儿童急性局灶性细菌性肾炎临床特点及其危险因素分析  

Clinical characteristics and risk factors of acute focal bacterial nephritis in children

作　　者：林甜甜 陈朝英[1] 涂娟[1] 李华荣[1] 耿海云[1] Lin Tiantian;Chen Chaoying;Tu Juan;Li Huarong;Geng Haiyun(Department of Nephrology,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院肾脏内科,北京100020

出　　处：《中华肾脏病杂志》2023年第5期361-368,共8页Chinese Journal of Nephrology

摘　　要：目的总结和分析儿童急性局灶性细菌性肾炎(acute focal bacterial nephritis,AFBN)的临床特点及危险因素。方法该研究为回顾性队列研究,收集2016年7月1日至2021年7月31日在首都儿科研究所附属儿童医院诊断为上泌尿道感染且同时接受过腹部增强CT检查患儿的临床资料。根据影像学检查结果将患儿分为AFBN组和急性肾盂肾炎(acute pyelonephritis,APN)组,比较两组患儿临床表现、实验室及影像学检查的差异。采用Logistic回归和受试者工作特征曲线分析AFBN的危险因素。结果共135例上泌尿道感染患儿入选该研究,年龄2.5(0.5,3.7)岁,男性68例(50.4%)。AFBN组67例(49.6%),APN组68例(50.4%)。两组患儿在发热最高体温、治疗后发热持续时间、有下尿路刺激征比例、合并尿路畸形/异常比例、血白细胞计数、中性粒细胞计数、降钙素原、C反应蛋白、脓尿比例、尿β2微球蛋白以及使用碳青霉烯类抗生素比例等项目上的差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示尿路畸形/异常(OR=3.34,95%CI 1.23~9.10)和血白细胞升高(OR=1.25,95%CI 1.03~1.51)为AFBN发生的独立危险因素。受试者工作特征曲线预测AFBN发生的曲线下面积为0.668。结论尿路感染患儿发热峰值高、时间长,炎性指标及尿β2微球蛋白明显升高时提示AFBN可能。尿路畸形/异常和血白细胞升高是AFBN发生的危险因素。Objective To summarize and analyze the clinical features and risk factors of acute focal bacterial nephritis(AFBN)in children.Methods It was a retrospective cohort study.The clinical data of patients diagnosed with upper urinary tract infection in Children's Hospital Affiliated to Capital Institute of Pediatrics from July 1,2016 to July 31,2021 were collected,and the patients all received abdominal enhanced CT examination.According to the imaging examination results,the patients were divided into AFBN group and acute pyelonephritis(APN)group,and the clinical manifestations,laboratory and imaging examination between the two groups were compared.Logistic regression model and receiver operating characteristic curve were used to analyze the risk factors of AFBN.Results A total of 135 patients with upper urinary tract infection were enrolled in this study,with age of 2.5(0.5,3.7)years old,and 68 males(50.4%).There were 67 patients(49.6%)in AFBN group and 68 patients(50.4%)in APN group.There were statistically significant differences in the highest fever temperature,duration of fever after treatment,proportion of lower urinary tract irritation symptoms,proportion of urinary tract malformation or abnormality,white blood cell count,neutrophil count,procalcitonin,C-reactive protein,proportion of pyuria,urinaryβ2 microglobulin and proportion of using carbapenem antibiotics between the two groups(all P<0.05).Multivariate logistic regression analysis result showed that urinary tract malformation/abnormality(OR=3.34,95%CI 1.23-9.10)and leukocytosis(OR=1.25,95%CI 1.03-1.51)were the independent risk factors of AFBN.Conclusions The children with urinary tract infection who have high peak fever,long duration,obvious increase of inflammatory indexes and urinaryβ2 microglobulin may suggest AFBN.Urinary tract malformation/abnormality and high white blood cells are risk factors of AFBN.

关 键 词：泌尿道感染 肾盂肾炎 膀胱输尿管反流 急性局灶性细菌性肾炎 

分 类 号：R726.9[医药卫生—儿科]