Department of Public Health and Primary Care, Primary Care Unit, University of Cambridge, Cambridge, United Kingdom; Department of Clinical Child and Family Studies and Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Clinical Child and Family Studies and Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
J Psychosom Res. 2019 Jun;121:8-13. doi: 10.1016/j.jpsychores.2019.01.011. Epub 2019 Jan 19.
Steroid-sensitive nephrotic syndrome (SSNS) in children is often complicated by one or more relapses, as manifested by the appearance of proteinuria. Besides health-related triggers, psychological stress might be related to relapse. This longitudinal study examined the link between perceived stress, emotional valence (feeling happy vs. unhappy) and daily reported proteinuria, and investigated the temporal relation between stressful events and proteinuria.
Sixteen children (4-13 years) diagnosed with SSNS were included. Patients kept an online diary for an average of 124 days, wherein they reported proteinuria (n = 1985 urine samples), perceived stress, emotional valence, medication use and health complaints. Stressful days were determined at the start of the study. Using multilevel analysis, the following associations were tested: (1) the relation between perceived stress, emotional valence and proteinuria, and (2) the temporal relation between stressful days and proteinuria.
Appearance of proteinuria was reported in 410/1985 urine samples. Perceived stress and not emotional valence significantly predicted proteinuria (95% CI [0.11, 0.27]), even five days later. There was a significant temporal association between stressful days and proteinuria (95% CI [0.22, 1.14]). The effect sizes of these associations were small, f = 0.04 and f = 0.12, respectively.
Our findings suggest that psychological stress may trigger proteinuria in children with SSNS. Future research in larger samples is needed to support our findings.
儿童类固醇敏感性肾病综合征（SSNS）常因蛋白尿的出现而并发一次或多次复发。除了与健康相关的诱因外，心理压力也可能与复发有关。本纵向研究探讨了感知压力、情绪效价（感觉快乐与不快乐）与每日蛋白尿报告之间的关系，并调查了应激事件与蛋白尿之间的时间关系。
纳入 16 名被诊断为 SSNS 的儿童（4-13 岁）。患者平均记录了 124 天的在线日记，在此期间他们报告了蛋白尿（n=1985 个尿液样本）、感知压力、情绪效价、药物使用和健康状况。在研究开始时确定了有压力的日子。使用多层分析，测试了以下关联：（1）感知压力、情绪效价和蛋白尿之间的关系；（2）有压力的日子与蛋白尿之间的时间关系。
在 1985 个尿液样本中，有 410 个样本报告出现蛋白尿。感知压力而非情绪效价显著预测蛋白尿（95%CI[0.11,0.27]），即使在五天后也是如此。有压力的日子与蛋白尿之间存在显著的时间关联（95%CI[0.22,1.14]）。这些关联的效应大小较小，f=0.04 和 f=0.12。
我们的研究结果表明，心理压力可能会触发 SSNS 儿童的蛋白尿。需要在更大的样本中进行未来研究以支持我们的发现。
