138例儿童膀胱输尿管反流的随访观察  

Long-term prognosis of vesicoureteral reflux: a follow-up observation of 138 children

作　　者：林洪洲[1] 朱奇凡 杨青[1] 庄捷秋[1] LIN Hong-Zhou;ZHU Qi-Fan;YANG Qing;ZHUANG Jie-Qiu(Department of Pediatric Nephrology,Second Affiliated Hospital&Yuying Children's Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿童肾内科

出　　处：《中国当代儿科杂志》2019年第11期1069-1072,共4页Chinese Journal of Contemporary Pediatrics

摘　　要：目的 探讨儿童膀胱输尿管反流的远期预后.方法 回顾性分析2005年11月至2017年3月首次确诊为膀胱输尿管反流、予以内科保守治疗且行定期随访的138例患儿(反流输尿管218支)的临床资料.根据初始反流级别分为低级别组(Ⅰ~Ⅲ级,141支)和高级别组(Ⅳ~Ⅴ级,77支),比较两组临床资料及随访结果 .结果138例入组患儿中,男82例,女56例.患儿确诊时年龄31 d至10岁(中位年龄8个月);随访时间8个月至7年(中位数1.4年).确诊时高级别组尿液N-乙酰-β-D氨基葡萄糖苷酶、尿液微量白蛋白、尿液免疫球蛋白G水平显著高于低级别组(P<0.05).存在反流的218支输尿管中,随访中反流级别降低有132支(60.6%,其中完全消失74支),级别不变43支,级别加重43支.其中低级别组完全缓解率高于高级别组(41.1%vs 19.5%,P=0.001),反流完全缓解时间亦短于高级别组(P=0.002).结论 大部分膀胱输尿管反流患儿的反流级别在随访过程中可降低,甚至达到完全消失,其中低级别反流患儿的转归优于高级别.Objective To study the long-term prognosis of vesicoureteral reflux in children. Methods A retrospective analysis was performed for the clinical data of 138 children(218 ureters with reflux) who were diagnosed with vesicoureteral reflux for the first time from November 2005 to March 2017 and received medical treatment and regular follow-up. According to the initial grade of reflux, the ureters with reflux were divided into a low-grade group(141 ureters, grade I-III) and a high-grade group(77 ureters, grade IV-V), and the two groups were compared in terms of clinical data and follow-up results. Results Among the 138 children, there were 82 boys and 56 girls. Their age ranged from 31 days to 10 years at the time of confirmed diagnosis, with a median age of 8 months. The follow-up time ranged from 8 months to 7 years, with a median follow-up time of 1.4 years. At the time of confirmed diagnosis, the high-grade group had significantly higher levels of urinary N-acetyl-β-D-glucosaminidase, urinary microalbumin and urinary immunoglobulin G than the low-grade group(P<0.05). Among the 218 ureters with reflux, 132(60.6%) achieved a reduction in the grade of reflux(among which 74 achieved complete disappearance of reflux), 43 had no change in the grade of reflux, and 43 had an increase in the grade of reflux. Compared with the high-grade group, the low-grade group had a significantly higher complete remission rate(41.1% vs 19.5%, P=0.001) and a significantly shorter time to complete remission of reflux(P=0.002). Conclusions Most children with vesicoureteral reflux can achieve a reduction in the grade of reflux or even complete disappearance of reflux during follow-up, and the children with low-grade reflux have better prognosis than those with high-grade reflux.

关 键 词：膀胱输尿管反流 预后 随访 儿童 

分 类 号：R69[医药卫生—泌尿科学]