CAJ | 학술논문

目的：了解妊娠合并急性肾盂肾炎的临床特点，并探讨其影响因素。方法以2010年8月—2014年8月在宁波市第一医院就诊的182例妊娠期急性肾盂肾炎患者为观察组，以同时期在该院就诊但未合并感染性疾病的164例妊娠期妇女为对照组。通过查阅电子病历的方法，收集两组患者临床资料，包括年龄、职业、文化程度、妊娠分期、合并症、实验室检查指标；同时收集观察组患者的临床表现、超声检查结果、治疗与转归情况。结果（1）观察组182例患者均有畏寒发热、寒战、头痛、全身酸痛等感染中毒症状，伴腰痛的患者数为135例（占74.2％），无尿路刺激症状的患者数为97例（占53.3％）；116例（占63.7％）患者的血红蛋白（ Hb）≤110 g/L；所有患者的尿常规检查均呈白细胞阳性；9例（占4.9％）患者的血培养呈阳性，其中大肠埃希菌6株（占66.7％）；41例（占22.5％）患者的尿培养呈阳性，其中大肠埃希菌19株（占46.3％）；85例（占46.7％）患者合并肾积水；86例（占47.2％）患者采用头孢曲松进行抗感染治疗，完成随访的175例患者均治愈。（2）两组平均年龄、职业、文化程度、妊娠分期、合并症、Hb、清蛋白（Alb）比较，差异有统计学意义（P﹤0.05）；而血肌酐（SCr）和总胆固醇（TC）比较，差异无统计学意义（P﹥0.05）。Logistic回归分析显示，年龄、妊娠分期、合并症及Alb对妊娠合并急性肾盂肾炎的影响有统计学意义（P﹤0.05）。结论妊娠合并急性肾盂肾炎的起病较急，多伴高热和腰痛症状，半数以上患者无尿路刺激症状，致病菌主要为大肠埃希菌，头孢曲松等三代头孢菌素、半合成广谱青霉素、碳青霉烯类药物的治疗效果较好，治愈率较高。年龄、妊娠分期、合并症及Alb是妊娠合并急性肾盂肾炎的影响因素。目的：瞭解妊娠閤併急性腎盂腎炎的臨床特點，併探討其影響因素。方法以2010年8月—2014年8月在寧波市第一醫院就診的182例妊娠期急性腎盂腎炎患者為觀察組，以同時期在該院就診但未閤併感染性疾病的164例妊娠期婦女為對照組。通過查閱電子病歷的方法，收集兩組患者臨床資料，包括年齡、職業、文化程度、妊娠分期、閤併癥、實驗室檢查指標；同時收集觀察組患者的臨床錶現、超聲檢查結果、治療與轉歸情況。結果（1）觀察組182例患者均有畏寒髮熱、寒戰、頭痛、全身痠痛等感染中毒癥狀，伴腰痛的患者數為135例（佔74.2％），無尿路刺激癥狀的患者數為97例（佔53.3％）；116例（佔63.7％）患者的血紅蛋白（ Hb）≤110 g/L；所有患者的尿常規檢查均呈白細胞暘性；9例（佔4.9％）患者的血培養呈暘性，其中大腸埃希菌6株（佔66.7％）；41例（佔22.5％）患者的尿培養呈暘性，其中大腸埃希菌19株（佔46.3％）；85例（佔46.7％）患者閤併腎積水；86例（佔47.2％）患者採用頭孢麯鬆進行抗感染治療，完成隨訪的175例患者均治愈。（2）兩組平均年齡、職業、文化程度、妊娠分期、閤併癥、Hb、清蛋白（Alb）比較，差異有統計學意義（P﹤0.05）；而血肌酐（SCr）和總膽固醇（TC）比較，差異無統計學意義（P﹥0.05）。Logistic迴歸分析顯示，年齡、妊娠分期、閤併癥及Alb對妊娠閤併急性腎盂腎炎的影響有統計學意義（P﹤0.05）。結論妊娠閤併急性腎盂腎炎的起病較急，多伴高熱和腰痛癥狀，半數以上患者無尿路刺激癥狀，緻病菌主要為大腸埃希菌，頭孢麯鬆等三代頭孢菌素、半閤成廣譜青黴素、碳青黴烯類藥物的治療效果較好，治愈率較高。年齡、妊娠分期、閤併癥及Alb是妊娠閤併急性腎盂腎炎的影響因素。
목적：료해임신합병급성신우신염적림상특점，병탐토기영향인소。방법이2010년8월—2014년8월재저파시제일의원취진적182례임신기급성신우신염환자위관찰조，이동시기재해원취진단미합병감염성질병적164례임신기부녀위대조조。통과사열전자병력적방법，수집량조환자림상자료，포괄년령、직업、문화정도、임신분기、합병증、실험실검사지표；동시수집관찰조환자적림상표현、초성검사결과、치료여전귀정황。결과（1）관찰조182례환자균유외한발열、한전、두통、전신산통등감염중독증상，반요통적환자수위135례（점74.2％），무뇨로자격증상적환자수위97례（점53.3％）；116례（점63.7％）환자적혈홍단백（ Hb）≤110 g/L；소유환자적뇨상규검사균정백세포양성；9례（점4.9％）환자적혈배양정양성，기중대장애희균6주（점66.7％）；41례（점22.5％）환자적뇨배양정양성，기중대장애희균19주（점46.3％）；85례（점46.7％）환자합병신적수；86례（점47.2％）환자채용두포곡송진행항감염치료，완성수방적175례환자균치유。（2）량조평균년령、직업、문화정도、임신분기、합병증、Hb、청단백（Alb）비교，차이유통계학의의（P﹤0.05）；이혈기항（SCr）화총담고순（TC）비교，차이무통계학의의（P﹥0.05）。Logistic회귀분석현시，년령、임신분기、합병증급Alb대임신합병급성신우신염적영향유통계학의의（P﹤0.05）。결론임신합병급성신우신염적기병교급，다반고열화요통증상，반수이상환자무뇨로자격증상，치병균주요위대장애희균，두포곡송등삼대두포균소、반합성엄보청매소、탄청매희류약물적치료효과교호，치유솔교고。년령、임신분기、합병증급Alb시임신합병급성신우신염적영향인소。
Objective To investigate the clinical features and risk factors of acute pyelonephritis during pregnancy. Methods We included 182 patients with acute pyelonephritis during pregnancy who received treatment in the First Hospital of Ningbo from August 2010 to August 2014 as observation group,and we included 164 pregnant women who received treatment in the hospital in the same period but had no complications of infectious diseases as control group. Through the review of electronic medical records,we collected clinical data of the subjects,including age,occupation,education level,staging of gestation,complications and laboratory indicators. And data about clinical symptoms,ultrasound examination results,treatment and outcomes were also collected. Results (1) In observation group,all the 182 patients had intolerance of cold,fever, shiver,headache,sore feeling all over the body and other infectious and toxic symptoms,among which 135(74. 2%)patients were complicated with loin pain and 97(53. 3%)patients had no urinary irritation symptoms;116(63. 7%)patients had hemoglobin(Hb)≤110 g/L;all patients showed positive in white blood cells by routine urine examination;9(4. 9%) patients showed positive in blood culture, among which escherichia coli was found in 6 ( 66. 7%) patients;41 ( 22. 5%) patients showed positive in urine culture,among which escherichia coli was found in 19(46. 3%)patients;85(46. 7%) patients were complicated with hydronephrosis;86(47. 2%)patients took ceftriaxone in anti-infection treatment,and the 175 patients who completed follow - up were all cured. ( 2 ) The two groups were significantly different ( P ﹤ 0. 05 ) in age, occupation,education level,staging of gestation,complications,Hb and Alb;the two groups were not significantly different (P﹥0. 05)in SCr and TC. The logistic regression analysis showed that age,staging of gestation,complications and Alb had significant influence on acute pyelonephritis during pregnancy(P﹤0. 05). Conclusion Acute pyelonephritis during pregnancy usually has a sudden onset with fever and loin pain. More than half of the patients have no urinary irritation symptoms. The major pathological bacterium is escherichia coli. Ceftriaxone and other third generation cephalosporins,semisynthetic broad-spectrum penicillin and carbapenems are effective and have high cure rate. Age,staging of gestation,complications and Alb are influencing factors for acute pyelonephritis during pregnancy.