三聚氰胺污染奶粉喂养婴幼儿致泌尿系结石并发肾积水46例分析  

Clinical analysis of urolithiasis complicated hydronephrosis in infants fed melamine-contaminated milk powder

作　　者：王焱[1,2,3] 文建国[1,2,3] 杨贺军[1,2,3] 范应中[1] 王家祥[1] 张大[1] 李苏宁[1] 张谦[1] 

机构地区：[1]郑州大学第一附属医院小儿外科,郑州450052 [2]郑州大学第一附属医院尿动力学中心,郑州450052 [3]河南省高等学校临床医学重点学科开放实验室,郑州450052

出　　处：《郑州大学学报（医学版）》2009年第1期7-10,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：国家自然科学基金资助项目30571931;河南省医学科技创新人才工程基金资助项目200703040;河南省医学科技攻关计划基金资助项目200801002

摘　　要：目的:了解三聚氰胺污染奶粉喂养婴幼儿泌尿系结石并发肾积水的临床特点。方法:回顾性分析三聚氰胺污染奶粉喂养致泌尿系结石并发肾积水婴幼儿46例和无肾积水患儿115例的临床特征,依据Grignon等婴幼儿肾积水分级标准,分为轻、中和重度3组,比较结石患儿(161例)和无泌尿系疾病患儿(30例)血清尿素氮(BUN)、血清肌酐(SCr)、血清尿酸(BUA)、尿pH水平。结果:161例三聚氰胺污染奶粉喂养患儿中发生泌尿系结石并发肾积水46例。半数患儿临床症状不明显,有17.0%的患儿发生排尿困难(包括排尿费力、尿不成线呈滴沥状),14.6%的患儿不明原因哭闹、拒食,10.7%的患儿少尿无尿,6.6%的患儿出现血尿。轻度肾积水7例,中度22例,重度17例。其中并发输尿管扩张21例。肾积水组与无积水组相比,结石直径差异有统计学意义(P<0.05),结石形态差异无统计学意义(P>0.05)。输尿管结石并发积水发生率显著高于肾结石并发积水发生率(P<0.05)。肾积水组、无积水组和对照组患儿血清BUN、SCr、BUA差异均无统计学意义(P>0.05);肾积水组、无积水组治疗前尿pH均低于对照组,差异有统计学意义(P<0.05)。经卫生部推荐方案治疗(9±5)d后,患儿结石排出率为42.7%,肾脏积水减轻或消失,肾脏功能恢复,尿量正常。结论:三聚氰胺污染奶粉喂养致婴幼儿泌尿系结石并发肾积水发病率高;结石并发积水与结石发生部位、大小有关;该类疾病保守治疗效果好。Aim： To investigate the clinical features of urolithiasis complicated hydronephrosis in infants and young children who had history of feeding melamine-contaminated milk powder. Methods： The clinical data of 46 infants and young children with hydronephrosis due to urolithiasis （HDU） induced by feeding melamine contaminated milk powder were retrospectively analyzed and 115 urolithiasis cases without hydronephrosis（UWH） as control. Blood BUN, SCr, BUA and u- rine PH were compared between hydronephrotic, non-hydronephrotic cases and 30 children without urinary diseases（WUD） （with no history of feeding melamine contaminating milk powder）. Results： Forty-six cases of urolithiasis complicated with hydronephrosis were detected in the 161 cases with urolithiasis（ incidence 28.6% ）. Among these patients,51.1% show asymptomatic, others, dysuria 17.0% , infantile colic 14.6% , oliguria or anuria 10.7% and hematuria 6.6%. All hydronephrosis patients were classified into mild （n = 7 ） , moderate （n = 22） , and severe （n = 17 ） group. Twenty-one cases complicated ureterectasis. There is significant difference （P 〈 0.05 ） in the mean diameter of calculi, but no significant difference （ P 〉 0.05 ） of the stone structure pattern between HDU and UWH group. The incidence of hydronephrosis due to kidney calculi is remarkly higher than hydronephrosis due to ureteral calculi（ P 〈 0.05）. There is no significant difference of the BUN, SCr and BUA between HDU, UWH and WUD（P 〉 0.05） ; the mean urinary pH value are remarkably decreased in HDU and UWH compared to WUD. All cases were treated for （9 ± 5） d using noninvasive treatment procedure according the guidanline from Chinese Ministry of Health. The stone dischanrge rate of all cases in the hospitalization period was 42.9%. Five cases of renal failure recovered to normal. Conclusion ：The incidence of hydronephrosis in infants with melamine stone is higher but clinical symptoms were mild. The severiety of hydronephrosis

关 键 词：三聚氰胺 婴幼儿 泌尿系结石 肾积水 

分 类 号：R692.4[医药卫生—泌尿科学]