先天性肾积水早期筛查及随访  

Early screening and follow-up of congenital hydronephrosis

作　　者：余晓静 刘玉玲[2] 付四毛 谢娴 张碧宏[5] 潘晓芬[2] 李小琳[2] 孙智才[2] Yu Xiaojing;Liu Yuling;Fu Simao;Xie Xian;Zhang Bihong;Pan Xiaofen;Li Xiaolin;Sun Zhicai(Second Clinical Medical School of Southern Medical University,Guangzhou 510515,Guangdong Province,China;Department of Pediatric,Boai Hospital of Zhongshan,Zhongshan 528403,Guangdong Province,China;Department of Pediatric,People′s Hospital of Zhongshan,Zhongshan 528403,Guangdong Province,China;Department of Pediatric,Dongguan Maternal and Child Health Care Hospital,Dongguan 523002,Guangdong Province,China;Department of Ultrasound,Boai Hospital of Zhongshan,Zhongshan 528403,Guangdong Province,China)

机构地区：[1]南方医科大学第二临床医学院,广州510515 [2]中山市博爱医院儿科,528403 [3]中山市人民医院儿科,528403 [4]东莞市妇幼保健院儿科,523002 [5]中山市博爱医院超声科,528403

出　　处：《中华妇幼临床医学杂志（电子版）》2021年第5期582-589,共8页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：广东省医学科研基金(A2015609);中山市社会公益科技研究项目(2019B1010)。

摘　　要：目的探讨儿童先天性肾积水(CH)早期筛查的临床意义及对其早期随访的临床价值。方法选择2019年8月1日至2020年7月31日,在中山市博爱医院产科出生,于生后7 d内接受泌尿系统超声筛查,并且临床病例资料完整的4811例新生儿为研究对象(男性新生儿为2566例,女性为2245例)。对其中符合CH诊断标准者进行随访,观察CH患儿生后6个月肾积水部位及分度变化、并发症发生情况。本研究遵循的程序经中山市博爱医院伦理委员会批准(审批文号:KY-2019-002-17),与受试儿监护人均签署泌尿系统超声筛查知情同意书。结果①本组4811例受试儿中,生后7 d内新生儿泌尿系统超声筛查结果提示,先天性肾脏尿路发育异常(CAKUT)者为268例(5.6%),其中CH患儿为248例。本组CAKUT新生儿的肾积水阳性率为92.5%(248/268)。248例CH患儿中,男性患儿为164例,女性为84例;轻、中、重度肾积水患儿分别为213、19、16例。②本组4811例受试儿中,产前胎儿超声筛查肾积水阳性率为2.3%(111/4811),显著低于生后7 d内新生儿泌尿系统超声筛查阳性率(5.2%,248/4811),并且差异有统计学意义(χ^(2)=99.408、P<0.001)。③对248例CH患儿随访至3个月时,肾积水恢复正常患儿为125例(50.4%),好转为37例(14.9%),维持原状为61例(24.6%),加重为18例(7.3%),7例发生发热性尿路感染(UTI)。④随访至6个月,213例轻度肾积水患儿中,170例肾积水恢复正常,4例加重;19例中度肾积水患儿中,11例恢复正常或好转;16例重度肾积水患儿中,无一例恢复正常,12例好转。15例发生发热性UTI。对本组16例重度肾积水和4例肾积水加重患儿进行磁共振泌尿系水成像(MRU)或多层螺旋CT尿路造影(CTU)检查发现,先天性肾盂输尿管连接部梗阻(UPJO)和尿道瓣膜症(PUV)分别为15、1例,无一例患儿由单侧肾积水发展为双侧。⑤6个月的随访期内,248例CH患儿中,19例(7.7%,19/248)出现发热性UTI中,男性为14例,女�Objective To investigate the early onset and screening implications of congenital hydronephrosis(CH)in neonates.Methods From August 1,2019 to July 31,2020,a total of 4811 newborns,2566 boys and 2245 girls,were born in Boai Hospital of Zhongshan.Urological ultrasound screening was performed within 7 d after birth,and children with CH who met the diagnostic criteria were followed up and observed for disease changes and complications in 6 months after birth.The procedures followed in the study were approved by the Ethics Committee of Boai Hospital of Zhongshan(approval No.KY-2019-002-17),and guardians of the subjects all signed the informed consent forms for urinary ultrasound screening.Results①From August 1,2019 to July 31,2020,4811 cases were born in the Department of Obstetrics and had ultrasonographic information recorded,and 268 cases(5.6%)were screened for congenital anomalies of renal urogenital development(CAKUT),of which 248 cases(92.5%)were CH.②Among 248 neonates with CH,164 were boys and 84 were girls.And 213,19,and 16 were mild,moderate,and severe cases,respectively.A total of 111 of 4811 newborns(2.3%,111/4811)had CH suggested by prenatal examination,which was significantly lower than those of screening within 7 d after birth(5.2%,248/4811),and the difference between them was statistically significant(χ^(2)=99.408,P<0.001).③After 3 months of follow-up,125 cases(50.4%)hydronephrosis returned to normal,37 cases(14.9%)improved,61 cases(24.6%)remained unchanged,18 cases(7.3%)got worse,and 7 cases had febrile urinary tract infection(UTI).④After 6 months of follow-up,among 213 mild hydronephrosis children,164 cases returned to normal,and 4 cases of renal pelvis separation became worse.Of 19 children with moderate hydronephrosis,11 returned to normal or improved.None of the 16 cases of severe hydronephrosis returned to normal and 12 cases improved.Febrile UTI occurred in 15 cases.16 cases of severe hydronephrosis and 4 cases of aggravated were examined by magnetic resonance urography(MRU)or computed t

关 键 词：先天性肾积水 泌尿生殖系统 输尿管梗阻 膀胱输尿管反流 尿路感染 多普勒 彩色 新生儿筛查 婴儿 新生 

分 类 号：R69[医药卫生—泌尿科学]