Objective To investigate the diagnostic criteria of hypoalbuminemia in nephrotic syndrome in children.Methods Data from children with idiopathic nephrotic syndrome hospitalized in Peking University First Hospital during January of 1993 to December of 2012 were collected and analyzed retrospectively.Children were divided into 2 groups,including a group with serum albumin 25 to 30 g·L-1and another group with serum albumin < 25 g·L-1at onset.Data on children's general information,renal pathology,clinical presentations,treatment,steroid response,serious complications and prognosis were compared between two groups.Results Data from 458 children were analyzed including 28 cases in group with serum albumin 25 to 30 g·L-1and 430 cases in group with serum albumin less than 25 g·L-1.No significant differences were found in gender and onset age between two groups.①Twelve children from group with serum albumin < 25 g·L-1and 141 children from group with serum albumin 25 to 30 g·L-1underwent renal biopsy.There was no significant difference in the renal pathological diagnosis type between two groups.Focal segmental glomerulosclerosis was the most common pathological change in both groups.Minimal change disease or minor change disease accounted for 21.9%in group with serum albumin < 25 g·L-1and 8.3％in group with serum albumin 25 to 30 g·L-1.② There were no significant differences between two groups in the clinical phenotype,the kinds of immunosuppressant,the occurrence of severe complications and the incidence of steroid related adverse events.There was a significant difference in steroid response between the two groups.The steroid response rate was 68.4％(294/430)in group with serum albumin < 25 g·L-1and 50.0％(14/28)in group with serum albumin 25 to 30 g·L-1.③The occurrence of serious prognosis in group with serum albumin 25 to 30 g·L-1was significantly higher than in group with serum albumin < 25 g·L-1(14.3％vs 4.4％,P=0.04).Conclusion Children with heavy proteinuria and serum albumin 25 to 30 g·L-1manifested mainly with non minimal/minor change disease and more serious prognosis.Early renal biopsy should be performed on them.%目的 探讨儿童原发性肾病综合征低白蛋白血症诊断标准.方法 收集1993年1月至2012年12月在北京大学第一医院住院的原发性肾病综合征患儿的临床资料,根据初次诊断肾病综合征时的最低血浆白蛋白水平将患儿分为<25 g·L-1 组和25~30 g·L-1 组.比较两组的肾脏病理类型、临床表型、激素效应、合并症和预后.结果 进入本文分析患儿458例,白蛋白25~30 g·L-1 组28例,白蛋白<25 g·L-1 组430例,两组性别和年龄差异无统计学意义.①血浆白蛋白水平<25 g·L-1 组和25~30 g·L-1 组分别有12例和141例行肾脏病理分析,两组肾脏病理类型分布差异无统计学意义,均以局灶节段性肾小球硬化症为主,两组微小病变或轻微病变分别占21.9%和8.3%;②2组临床表型、免疫抑制剂的应用种类、严重合并症的发生情况和激素相关不良反应的发生情况差异均无统计学意义,2组激素效应分布差异有统计学意义,血浆白蛋白水平<25 g·L-1 组和25~30 g·L-1 组激素敏感比例分别为68.4%(294/430)和50.0%(14/28);③血浆白蛋白水平25~30 g·L-1 组严重预后发生率(14.3%,4/28)高于<25 g·L-1 组(4.4%,19/430).结论 具有大量蛋白尿伴有血浆白蛋白25~30 g·L-1 的患儿肾脏病理类型以非微小病变为主,其预后较血浆白蛋白<25 g·L-1 者更为严重,建议早期行肾活检.
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