４％（３３／６３），位居第一。两组患儿在年龄、病程、性别、临床分型、外周血白细胞、血ＩｇＡ、ＩｇＭ、尿素氮和２４ ｈ尿蛋白定量上差异均无显著性（Ｐ＞０．０５）。ＨＡＰ组的住院天数长于对照组[（４４．６±７．６） ｄ ｖｓ(２３．９±９．３ ）ｄ］、严重水肿者多于对照组（５１．５％ｖｓ ２６．８％），血白蛋白及ＩｇＧ的水平低于对照组[（１１．４６±３．３７）ｇ／Ｌ ｖｓ(２２．９１±８．６７）ｇ／Ｌ，（２．７２±１．３２）ｇ／Ｌ ｖｓ(６．８１±１．８９）ｇ／Ｌ］，联合应用免疫抑制剂者也多于对照组（４５．５％ ｖｓ １９．１％），经统计学处理差异均有显著性（Ｐ ＜ ０．０５）。结论  ＮＳ患儿并发ＨＡＰ的危险因素有较长的住院天数，严重水肿，白蛋白明显下降，血ＩｇＧ的下降及激素联合免疫抑制剂的应用。

Abstract:

OBJECTIVE: To investigate the risk factors for hospital acquired pneumonia(HAP) in children with the nephrotic syndrome(NS).METHODS: Clinical data of 198 children with NS admitted between December,1997 and December, 2000 were analyzed retrospectively. RESULTS: Of the 198 cases, 63 had nosocomial infection(31.8%), including 33 cases of HAP(52.3%), accounting for the largest percentage of nosocomial infection. There was no difference between the HAP children and non-infection children with respect to age, course of disease, sex, clinical type of NS, leucocyte count, serum IgA, IgM ,and BUN levels, and 24 h urine protein quantity. Duration of hospitalization before acquiring nosocomial infection was longer [(44.6±7.6) days vs((23.9±9.3)days, the percentage of patients with severe edema(51.5% vs 26.8%) and immunosuppressive agent administration was higher(45.5% vs 19.1%), and the serum albumin and IgG levels were lower [(11.46±3.37) g/L vs(22.91±8.67) g/L and(2.72±1.32) g/L vs(6.81±1.89)g/L ,respectively] in HAP children copmpared to those non infection children(all P < 0.05). CONCLUSIONS: Severe edema, reduced levels of serum albumin and IgG, use of immunosuppressive agent, a nd longer hospitalization duration may be risk factors for HAP in childre n with NS.