Hingorani Sangeeta R, Weiss Noel S, Watkins Sandra L
Children's Hospital and Regional Medical Center, 4800 Sandpoint Way NE, CH-46, Seattle, WA 98105, USA.
Pediatr Nephrol. 2002 Aug;17(8):678-82. doi: 10.1007/s00467-002-0890-6. Epub 2002 Jun 7.
Patients with nephrotic syndrome (NS) are at increased risk for infection. Peritonitis is difficult to diagnose in the absence of peritoneal fluid analysis and empiric therapy carries significant risks. We identified factors present at initial presentation that are associated with an increased risk for the later development of spontaneous bacterial peritonitis in children with NS. A case-control study of patients admitted to Children's Hospital and Regional Medical Center, Seattle from 1989 to 1999 with a diagnosis of NS was conducted; 8 cases of NS and peritonitis (aged 20-113 months) and 24 controls with NS alone (aged 10-193 months) were identified and matched on year of diagnosis of NS. Medical charts were reviewed and laboratory values at the time of initial presentation of NS were recorded. Odds ratios (OR) were estimated, Fischer's exact test was used to obtain P values, and 95% exact confidence intervals (CI) were also calculated. Cases tended to be younger than controls (mean age 50.5 months vs. 65.3 months), and were more likely to be white and male. There was a suggestion of an association between serum albumin level at presentation and the risk of subsequent peritonitis. Those patients with a serum albumin level less than or equal to 1.5 g/dl at initial presentation were estimated to have a 9.8-fold (95% CI 0.93, 472; P=0.06) increase in the odds of developing peritonitis than those with an initial albumin greater than 1.5 g/dl. A platelet count greater than 500 cells/mm(3)tended toward a reduced risk (OR=0.12, 95% CI 0.002,1.29; P=0.10) for subsequent peritonitis when compared with patients with a platelet count less than 500 cells/mm(3), but was not statistically significant. Hypertension, hematuria, or normal serum complement levels (C3, C4) at the time of initial diagnosis were not associated with an increased risk of subsequent peritonitis. Low serum albumin (< or = 1.5 g/dl) at presentation was associated with an increased risk of peritonitis among children with NS at our institution.
肾病综合征（NS）患者发生感染的风险增加。在缺乏腹水分析的情况下，腹膜炎很难诊断，经验性治疗存在重大风险。我们确定了初诊时存在的与NS患儿后期发生自发性细菌性腹膜炎风险增加相关的因素。对1989年至1999年入住西雅图儿童医院和地区医疗中心且诊断为NS的患者进行了一项病例对照研究；确定了8例NS合并腹膜炎患者（年龄20 - 113个月）和24例单纯NS对照患者（年龄10 - 193个月），并根据NS诊断年份进行匹配。查阅了病历并记录了NS初诊时的实验室值。估计了比值比（OR），使用费舍尔精确检验获得P值，并计算了95%精确置信区间（CI）。病例组患者往往比对照组患者年龄小（平均年龄50.5个月对65.3个月），且更可能为白人及男性。初诊时血清白蛋白水平与随后发生腹膜炎的风险之间存在关联迹象。初诊时血清白蛋白水平小于或等于1.5 g/dl的患者发生腹膜炎的几率估计比初诊白蛋白大于1.5 g/dl的患者增加9.8倍（95% CI 0.93，472；P = 0.06）。与血小板计数小于500细胞/mm³的患者相比，血小板计数大于500细胞/mm³的患者随后发生腹膜炎的风险有降低趋势（OR = 0.12，95% CI 0.002，1.29；P = 0.10），但无统计学意义。初诊时高血压、血尿或血清补体水平正常（C3、C4）与随后发生腹膜炎的风险增加无关。在我们机构，NS患儿初诊时低血清白蛋白（<或 = 1.5 g/dl）与发生腹膜炎的风险增加相关。
