Persistence of behavioral abnormalities following corticosteroid therapy in children with initial episode of idiopathic nephrotic syndrome: a prospective longitudinal observation

Abstract Introduction: Treatment of nephrotic syndrome with corticosteroid can cause several side- effects including behavioral abnormalities. The objectives of the study were to observe the proportion of non-relapsers having persistence of behavioral abnormalities after completion of treatment of initial episode and compare the abnormalities with relapsers, and to determine risk factors for persistence. Methods: Seventy-five children with a first episode of idiopathic nephrotic syndrome and 60 normal children were rated by parents for behavioral problems using the Child Behavior Checklist. The Parenting Stress Index was also evaluated. The children were rated before treatment and 12 and 36 weeks after. Results: Both relapsers and non-relapsers showed abnormalities in internalizing and externalizing domains at 12 weeks of steroid therapy. Non-relapsers had abnormal scores in the internalizing domain in 63.5 % and externalizing domain in 48.1% of cases at 36 weeks. Relapsers had abnormal scores in all the three behavior domains, but a significantly higher proportion of relapsers had abnormal scores regarding total behavior (65.2% vs 28.8%, p<0.01) and child domains (100% vs 57.7%, p<0.001) of Parenting Stress Index in comparison to non-relapsers at 36 weeks. Occurrence of relapse increased the risk (odds ratio 5.76, 95% CI 1.35-10.76, p< 0.001) for persistence of abnormal total behavior at 36 weeks follow-up. Conclusion: Persistence of abnormalities was observed not only in relapsers but also in non-relapsers. Relapse was found to be a significant risk factor for persistence of abnormal behaviors in these patients.

摘要：
研究背景：糖皮质激素（corticosteroid）治疗肾病综合征可引发包括行为异常在内的多种不良反应。本研究旨在观察初治疗程结束后未复发患儿行为异常持续存在的比例，并与复发患儿的行为异常情况进行对比，同时明确行为异常持续存在的危险因素。
方法：本研究纳入75例初发性特发性肾病综合征（idiopathic nephrotic syndrome）患儿与60名正常儿童，由家长采用儿童行为量表（Child Behavior Checklist）对其行为问题进行评定，并同步评估育儿压力指数（Parenting Stress Index）。分别于治疗前、治疗后12周及36周对患儿开展评定。
结果：在糖皮质激素治疗12周时，复发组与未复发组患儿均在内化性与外化性行为领域出现异常。治疗36周时，未复发组患儿内化性行为领域异常占比为63.5%，外化性行为领域异常占比为48.1%。复发组患儿在全部三项行为领域均存在异常评分；与未复发组相比，复发组育儿压力指数的总行为异常评分占比（65.2% vs 28.8%，p<0.01）及儿童领域异常评分占比（100% vs 57.7%，p<0.001）均显著更高。在36周随访阶段，复发可提升异常总行为持续存在的风险（优势比OR=5.76，95%置信区间CI：1.35~10.76，p<0.001）。
结论：行为异常持续存在的情况不仅见于复发患儿，未复发患儿亦可出现。本研究证实，复发是此类患儿行为异常持续存在的显著危险因素。