摘要
目的分析2005至2010年复旦大学附属儿科医院先天性肾脏和尿道畸形(CAKUT)诊断情况,为CAKUT的早期诊断提供线索。方法系统提取住院诊断为CAKUT病例的病史资料,将三聚氰胺事件结石筛查作为特殊暴露因素,与正常暴露因素下进行比较,分析CAKUT病种构成比、首次入院的病因和影像学检查。结果 6年间1358例CAKUT患儿进入分析,在重复入院只计1次的前提下CAKUT占同期住院患儿的1.33%(1358/102442)。男913例,女445例,男女比例为2.05∶1;首次入院时平均年龄为(3.0±3.4)岁。①正常暴露因素下CAKUT的住院构成比2005至2010年呈缓慢增高趋势(P<0.05),CAKUT的住院构成比特殊暴露因素较正常暴露因素下高0.67%和0.26%,2008至2009两个年度多筛查出112例达到手术干预指征的CAKUT病例,占同期正常因素暴露下达到手术干预指征CAKUT病例的24.4%[112/(227+232)]。②CAKUT构成比排序前4位的病种分别为肾盂输尿管连接处梗阻(PUJO)、膀胱输尿管反流(VUR)、双集合系统和输尿管膀胱连接部梗阻(UVJO),占总CAKUT病例的79.6%;③首诊通过产前B超检查发现异常406例(29.9%),以PUJO、UVJO和输尿管膨出比例最高;48.5%(658/1358)CAKUT患儿有泌尿系统症状和体征(腹部症状、血尿、排尿异常、尿路感染伴发热和尿路感染);尿路感染伴发热占41%(270/658),为CAKUT病种主要的症状,<2岁患儿是≥2岁患儿的3.2倍(206/64);其他症状和体征均为≥2岁患儿明显多于<2岁患儿。98.0%的CAKUT患儿进行B超检查,除VUR的B超异常检出率为68.5%外,其他CAKUT病种的B超异常检出率均>94.0%;根据B超检查和临床表现,选择性进行了功能状态检查(DTPA、DMSA)1203例,形态学检查(MR、CT或IVP)1009例,反流情况(MCU)400例。结论 CAKUT构成比以PUJO、VUR、双集合系统和UVJO最为常见,泌尿系统B超筛查CAKUT的准确性较好。在人群中常规筛查可检出CAKUT,其成本效益有待进一步研究。
Objective To analyze the diagnosis of congenital anomalies of the kidney and urinary tract（CAKUT） in Children’s Hospital of Fudan University from January 2005 to December 2010,and to provide the clues to the early diagnosis of CAKUT.Methods The medical records of CAKUT cases were reviewed.Data of the diagnosis,chief complaint and imaging reports were collected and analyzed between the normal exposure factors and the special exposure factors（stone screening of the melamine incident）.Results A total of 1 358 out of 102 442 patients（1.33%） were documented as CAKUT during the survey period（during this period,if a patient was in-hospital more than once,it was calculated as one case）.The mean age was（3.0±3.4） years with gender ratio of 2.05∶1（male to female）.①The proportion of CAKUT was increased from 2005 to 2010 among inpatients with normal exposure factors（P〈0.05）,lower than that in those with special exposure factors in the same period.A total of 112 CAKUT cases that needed surgical interventions were found under the special exposure factors,24.4%[112/（227＋232）] CAKUT cases were found under the normal exposure factors in the same period.②The major CAKUT diseases included PUJO,VUR,duplex collecting system,UVJO,accounting for 79.6% of CAKUT cases.③406 cases were found with abnormalities by the prenatal B ultrasound examination,and most of them were PUJO,UVJO and ureterocele.48.5%（658/1 358）CAKUT patients had urinary system symptoms（abdominal symptoms,gross hematuria,voiding dysfunction,urinary tract infections with fever and urinary tract infections）.Otherwise,the patients elder than 2 years old with other urinary symptoms were more common than those younger than 2 years old.Patients with febrile urinary tract infections were the most common in the symptomatic CAKUT cases,accounting for 41%（270/658）,among them the number of younger than 2 years old was 3.2 times of that elder than 2 years old（206/64）.④B ultrasound examination was performed in the 98.0% CAKUT patients,the detection rate for VUR and the other abnormalities were 68.5%.On the basis of B ultrasound results and clinical manifestations,other examinations were performed for the patients including functional examination（DTPA and DMSA） for 1 203 cases,morphological examination（MR,CT and IVP） on 1 009 cases and MCU for 400 cases.Conclusions PUJO,VUR,duplex collecting system and UVJO were the most common types in CAKUT.Lots of CAKUT cases could be found in the B ultrasound screening,and the cost-benefit analysis is expected in future studies.
出处
《中国循证儿科杂志》
CSCD
2012年第4期263-268,共6页
Chinese Journal of Evidence Based Pediatrics
关键词
先天性肾脏和尿道畸形
肾盂输尿管连接处梗阻
膀胱输尿管反流
双集合系统
输尿管膀胱连接部梗阻
筛查
首发症状
Congenital anomalies of the kidney and urinary tract； Pyeloureteric junction obstruction； Vesicoureteral junction obstruction； Vesicoureteralreflux； Duplex collecting system； Screening； Sympotom of onset
