三聚氰胺相关结石患儿单中心、大样本随访和预后分析
삼취청알상관결석환인단중심、대양본수방화예후분석
Large sample follow-up of single centre and assessment of pediatric urolithiasis caused by melamine-contaminated milk powder
  • 万方数据
    中华肾脏病杂志 중화신장병잡지

    2010年 12期 887-891 ,共5页

    匡新宇%高建%徐虹%简龙海%黄文彦%赵耐青%饶佳%钱蔷英%程献影%冯志敏%许靖%张欣%王翔%阮双岁%孙利%沈茜%曹琦%方晓燕%周利军%王素娟%葛晓玲%王立波

    광신우%고건%서홍%간룡해%황문언%조내청%요가%전장영%정헌영%풍지민%허정%장흔%왕상%원쌍세%손리%침천%조기%방효연%주리군%왕소연%갈효령%왕립파

    儿童%三聚氰胺%肾结石%随访%预后 兒童%三聚氰胺%腎結石%隨訪%預後
    인동%삼취청알%신결석%수방%예후
    Child%Melamine%Urolithiasis%Follow-up%Prognosis
    目的 评估三聚氰胺相关泌尿系统结石患儿的长期预后和三聚氰胺对肾功能的长期影响.方法 以我院8335名≤6岁的筛查儿童中确诊为三聚氰胺相关泌尿系统结石的102例患儿为研究对象,随访18个月,通过泌尿系统超声、尿三聚氰胺(三聚氰酸)、尿常规及尿微量蛋白系列检测进行评估.结果 18个月后随访患儿91例,其中82例(90.1%)已排出结石.直径小于5 mm的结石最易排出,而直径大于10 mm的结石自然排石率较低,需通过干预排石.74例患儿尿液中未检测有三聚氰胺和三聚氰酸的残留.尿常规显示,18个月后蛋白尿全部消失,镜下血尿和白细胞尿的检出率分别为5.1%和2.0%,明显低于初诊时的检测结果 (P蛋白尿=0.123,P血尿=0.038,P白细胞尿=0.005).尿微量蛋白系列检测结果 提示,本次随访尿常规正常的患儿仍有部分存在肾小球和肾小管的损伤,其异常检出率分别为8.8%和12.1%,而结石未排出、男性和患病年龄小是肾小球受损的主要因素.结论 18个月后90.1%的患儿已排出结石,而结石直径是影响其排出的主要因素;患儿体内已无三聚氰胺和三聚氰酸的残留.少数患儿在18个月后仍然存在肾小球和肾小管的损伤,其恢复情况还需长期的随访监测.
    목적 평고삼취청알상관비뇨계통결석환인적장기예후화삼취청알대신공능적장기영향.방법 이아원8335명≤6세적사사인동중학진위삼취청알상관비뇨계통결석적102례환인위연구대상,수방18개월,통과비뇨계통초성、뇨삼취청알(삼취청산)、뇨상규급뇨미량단백계렬검측진행평고.결과 18개월후수방환인91례,기중82례(90.1%)이배출결석.직경소우5 mm적결석최역배출,이직경대우10 mm적결석자연배석솔교저,수통과간예배석.74례환인뇨액중미검측유삼취청알화삼취청산적잔류.뇨상규현시,18개월후단백뇨전부소실,경하혈뇨화백세포뇨적검출솔분별위5.1%화2.0%,명현저우초진시적검측결과 (P단백뇨=0.123,P혈뇨=0.038,P백세포뇨=0.005).뇨미량단백계렬검측결과 제시,본차수방뇨상규정상적환인잉유부분존재신소구화신소관적손상,기이상검출솔분별위8.8%화12.1%,이결석미배출、남성화환병년령소시신소구수손적주요인소.결론 18개월후90.1%적환인이배출결석,이결석직경시영향기배출적주요인소;환인체내이무삼취청알화삼취청산적잔류.소수환인재18개월후잉연존재신소구화신소관적손상,기회복정황환수장기적수방감측.
    Objective To assess the prognosis and effect on renal function of pediatric urolithiasis caused by melamine-contaminated milk powder (PUMMP) in a long-term follow-up.Methods One hundred and two of 8335 children (≤ 6-year-old) with history of consuming melamine-contaminated milk powder screened in our hospital were followed up for eighteen months after diagnosis. Urinary system ultrasonography, urinalysis, urinary microprotein profiles [microalbumin (ALBU), immunoglobulin G (IgG), and N-acetyl-β-D-glucosidase (NAG)], urinary melamine and cyanuric acid were examined in the first visit and at the end of follow-up. Results Follow-up was completed in 91 children and the stone was excreted in 82 children (90.1%).Stones less than 5 mm in diameter were most vulnerable to discharge, and stones larger than 10 mm could not be expelled without interventions. At the end of follow-up, no melamine or cyanuric acid was found in the urine samples of 74 patients. Urinalysis showed that incidences of proteinuria, microscopic hematuria and leukocyturia were 0%, 5.1% and 2.0%, which were significant different from those in the first visit (Pproteinutria=0.123, Phemnatuna=0.038 and Pleukocyhuris=0.005).Urinary microprotein profiles revealed that some children whose urinalysis was normal still presented glomerular and renal tubular injury and the abnormal rates were 8.8% and 12.1%respectively. The glomerular injury was mainly related to persistent stone, male and younger.Conclusions 90.1% of children with PUMMP passes urinary stones at the end of follow-up.Stone size is the major risk factor of discharge. No melamine or cyanuric acid is found in the urine of children. After eighteen months, glomerular and renal tubular injury is still found in some patients. Further follow-up is necessary.
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