小儿神经源性膀胱保守治疗期间伴发慢性肾病的相关因素分析  

Analysis of causes of chronic kidney disease associated with conservative treatment of neurogenic bladder in children

作　　者：刘晓东[1] 李守林[1] 姜俊海[1] 文建国[2] Liu Xiaodong;Li Shoulin;Jiang Junhai;Wen Jianguo(Department of Urology,Shenzhen Children's Hospital,Shenzhen 518038,China;Pediatric Urodynamic Center,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]深圳市儿童医院泌尿外科,广东省深圳市518038 [2]郑州大学第一附属医院小儿尿动力中心,河南省郑州市450052

出　　处：《临床小儿外科杂志》2021年第11期1011-1015,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金委联合基金项目(编号:U1904208);广东省医学科学技术研究基金项目(编号:A2018341);深圳市医疗卫生三名工程(编号:SZSM201612013);深圳市医学重点学科(编号:(2020-2024)(SZXK035))。

摘　　要：目的回顾性分析小儿神经源性膀胱患者的诊治过程,探讨其在保守治疗期间伴发慢性肾病的相关因素。方法研究对象为2015年1月至2020年1月期间深圳市儿童医院收治的25例神经源性膀胱患者,将所有患者分为两组:伴发慢性肾病G3期及以上者为A组,伴发慢性肾病G3期以下者为B组;根据血肌酐水平,通过公式测算得到所有患者肾小球滤过率(estimated glomerular filtration rate,eGFR)。收集两组年龄、性别等一般资料以及eGFR、开始间歇导尿时间、随访情况等临床资料,并进行统计学分析。结果两组年龄、性别差异无统计学意义(P>0.05)。A、B组eGFR分别为(23.6±13.8)mL·min^(-1)·1.73 m^(-2)和(89.3±17.3)mL·min^(-1)·1.73 m^(-2),差异有统计学意义(P<0.05);A、B组开始清洁间歇导尿的年龄分别为4(3,5)岁和2(2,3.25)岁。A、B组确诊神经源性膀胱后第1年在泌尿外科门诊随访次数分别为2(1,2)次和4(3,4.25)次。发热性尿路感染发生次数A、B组分别为3(3,4)次、2(1,1.25)次,差异有统计学意义(P<0.05)。结论小儿神经源性膀胱保守治疗期间可伴发慢性肾病,未能实施早期清洁间歇导尿、规范随访和控制发热性尿路感染是导致保守治疗期间伴发慢性肾病的相关因素。Objective To explore the causes of chronic kidney disease(CKD)due to neurogenic bladder(NB)in children during the conservative treatment.Methods A retrospective study was conducted for 25 children with neurogenic bladder from January 2015 to January 2020.The patients'estimated glomerular filtration rate(eGFR)was measured by Schwartz formula based upon serum creatinine level.They were divided into two groups.Group A:patients with CKD stage 3 or above(n=8).Group B:patients with CKD stage 3 below(n=17).Clinical data of two groups were compared and statistically analyzed.Results There was no inter-group statistical difference in age or gender.eGFR was(23.6±13.8)mL·min^(-1)·1.73 m^(-2) vs.(89.3±17.3)mL·min^(-1)·1.73 m^(-2) with statistical difference.The age of first cleaning intermittent catheterization was 4(3,5)vs.2(2,3.25)years old,frequency of outpatient follow-up visits in the first year after diagnosis of NB was 2(1,2)vs.4(3,4.25)and the frequency of febrile urinary tract infection(fUTI)was 3(3,4)vs.2(1,2.25),indicating statistically significant differences between two groups.Conclusion CKD may occur during conservative treatment of NB in children.Lack of early clean intermittent catheterization,standardized follow-up and control of fUTI are important contributors for CKD.

关 键 词：神经源性膀胱 慢性肾病 保守治疗 儿童 

分 类 号：R726.945[医药卫生—儿科] R726.9[医药卫生—临床医学]