CAJ | 학술논문

目的分析原发性膀胱输尿管反流(VUR)患儿非手术干预下,预后与相关临床因素的关系.方法回顾性分析2000年1月至2009年12月,复旦大学附属儿科医院经排泄性膀胱尿路造影( MCU)诊断为原发性VUR、未行手术治疗,并在我院随访超过1年并重复MCU检查患儿的医疗记录及影像学资料.结果共有73例患儿(男30例,女43例)纳入研究,其中轻度反流(Ⅰ～Ⅱ级)14例(19.2％)、中度反流(Ⅲ级)39例(53.4％)、重度反流(Ⅳ～Ⅴ级)20例(27.4％)；其中伴有肾损害的反流患儿27例(37.0％)；2次MCU检查间平均随访时间1-2年,平均(1.29±0.40)年.随访发现反流级别缓解的有41例(56.2％),其中反流完全缓解的有27例(37.0％)；反流级别未缓解的有32例(43.8％),其中反流级别加重的13例(17.8％).Logistic回归分析发现诊断时已有肾脏损害是影响反流缓解(P =0.000)、完全缓解(P=0.008)及导致反流加重(P =0.002)的重要临床因素.结论原发性VUR确有一定比例的自愈性,甚至可见于重度反流患儿；诊断时已有肾损害是影响反流预后的重要临床因素,伴有肾损害的轻度及中度反流患儿有反流级别加重的风险.无肾损害的重度反流患儿其反流状况仍可改善甚至消失,伴有肾损害的重度反流患儿仍推荐为手术治疗的绝对指征.
목적 분석원발성방광수뇨관반류(VUR)환인비수술간예하,예후여상관림상인소적관계.방법 회고성분석2000년1월지2009년12월,복단대학부속인과의원경배설성방광뇨로조영( MCU)진단위원발성VUR、미행수술치료,병재아원수방초과1년병중복MCU검사환인적의료기록급영상학자료.결과 공유73례환인(남30례,녀43례)납입연구,기중경도반류(Ⅰ～Ⅱ급)14례(19.2％)、중도반류(Ⅲ급)39례(53.4％)、중도반류(Ⅳ～Ⅴ급)20례(27.4％)；기중반유신손해적반류환인27례(37.0％)；2차MCU검사간평균수방시간1-2년,평균(1.29±0.40)년.수방발현반류급별완해적유41례(56.2％),기중반류완전완해적유27례(37.0％)；반류급별미완해적유32례(43.8％),기중반류급별가중적13례(17.8％).Logistic회귀분석발현진단시이유신장손해시영향반류완해(P =0.000)、완전완해(P=0.008)급도치반류가중(P =0.002)적중요림상인소.결론 원발성VUR학유일정비례적자유성,심지가견우중도반류환인；진단시이유신손해시영향반류예후적중요림상인소,반유신손해적경도급중도반류환인유반류급별가중적풍험.무신손해적중도반류환인기반류상황잉가개선심지소실,반유신손해적중도반류환인잉추천위수술치료적절대지정.
Objective To analyze the relationship between the prognosis and clinical factors of primary vesicoureteral reflux (VUR) patients under the condition of non-surgical treatment.Method The medical records of the patients who were diagnosed as VUR by micturating cystourethrography (MCU) from January 2000 to December 2009 in Children's Hospital of Fudan University underwent non-surgical treatment,and followed up for more than one year then had repeated MCU,were retrospectively reviewed.Result A total of 73 children (30 boys,43 girls) were included in this study.The percentage of mild reflux ( grade Ⅰ - Ⅱ ) was 19.2％ ( 14/73 ),that of moderate reflux ( grade Ⅲ ) was 53.4％ (39/73),and that of severe reflux ( grade Ⅳ- Ⅴ ) was 27.4％ ( 20/73 ).Among 73 patients,27 ( 37.0％ ) patients were found to have renal damage.The average interval of repeated MCU was ( 1.29 ± 0.40) years ( 1-2 years).After follow-up,it was found that the reflux grade was relieved in 41 (56.2％ ) patients,of whom 27 (37.0％)patients achieved complete resolution,32 (43.8％) patients did not have remission in reflux grade,of whom 13 (17.8％ ) patients had worsened reflux grade.Logistic regression analysis showed that VUR patients with renal damage at initial diagnosis was an important clinical factor to affect reflux remission ( P =0.000),complete resolving ( P =0.008 ) and result in worsening ( P =0.002 ).Conclusion A certain proportion of primary VUR patients could get reflux grade self-resolution,it was also quite common in severe VUR patients.VUR patients with renal damage at initial diagnosis was an important clinical factor affecting the reflux grade prognosis.Mild and moderate VUR patients with renal damage were at risk of worsening.VUR patients with high reflux grade had normal renal status could still get remission or even disappearance of VUR.But severe VUR patients with renal damage were still recommended to receive surgical therapy.