中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2012年
6期
346-349
,共4页
杨建环%余方芳%庄捷秋%张红征
楊建環%餘方芳%莊捷鞦%張紅徵
양건배%여방방%장첩추%장홍정
肾盂肾炎%临床特征%病原学%儿童%瘢痕肾
腎盂腎炎%臨床特徵%病原學%兒童%瘢痕腎
신우신염%림상특정%병원학%인동%반흔신
Pyelonephritis%Clinical features%Etiology%Children%Cicatricial kidney
目的 分析儿童急性肾盂肾炎的临床特点及预后转归.方法 选择2009年1月-2010年12月在温州医学院附属第二医院育英儿童医院肾内科诊断为急性肾盂肾炎的患儿共230例,分析其临床特征、病原学、细菌耐药情况及预后,并采用Logistic回归分析儿童急性肾盂肾炎后肾疤痕形成的危险因素.结果 230例急性肾盂肾炎患儿中,男性93例,女性137例,男女比1∶1.47,其中＜1岁99例,男女比为1.30∶1；1～5岁75例,男女比为1∶2.75；＞5岁56例,男女比为1∶2.29.在230例APN患儿中,共检出病原菌106株,其中革兰阴性菌91株,革兰阳性菌13株,真菌2株；居前3位病原菌分别为大肠埃希菌65株(61.32％),肺炎克雷伯杆菌13株(12.6％)和屎肠球菌9株(8.49％).65株大肠埃希菌产ESBLs有44株,均对氨苄西林耐药,对头孢菌素及复方磺胺甲噁唑、氨曲南等中等耐药,而对阿米卡星、阿莫西林/克拉维酸、呋喃妥因、亚胺培南等敏感.52例患儿于出院后6-12月进行双肾发射单光子计算机断层(ECT)复查,其中31例有肾疤痕形成(59.62％),21例好转(40.38％).泌尿系统畸形或膀胱输尿管返流是儿童急性肾盂肾炎肾疤痕形成的独立危险因素(OR值6.89,P＜0.05).结论 儿童急性肾盂肾炎的发病率随年龄的增加而逐渐下降,≤1岁以男性患儿为主,而＞1岁则好发于女性.大肠埃希菌仍是主要的致病菌,且存在着多重耐药.伴有泌尿系统畸形或膀胱输尿管返流的急性肾盂肾炎患儿更易有肾疤痕形成.
目的 分析兒童急性腎盂腎炎的臨床特點及預後轉歸.方法 選擇2009年1月-2010年12月在溫州醫學院附屬第二醫院育英兒童醫院腎內科診斷為急性腎盂腎炎的患兒共230例,分析其臨床特徵、病原學、細菌耐藥情況及預後,併採用Logistic迴歸分析兒童急性腎盂腎炎後腎疤痕形成的危險因素.結果 230例急性腎盂腎炎患兒中,男性93例,女性137例,男女比1∶1.47,其中＜1歲99例,男女比為1.30∶1；1～5歲75例,男女比為1∶2.75；＞5歲56例,男女比為1∶2.29.在230例APN患兒中,共檢齣病原菌106株,其中革蘭陰性菌91株,革蘭暘性菌13株,真菌2株；居前3位病原菌分彆為大腸埃希菌65株(61.32％),肺炎剋雷伯桿菌13株(12.6％)和屎腸毬菌9株(8.49％).65株大腸埃希菌產ESBLs有44株,均對氨芐西林耐藥,對頭孢菌素及複方磺胺甲噁唑、氨麯南等中等耐藥,而對阿米卡星、阿莫西林/剋拉維痠、呋喃妥因、亞胺培南等敏感.52例患兒于齣院後6-12月進行雙腎髮射單光子計算機斷層(ECT)複查,其中31例有腎疤痕形成(59.62％),21例好轉(40.38％).泌尿繫統畸形或膀胱輸尿管返流是兒童急性腎盂腎炎腎疤痕形成的獨立危險因素(OR值6.89,P＜0.05).結論 兒童急性腎盂腎炎的髮病率隨年齡的增加而逐漸下降,≤1歲以男性患兒為主,而＞1歲則好髮于女性.大腸埃希菌仍是主要的緻病菌,且存在著多重耐藥.伴有泌尿繫統畸形或膀胱輸尿管返流的急性腎盂腎炎患兒更易有腎疤痕形成.
목적 분석인동급성신우신염적림상특점급예후전귀.방법 선택2009년1월-2010년12월재온주의학원부속제이의원육영인동의원신내과진단위급성신우신염적환인공230례,분석기림상특정、병원학、세균내약정황급예후,병채용Logistic회귀분석인동급성신우신염후신파흔형성적위험인소.결과 230례급성신우신염환인중,남성93례,녀성137례,남녀비1∶1.47,기중＜1세99례,남녀비위1.30∶1；1～5세75례,남녀비위1∶2.75；＞5세56례,남녀비위1∶2.29.재230례APN환인중,공검출병원균106주,기중혁란음성균91주,혁란양성균13주,진균2주；거전3위병원균분별위대장애희균65주(61.32％),폐염극뢰백간균13주(12.6％)화시장구균9주(8.49％).65주대장애희균산ESBLs유44주,균대안변서림내약,대두포균소급복방광알갑오서、안곡남등중등내약,이대아미잡성、아막서림/극랍유산、부남타인、아알배남등민감.52례환인우출원후6-12월진행쌍신발사단광자계산궤단층(ECT)복사,기중31례유신파흔형성(59.62％),21례호전(40.38％).비뇨계통기형혹방광수뇨관반류시인동급성신우신염신파흔형성적독립위험인소(OR치6.89,P＜0.05).결론 인동급성신우신염적발병솔수년령적증가이축점하강,≤1세이남성환인위주,이＞1세칙호발우녀성.대장애희균잉시주요적치병균,차존재착다중내약.반유비뇨계통기형혹방광수뇨관반류적급성신우신염환인경역유신파흔형성.
Objective To analyze the clinical characteristics and prognosis of acute pyelonephritis (APN) in children.Methods A retrospective analysis was performed in 230 pediatric patients with APN admitted from January 2009 to December 2010.The clinical characteristics,etiology,drug-resistant and prognosis were reviewed,and logistic regression analysis was performed to identify the risk factors of renal scarring after APN.Results Among 230 patients with APN,93 were boys and 137 were girls with a malefemale ratio of 1∶ 1.47.Ninety-nine patients were younger than 1 year with a male-female ratio of 1.30∶1 ;75 patients were 1 to 5 year with a male-female ratioof 1 ∶ 2.75 ; 56 patients were older than 5 year with a male-female ratio of 1∶2.29.A total of 106 strains were detected,in which 91 strains were Gram-negative bacteria,13 strains were Gram-positive bacteria and 2 strains were fungus.The most frequent bacteria were Escherichia coli (65 strains,61.32％),Klebsiella pneumonia (13 strains,12.6％) and Enterococcus faecium (9 strains,8.49％).Forty-four strains of Escherichia coli produced ESBLs,and all of them were resistant to ampicillin,part of them resistant to cephalosporin,compound sulfamethoxazole and aztreonam,but all were sensitive to amikacin,amoxicillin/clavulanic acid,nitrofurantoin,and imipenem.Renal emission computed tomography (ECT) was performed again in 52 children who were followed up for 6-12 months,in which 31 cases (59.62％) developed renal scar,and 21 cases (40.38％) were recovered.Abnormalities in urinary system or vesicoureteric reflux were identified as the risk factors for renal scarring after APN (OR =6.89,P ＜ 0.05).Conclusions The incidence of APN in children drops with age,which is frequently in the males younger than 1 year,and in the females older than 1 year.Escherichia coli is the most frequent pathogen of APN in children,and most strains are multidrug resistant.Children with abnormalities in urinary system or vesicoureteric reflux are prone to develop renal scarring.
