原发性膀胱输尿管返流患儿肾实质损害评估  

Evaluation of renal parenchymal damage in children with primary vesicoureteral reflux

作　　者：董瑜[1] 卫敏江[1] 陈慧敏[1] 沈加[1] 李玉峰[1] 金晶[1] 朱建幸[1] 

机构地区：[1]上海交通大学医学院附属新华医院儿肾内科,200092

出　　处：《中华实用儿科临床杂志》2013年第17期1327-1330,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 评估膀胱输尿管返流（VUR）患儿的临床特点,探讨VUR患儿性别、年龄、返流级别与肾实质损害的关系.方法 以2000年1月至2012年5月上海交通大学医学院附属新华医院儿肾内科收治的85例VUR患儿为研究对象,对其临床资料进行临床研究.VUR患儿均经排泄性尿路造影（VCUG）确诊为VUR,依据返流级别分为低级别VUR组（Ⅰ～Ⅱ级）和高级别VUR组（Ⅲ～Ⅴ级）.VUR患儿均在住院期间接受99Tcm-二巯基丁二酸（DMSA）肾静态显像检查,并以肾静态显像异常和相对肾摄取率降低作为肾实质损害的标准.比较VUR患儿不同性别、年龄、返流级别、返流侧与肾实质损害的关系.结果 85例患儿（男33例,女52例）纳入本研究,其中≤2岁59例（69.4％）,＞2岁26例（30.6％）；单侧返流45例（52.9％）,双侧返流40例（47.1％）,共计125组返流肾输尿管单位,其中高级别VUR有93组返流肾输尿管单位,占所有VUR的74.4％.≤2岁儿童较＞2岁儿童更易出现高级别VUR,但返流的级别与性别并无相关性.共有89组（71.2％）肾输尿管单位出现肾实质损害,VUR肾实质损害与返流级别（P =0.030）、性别（P=0.021）和年龄（P =0.005）均明显相关.结论 ≤2岁儿童较＞2岁儿童更易出现高级别VUR.≤2岁的VUR患儿更易发生肾实质损害,男童较女童更易发生肾实质损害.高级别VUR是儿童发生肾实质损害的一个重要危险因素.Objective To evaluate the clinical features of primary vesicoureteral reflux（VUR） in children and to investigate the association of sex,age,reflux grade and renal parenchymal damage （RPD） in VUR.Methods Medical records of 85 patients in Department of Pediatric Nephrology,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine diagnosis as VUR from Jan.2000 to May 2012 were reviewed.VUR was diagnosed by voiding cystourethrogram（VCUG）.According to the results of VCUG,patients were divided into groups of low-grade（Ⅰ-Ⅱ）VUR and high-grade （Ⅲ-Ⅴ） VUR.All cases underwent Tc-dimercaptosuccimc acid （DMSA） renal scan,RPD was defined by image appearance and relative kidney uptake.The impact of patient＇s gender and age as well as VUR grade on RPD were compared.Results A total of 85 patients （33 boys,52 girls） were included,of whom 59 cases （69.4％）were under 2 years old,26 cases（30.6％） were older than 2 years.VUR was unilateral in 45 patients（52.9％） and bilateral in 40 patients（47.1％）,total of 125 renal units.The high-grade VUR was 93 renal units（74.4％）,the incidence of high-grade VUR was significantly higher in patients who under 2 years old,but the reflux grade showed no association with gender.RPD was found in 89 renal units（71.2％）.RPD rate was associated with high-grade reflux （P =0.030）,male gender （P=0.021）and age（P =0.005）.Conclusions The high-grade VUR is common seen in patients under 2 years old.The risk of RPD in patients were under 2 years old and in boys.High-grade VUR is a critical risk factor of RPD in children.

关 键 词：膀胱输尿管返流 原发性 肾实质损害 年龄 性别 儿童 

分 类 号：R726.9[医药卫生—儿科]