CAJ | 학술논문

目的通过实施学龄儿童慢性肾脏病(chronic kidney disease,CKD)的尿液筛查模式,及早发现和诊断CKD,建立“初级登记、二级筛查随访、三级诊治严重患儿”的三级管理模式,从而使筛查出的肾脏病患儿得到有效管理,最终减少终末性肾病的发生率。方法选择小学一年级和六年级的学生3015名,由学校发放《告知尿液筛查告家长书》及专用试管留取晨尿。采用尿液试纸目测法检测尿液,将2次尿液筛检查均出现潜血、蛋白质或白细胞阳性者转至随州市妇幼保健院就诊,行尿液镜检或尿沉渣分析,阳性者定为尿检异常,对其中符合转诊条件者转诊至三级医院接受治疗,对不符合转诊条件者进行治疗或建档随访。结果完成尿液筛查总人数2926例,一年级有1533例(占53.39%),六年级有1393例(占47.61%)。第一次尿液筛阳性人数533人(占18.22%),第二次尿液筛阳性人数126人(占4.31%)。二级医院尿检阳性人数33人(占1.13%),其中一年级23例(占0.79%),六年级10例(占0.34%),男生10例(占0.34%),女生23例(占0.79%)。有3例患儿根据病情转诊至三级医院,17例尿白细胞阳性患儿经本院治疗后复查尿检转阴,6例确诊肾积石给予排石药物治疗,剩余7例每6月复诊随访1次,并建立随访档案。结论儿童 CKD尿液筛查模式具有经济、可操作性强等优点,能有效筛查出肾脏病患儿,其三级管理模式能对筛查出的患儿进行有效的管理,适合我国国情,适合在基层推广运用。
목적통과실시학령인동만성신장병(chronic kidney disease,CKD)적뇨액사사모식,급조발현화진단CKD,건립“초급등기、이급사사수방、삼급진치엄중환인”적삼급관리모식,종이사사사출적신장병환인득도유효관리,최종감소종말성신병적발생솔。방법선택소학일년급화륙년급적학생3015명,유학교발방《고지뇨액사사고가장서》급전용시관류취신뇨。채용뇨액시지목측법검측뇨액,장2차뇨액사검사균출현잠혈、단백질혹백세포양성자전지수주시부유보건원취진,행뇨액경검혹뇨침사분석,양성자정위뇨검이상,대기중부합전진조건자전진지삼급의원접수치료,대불부합전진조건자진행치료혹건당수방。결과완성뇨액사사총인수2926례,일년급유1533례(점53.39%),륙년급유1393례(점47.61%)。제일차뇨액사양성인수533인(점18.22%),제이차뇨액사양성인수126인(점4.31%)。이급의원뇨검양성인수33인(점1.13%),기중일년급23례(점0.79%),륙년급10례(점0.34%),남생10례(점0.34%),녀생23례(점0.79%)。유3례환인근거병정전진지삼급의원,17례뇨백세포양성환인경본원치료후복사뇨검전음,6례학진신적석급여배석약물치료,잉여7례매6월복진수방1차,병건립수방당안。결론인동 CKD뇨액사사모식구유경제、가조작성강등우점,능유효사사출신장병환인,기삼급관리모식능대사사출적환인진행유효적관리,괄합아국국정,괄합재기층추엄운용。
Objective Through the implementation model of chronic kidney disease of urine screening for school-age children,to early detect and diagnose chronic kidney disease (CKD)in chil-dren,establish the three-level management mode of “registration,screening and follow-up,and diag-nosis and treatment of severe CDK in the children",and thereby manage the children with kidney dis-ease effectively,and ultimately reduce the incidence of end-stage nephropathy.Methods 3 015 first-grade and sixth-grade students were selected,“a report letter to the parents about the urine screening”was issued by the schools,and morning urine specimens were obtained using special tubes.The urine was tested using visual method of urine test paper.The children with occult blood,protein,or white blood cells twice were sent to Suizhou Maternal and Child Health Hospital for urine microscopy or u-rine sediment analysis.Urine abnormalities were defined as the urine positive results.The children meeting the standards for transfer were transferred to a tertiary hospital for treatment,and the rest children were given treatment or follow-up.Results The total number of completing urine screening was 2 926 cases,including 1 533 cases in the first grade (accounting for 53.39%),and 1 393 cases in the sixth grade (accounting for 47.61%).The urine test was positive in 533 (18.22%)children in the first screening,and 126 (4.31%)in the second screening.Urine test was positive in 33 cases (1.13%)in the second-level hospitals,including 23 cases (0.79%)in the first grade,and 10 cases (0.34%)in the sixth grade [10(0.34%)boys and 23(0.79%)girls].Three children were trans-ferred to tertiary hospitals according to their ill conditions.Seventeen cases positive for urinary leuko-cytes obtained negative urine test after treatment.Six cases were diagnosed as having kidney stone and given medication.The rest 7 cases were followed up once every 6 months,and follow-up file was es-tablished.Conclusions The mode of urine screening for children with CKD has the advantage of econo-my,operability,etc,and can screen out kidney diseases in children effectively.The three-level man-agement model could manage the ill children effectively,which was suitable for the situation of our country,and spread at the grassroots.