儿童肾发育不良合并慢性肾脏病的临床特征及肾功能恶化的危险因素分析  

Clinical characteristics and risk factors of renal function deterioration in children with renal dysplasia complicated with chronic kidney disease

作　　者：王萱 钟庆涛 张力 何鑫 张德迎[1] 何云锋[2] 刘星[1] 何大维[1] 林涛[1] 李旭良[1] 魏光辉[1] WANG Xuan;ZHONG Qingtao;ZHANG Li;HE Xin;ZHANG Deying;HE Yunfeng;LIU Xing;HE Dawei;LIN Tao;LI Xuliang;WEI Guanghui(Department of Urology,Children's Hospital of Chongqing Medical University,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering,Key Laboratory of Child Development and Disorders of Ministry of Education,National Clinical Research Center for Child Health and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014;Department of Urology,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属儿童医院泌尿外科,儿童泌尿生殖发育与组织工程重点实验室,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿科学重庆市重点实验室,重庆400014 [2]重庆医科大学附属第一医院泌尿外科,重庆400016

出　　处：《现代泌尿外科杂志》2023年第4期297-301,306,共6页Journal of Modern Urology

基　　金：重庆医科大学未来医学青年创新团队支持计划资助项目(No.W0056)。

摘　　要：目的分析儿童肾发育不良合并慢性肾脏病(CKD)的临床特征及肾功能恶化的危险因素,为儿童肾发育不良的诊疗和管理提供依据。方法回顾性分析2012—2022年于重庆医科大学附属儿童医院就诊的肾发育不良合并CKD患儿的临床及随访资料,对其性别、确诊年龄、生长指标、伴发畸形、合并症等信息进行分析。CKD的诊断标准依据KDIGO2020指南并进行分期,将疾病转归为CKD 4~5期定义为转归组,通过Cox分析影响转归组患儿肾功能恶化的因素。结果共纳入肾发育不良合并CKD患儿122例。其中,CKD 4~5期66例(54.1%),男性多于女性。双侧肾发育不良88例(72.13%)、单侧34例(27.87%),64例(52.46%)合并其他泌尿系统疾病。体质量、身高及体质量指数(BMI)在CKD 1~5期之间比较差异具有统计学意义(P<0.01)。CKD发病年龄<10岁,BMI低于我国同性别、同年龄第3百分位,双侧肾发育不良,合并1种以上其他先天性肾脏和尿路异常(CAKUT)为肾功能恶化的危险因素(P<0.05)。结论肾发育不良合并CKD儿童中男性居多,双侧肾发育不良占比高。双侧肾发育不良,CKD发病年龄<10岁,BMI低于同年龄、同性别第3百分位,合并其他CAKUT是肾发育不良合并CKD儿童肾功能恶化的重要影响因素。Objective To explore the clinical characteristics and risk factors of renal function deterioration in children with renal dysplasia and chronic kidney disease(CKD),so as to provide a basis for the diagnosis,treatment,and management.Methods The clinical data of children with renal dysplasia complicated with CKD treated in the Children's Hospital of Chongqing Medical University during 2012 and 2022 were retrospectively analyzed,including the gender,age of diagnosis,growth index,concomitant malformation and complications.According to the diagnostic criteria and staging standard of KDIGO2020 guidelines,patients with disease deteriorated to CKD stage 4-5 were enrolled into the regression group.Factors affecting the deterioration of renal function were determined with Cox regression analysis.Results A total of 122 children were involved,including 66(54.1%)with CKD stag 4-5.There were more boys than girls.Bilateral and unilateral renal dysplasia occurred in 88(72.13%)and 34(27.87%)cases,respectively,and 64(52.46%)cases were complicated with other urinary diseases.There were significant differences in weight,height and body mass index(BMI)among patients with CKD stage 1-5(P<0.01).The age of onset of CKD<10 years,BMI lower than the 3rd percentile of the same sex and age,bilateral renal dysplasia,and one or more complications of congenital renal and urinary tract abnormalities(CAKUT)were the risk factors of deterioration of renal function(P<0.05).Conclusion Renal dysplasia complicated with CKD are more common in boys,with high incidence of bilateral renal dysplasia.Bilateral renal dysplasia,age of onset of CKD<10 years,BMI lower than 3%and complications are important influencing factors of renal dysplasia in children with CKD.

关 键 词：肾发育不良 慢性肾脏病 儿童 伴发疾病 COX回归分析 

分 类 号：R726.9[医药卫生—儿科]