原发性肾病综合征儿童糖皮质激素性高眼压的临床相关因素分析

doi:10.20274/j.cnki.issn.1674-3865.2025.05.011

摘要/Abstract

摘要：

目的分析原发性肾病综合征（PNS）儿童在糖皮质激素治疗期间高眼压(GIOH)的发生率及其临床相关危险因素。方法采用单组前瞻性队列研究。纳入2021年6月至2024年6月接受糖皮质激素治疗的82例PNS患儿。每月行动态眼压监测，根据是否发生GIOH分为GIOH组29例与非GIOH组53例，收集人口学特征、临床分型、糖皮质激素疗程及治疗方案等数据，采用χ2检验、Fisher精确检验及Mann-Whitney U检验分析组间差异，并通过Logistic回归分析独立危险因素。结果 GIOH总发生率为35.4%（29/82），女童发生率为58.8%（10/17），显著高于男童29.2%（19/65），差异有统计学意义（P=0.023）。多因素分析显示女性是独立危险因素（OR=3.75，95%CI:1.15～12.73，P=0.028）。学龄前儿童发生率最高，为47.8%（11/23），但年龄、糖皮质激素使用时间、病理分型及治疗方案与GIOH无显著相关性（P>0.05）。55.2%（16/29）患儿需降眼压药物治疗，所有患儿干预后均未进展为青光眼或白内障。结论 PNS患儿在糖皮质激素治疗期间，女童及学龄前儿童GIOH风险较高。动态眼压监测及早期干预可有效预防视力损害，适合临床推广。

关键词: 肾病综合征, 糖皮质激素, 高眼压, 前瞻性研究, 儿童

Abstract:

Objective To analyze the incidence of glucocorticoid-induced ocular hypertension(GIOH) and its clinical risk factors in children with primary nephrotic syndrome(PNS) during glucocorticoid treatment. Methods A single-group prospective cohort study was conducted. Eighty-two children with PNS receiving glucocorticoid treatment from June 2021 to June 2024 were enrolled. Dynamic intraocular pressure(IOP) monitoring was performed every month, and patients were divided into GIOH group(29 patients) and non-GIOH group(53 patients) based on whether GIOH occurred. The demographic data, clinical classification, glucocorticoid treatment duration, and treatment regimen were collected. Intergroup differences were analyzed using chi-square tests, Fisher's exact tests, and Mann-Whitney U tests, and independent risk factors were analyzed via Logistic regression analysis. Results The overall incidence of GIOH was 35.4%(29/82). The incidence in females was 58.8%(10/17), significantly higher than that in males(29.2%, 19/65)(P=0.023). Multivariate analysis confirmed female as an independent risk factor(OR=3.75, 95%CI: 1.15–12.73, P=0.028). The incidence was highest in preschool-aged children(47.8%, 11/23); however, age, duration of glucocorticoid use, pathological type, and treatment regimen showed no significant correlation with GIOH(P>0.05). A total of 55.2%(16/29) of children required IOP-lowering medication. None of the children progressed to glaucoma or cataract after intervention. Conclusion During glucocorticoid treatment for PNS, females and preschool-aged children have a higher risk for GIOH. Dynamic IOP monitoring and early intervention can effectively prevent visual impairment, making this approach suitable for clinical promotion..

Key words: Nephrotic syndrome, Glucocorticoid, Ocular hypertension, Prospective study, Child

中图分类号:

R692

潘瑞英. 原发性肾病综合征儿童糖皮质激素性高眼压的临床相关因素分析[J]. 中国中西医结合儿科学, 2025, 17(5): 424-428.

Ruiying PAN. Analysis of clinical related factors of glucocorticoid-induced ocular hypertension in children with primary nephrotic syndrome[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2025, 17(5): 424-428.

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参考文献 25

[1]	黄国英, 孙锟, 罗小平. 儿科学[M]. 10版. 北京: 人民卫生出版社, 2024: 299-303.
[2]	Zhong F, Zhang M, Gao Y. Study of the effects of glucocorticoid on growth and adult final height in children with primary nephrotic syndrome[J]. OJNeph, 2024, 14(1): 1-9.
[3]	潘瑞英. 儿童原发性肾病综合征糖皮质激素性眼损害的相关研究[J]. 中国中西医结合儿科学, 2023, 15(3): 203-207.
[4]	Mushtaq U, Ameen BS, Nie C, et al. Association between the use of systemic steroids and ocular hypertension as a side effect in pediatric population: a systematic review[J]. Cureus, 2023, 15(7): e42112.
[5]	Sawada M, Takachi T, Watanabe K, et al. Steroid-induced ocular hypertensive response in pediatric patients with acute lymphobla⁃stic leukemia[J]. Jpn J Ophthalmol, 2023, 67(4): 396-401.
[6]	Barzilai-Birenboim S, Elitzur S, Nirel R, et al. Elevated intraocular pressure in children with acute lymphoblastic leukaemia: a prospective study[J]. Br J Haematol, 2022, 196(5): 1248-1256.
[7]	李菁, 李光民, 历红, 等. 糖皮质激素性高眼压对肾病综合征儿童眼屈光的影响[J]. 河北医药, 2020, 42(22): 3409-3412.
[8]	石博影, 唐东永, 梁皓. 类固醇治疗肾病综合征儿童致激素性青光眼的相关进展[J]. 右江医学, 2021, 49(3): 166-171.
[9]	苗静, 徐虹, 沈茜, 等. 原发性肾病综合征患儿糖皮质激素治疗致眼科不良反应分析[J]. 临床儿科杂志, 2013, 31(4): 335-338.
[10]	赵芸, 苏白鸽, 肖慧捷, 等. 原发肾病综合征患儿糖皮质激素治疗致眼科不良反应临床特点分析[J]. 北京大学学报(医学版), 2017, 49(5): 794-797.
[11]	李菁, 王双连, 侯林静, 等. 肾病综合征全身应用激素对眼压产生影响的时机[J]. 世界最新医学信息文摘, 2018, 18(13): 69, 74.
[12]	于晓宁, 陈朝英, 涂娟, 等. 糖皮质激素治疗儿童原发性肾病综合征继发眼部疾病的临床特征分析[J]. 中国医刊, 2024, 59(1): 94-97.
[13]	李凤鸣. 中华眼科学[M]. 2版. 北京: 人民卫生出版社, 2005.
[14]	中华医学会儿科学分会肾脏学组.儿童激素敏感、复发/依赖肾病综合征诊治循证指南(2016)[J]. 中华儿科杂志, 2017, 55(10): 729-734.
[15]	Disease Kidney : Improving Global Outcomes Nephrotic Syndrome In Children Work Group, Floege J, Gibson KL, et al. KDIGO 2025 clinical practice guideline for the management of nephrotic syndrome in children[J]. Kidney Int, 2025, 107(5S): S241-289.
[16]	中华医学会眼科学分会青光眼学组. 中国高眼压症诊断治疗和随访专家共识(2020年)[J]. 中华眼科杂志,2020,56(1):21-24.
[17]	杨恩团, 李莉, 余继峰, 等. 儿童青少年高眼压症[J]. 中国斜视与小儿眼科杂志, 2021, 29(3): 38-41.
[18]	Krag S, Larsen D, Albertsen BK, et al. Risk of ocular hypertension in children treated with systemic glucocorticoid[J]. Acta Ophthalmol, 2021, 99(8): e1430-1434.
[19]	Sato M, Ishikura K, Ando T, et al. Prognosis and acute complications at the first onset of idiopathic nephrotic syndrome in children: a nationwide survey in Japan(JP-SHINE study)[J]. Nephrol Dial Transplant, 2021, 36(3): 475-481.
[20]	Takano F, Ueda K, Yamada-Nakanishi Y, et al. Risk factors of pediatric steroid-induced ocular hypertension[J]. Graefes Arch Clin Exp Ophthalmol, 2025, 263(3): 867-872.
[21]	Hariharan R, Krishnamurthy S, Kaliaperumal S, et al. Incidence and predictive risk factors for ophthalmological complications in children with nephrotic syndrome receiving long-term oral corticosteroids: a cohort study[J]. Paediatr Int Child Health, 2021, 41(3): 199-205.
[22]	李玉柳,刘翠华,张书锋,等. 原发性肾病综合征患儿应用糖皮质激素治疗所致眼损害的临床特点[J]. 中华实用儿科临床杂志,2019,34(12):938-941.
[23]	Elizabeth Fini M, Schwartz SG, Gao X, et al. Steroid-induced ocular hypertension/glaucoma: focus on pharmacogenomics and implications for precision medicine[J]. Prog Retin Eye Res, 2017, 56: 58-83.
[24]	Chan W, Wiggs JL, Sobrin L. The genetic influence on corticosteroid-induced ocular hypertension: a field positioned for discovery[J]. Am J Ophthalmol, 2019, 202: 1-5.
[25]	张建江,谈文秀. 原发性肾病综合征患儿应用糖皮质激素致眼部不良反应的防治[J]. 中华实用儿科临床杂志,2021,36(5):333-337.

疾病状态	n	高眼压例数	高眼压发生率（%）
初发	23	9	39.1
复发	20	7	35.0
频复发	39	13	33.3

临床分型	n	高眼压例数	高眼压发生率（%）
单纯型	79	29	36.7
肾炎型	3	0	0.0

激素治疗反应类型	n	高眼压例数	高眼压发生率（%）
激素敏感型	28	10	35.7
激素依赖型	44	15	34.1
激素耐药型	10	4	40.0

治疗方案	n	高眼压例数	高眼压发生率（%）
单纯口服糖皮质激素	37	13	35.1
甲泼尼龙冲击治疗	6	3	50.0
糖皮质激素联合免疫抑制剂/生物制剂	39	13	33.3

病理分型	n	高眼压例数	高眼压发生率（%）
微小病变型	31	12	38.7
非微小病变型	14	5	35.7