소아 스테로이드 반응성 신증후군에서 재발과 관련된 예측인자
Predictive Factors for Relapse in Children with Steroid Responsive Nephrotic Syndrome
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목 적:스테로이드 반응성 신증후군 환아들의 초기 치료 중에 나타나는 임상경과 중 재발빈도와 관련되는 자료들을 선별하여, 재발에 대한 예측인자로서의 의의를 확인하기 위해 본 연구를 시행하였다. 방 법:대상환아는 1996년부터 2001년까지 6년간 경북대학교병원 소아과에서 스테로이드 반응성 신증후군으로 진단되어 2년 이상 추적관찰이 가능하였던 73례로 하였고, 이 환아들을 대상으로 성별, 발병연령, 신장조직 검사결과, 각종 검사실 성적, 첫 치료 후 관해까지의 기간, 첫 치료 후 재발까지의 기간, 재발빈도 등을 의무기록지를 통해 후향적으로 고찰하였으며, 재발빈도와 다른 자료들간의 상관관계를 통계적으로 분석하였다. 결 과:대상환아의 신증후군 진단 당시 평균연령은 4.53±2.53세였으며 남녀비는 52:21로 남아가 많았다. 첫 치료 후 완해까지의 기간은 10.2±7.4일이었고 대부분(77%)은 2주 이내에 완해됨을 알 수 있었다. 재발은 전체의 78%인 57명에서 나타났는데, 첫 1년간은 2.6±1.4회, 2년째는 1.9±1.3회를 재발하였으며, 이 중 23%인 13명이 “빈발 재발형”으로 진단되었다. 재발이 있었던 환아들은 첫 치료 후 4.7±3.5개월 후에 첫 재발이 있었다. 진단 당시 시행한 혈액검사 및 요단백-크레아티닌 비, 24시간 요단백배설량, 진단 당시 연령, 성별, 혈뇨의 동반 유무와 재발빈도 간에는 유의한 상관관계를 발견할 수 없었다. 그러나, 첫 치료 후 완해까지의 기간과 재발빈도 간에는 유의한 상관관계를 발견할 수 있었으며, 7일 이내에 완해가 온 군은 7일 이후에 완해가 온 군에 비해, 첫 치료 후 1년간의 재발횟수가 통계적으로 유의하게 적었다(0.93±1.28 vs 2.22±1.60, P=0.006). 또한, Kaplan-Meier 모형을 이용한 누적완해율의 분석에서도 두 군간의 유의한 차이를 확인할 수 있었다(P=0.0017). 결 론:스테로이드 반응성 신증후군 환아에서 첫 발병 당시 경구 스테로이드 투여 후 완해까지의 기간은 이후 재발빈도를 추정할 수 있는 예측인자로 가능성이 있으며 이를 증명하기 위해서는 대규모의 전향적인 연구가 필요하다고 생각된다.
Abstract
Purpose : Relapses are a major problem in children with steroid responsive nephrotic syndrome(SRNS). This study has been performed to determine the predictive factors for relapse in children with SRNS. Methods : The study group consisted of 73 children with SRNS who had been admitted to the Department of Pediatrics, Kyungpook National University Hospital, over 6 years from 1996 to 2001. The medical records were reviewed retrospectively and analyzed to determine significant relationships between selected variables[age at onset, sex, laboratory data, the rapidity of response(days to remission), interval to first relapse] and the frequency of relapse. Results : The age(mean±SD) of patients was 4.53±2.53 years old. The male to female ratio was 52 : 21. In 95%, 39 out of the 41 children had a renal biopsy, and the final diagnosis was minimal change nephrotic syndrome. There was no significant correlation between the frequency of relapse and the following variables : age at onset, sex, and presence of hematuria. However, the rapidity of response correlated well with the frequency of relapse, especially during the first year after the onset of the disease(P=0.006). Conclusion : The rapidity of response is expected to be one of the predictive factors for relapse in children with SRNS.
참고문헌 (30)
- International Study of Kidney Disease in Children, "The primary nephrotic syndrome in children", 98, pp.561~4 (1981)
- Eddy AA, "Nephrotic syndrome in childhood", 362, pp.629~39 (2003)
- White RHR, "Clinicopathologic study of nephrotic syndrome in childhood", 1, pp.1353~9 (1970)
- Tune BM, "Treatment of he idiopathic nephrotic syndrome:Regimens and outcomes in children and adults", 8, pp.824~32 (1997)
- Bonilla-Felix M, "Changing patterns in the histopathology of idiopathic nephrotic syndrome in children", 55, pp.1885~90 (1999)
- Filler G, "Is there really an increase in non-minimal change nephrotic syndrome in children", 42, pp.1107~13 (2003)
- Ehrich JH, "Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children:Arbeitsgemeinschaft fur Padiatrische Nephrologie", 152, pp.357~61 (1993)
- Hogg RJ, "Evaluation and management of proteinuria and nephrotic syndrome in children recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria", 105, pp.1242~9 (2000)
- Fakhouri F, "Steroid-sensitive nephrotic syndrome:From childhood to adulthood", 41, pp.550~7 (2003)
- Constantinescu AR, "Predicting first-year relapses in children with nephrotic syndrome", 105, pp.492~5 (2000)
- Takeda A, "Risk factors for relapse in childhood nephrotic syndrome", 10, pp.740~1 (1996)
- Kabuki N, "Influence of age at onset on the outcome of steroid-sensitive nephrotic syndrome", 12, pp.467~70 (1998)
- Yap HK, "Risk factors for steroid dependency in children with idiopathic nephrotic syndrome", 16, pp.1049~52 (2001)
- Sim HS, "Clinical review of idiopathic nephrotic syndrome in children", 6, pp.37~47 (2002)
- Kim JS, "Long-term follow-up study of children with minimal change nephrotic syndrome", 41, pp.1675~84 (1998)
- Hiraoka M, "Favorable course of steroid-responsive nephrotic children with mild initial attack", 47, pp.1392~3 (1995)
- Kim PK, "Minimal change nephrotic syndrome on childhood", 6, pp.103~16 (1987)
- International Study of Kidney Disease in Children, "Early identification of frequent relapsers among children with minimal change nephrotic syndrome", 101, pp.514~8 (1982)
- Koskimies O, "Long-term outcome of primary nephrotic syndrome", 57, pp.544~8 (1982)
- Andenmatten F, "Outcome of idiopathic childhood nephrotic syndrome", 29, pp.15~9 (1995)
- Wynn SR, "Long- term prognosis for children with nephrotic syndrome", pp.63~8 (1988)
- Yoshimura A, "Aggravation of minimal change nephrotic syndrome by administration of human albumin", 37, pp.109~14 (1992)
- Carrie BJ, "Minimal change nephropathy:an electrochemical disorder of the glomerular membrane", 70, pp.262~8 (1981)
- Arbeitsgemeinschaft fur Padiatrische Nephrologie, "Short versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children", 1, pp.380~3 (1988)
- Brodehl J, "The treatment of minimal change nephrotic syndrome:lessons learned from multicentre co-operative studies", 150, pp.380~7 (1991)
- Hiraoka M, "A randomized study of two long course prednisolone regimens for nephrotic syndrome for children", 41, pp.1155~62 (2003)
- Hodson EM, "Corticosteroid therapyin nephrotic syndrome:a meta-analysis of randomized controlled trials", 83, pp.45~51 (2000)
- Brodehl J, "Conventional therapy for idiopathic nephrotic syndrome in children", 35(1), pp.~15 (1991)
- Ksiazek J, "Short versus long initial prednisone treatment in steroid-sensitive nephrotic syndrome in children", 84, pp.889~93 (1995)
- Lande MB, "Long versus standard initial steroid therapy for children with the nephrotic syndrome:A report from the Southwest Pediatric Nephrology Study Group", 18, pp.342~6 (2003)