42例膀胱输尿管反流患儿的临床分析  

Clinical analysis of 42 cases of vesicoureteric reflux in children

作　　者：张林[1] 赵丽萍[1] 周红霞[1] 葛婷婷[1] 

机构地区：[1]无锡市儿童医院肾脏风湿免疫科

出　　处：《临床肾脏病杂志》2015年第11期664-673,共10页Journal Of Clinical Nephrology

摘　　要：目的回顾性分析儿童泌尿道感染中膀胱输尿管反流（vesicouretericreflux，VUR）的发生情况，了解肾损害情况及其预后。方法选择2010年1月至2012年12月因尿路感染在无锡市儿童医院住院后确诊为VUR的42例患儿为研究对象，回顾性分析反流发生情况、肾瘢痕形成、随访其反流转归情况，其中有20例获得了完整随访资料。结果尿路感染中膀胱输尿管反流的发生率35．9％（42／117），反复尿路感染患儿中的VUR的发生率（62．2％）明显高于首次尿路感染（23．7％），在不同年龄段中，婴儿期（≤1岁）VUR的发生率高（61．9％），且以重度反流为主（48．6％）。有完整随访资料的20例中包括轻度反流2例，中度反流7例，重度反流11例；随访1～2年均重复第二次X线排尿期膀胱尿路造影检查，发现各反流等级均有不同程度改变：完全缓解为3例，部分缓解6例，无变化10例，加重1例。有7例肾瘢痕，5例在首次放射性核素肾静态扫描检查中即已发现，2例在随访过程中发现，均发生于中重度反流患儿，6例发现肾瘢痕时年龄均小于2岁。42例VUR患儿中2例在确诊后即转外科治疗，20例内科随访患儿中有2例转为外科治疗。结论VUR需要及早诊断和治疗，特别对婴儿期加强重视，对肾损害及时评估，合理调整治疗方案，加强宣教，做好长期随访和正规治疗，有效保护好肾脏。Objective To review retrospectively the clinical data, renal damage and prognosis of vesicoureteral reflux （VUR） in children, hoping to give more attention to early recognition and treat- ment of the disease. Methods Forty-two children with VUR who were hospitalized from January 2010 to December 2012 were studied, of whom the VUR grades, renal sear development, and prognosis of VUR were evaluated. Results The incidence of VUR in urinary tract infection（UIT） children was 35. 9% （42/117）, while the proportion of VUR in recurrent UIT group was 62. 2%, significantly higher than that in first UIT group （23.7%）. In different age groups, the incidence of VUR in infants was the highest （61.9%）, and that of severe reflux （grades IV-V） was 48. 60%. Only 20 children with VUR had complete follow-up data, including 2 eases of mild reflux （grade I-II ）, 7 cases of moderate reflux （grade Ⅲ ） and 11 cases of severe reflux （grade IV-V）. The average interval of re- peated micturating cystourethrography（MCU） was 1-2 years. After follow-up, it was found that the reflux grade had different degrees in changes： complete remission in 3 cases, partial remission in 6 ca- ses, no change in 10 cases, and worse situation in 1 case. There were 7 cases of renal scarring, all of which occurred in moderate and severe reflux. Six children with renal scar were younger than two years. Five cases were diagnosed in the first 99mTe-dimereaptosuccinic aeid（DMSA） examination, and 2 were found during the follow-up process. Of 42 children with VUR, 2 cases received surgical treat- ment after the definite diagnosis, and 40 eases were given internal medicine （in 20 eases having complete follow-up data, 2 cases received surgical treatment）. Conclusions Children with VUR need early diagnosis and treatment, especially for infants. It is necessary to evaluate renal damage timely, andreasonably adjust the treatment plarEfforts should be made to strengthen education, conduct good long-term follow-up and normal t

关 键 词：膀胱输尿管反流 尿路感染 预后 儿童 

分 类 号：R726.9[医药卫生—儿科]