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

Abstract

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

CLC Number:

R692

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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年龄分类	n	高眼压例数	高眼压发生率（%）
幼儿	6	0	0.0
学龄前	23	11	47.8
学龄期	38	13	34.2
青春期	15	5	33.3

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

Analysis of clinical related factors of glucocorticoid-induced ocular hypertension in children with primary nephrotic syndrome

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变量	β值	OR值	95%CI	P值
性别（女性vs.男性）	1.32	3.75	1.15～12.73	0.028
年龄组（学龄前vs.其他）	0.85	2.34	0.91～6.01	0.081
治疗方案（甲泼尼龙冲击vs.其他）	1.10	3.01	0.56～16.67	0.210
糖皮质激素使用时间（月）	0.05	1.05	0.98～1.13	0.230

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组别	n	糖皮质激素使用时间（月）
GIOH组	29	13（6，29）
非GIOH组	53	12（7，36.5）

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