摘要
目的比较分析急性局灶细菌性肾炎和急性肾盂肾炎的临床特点，提高急性局灶细菌性肾炎的诊疗水平。方法回顾性分析2007年1月至2013年1月北京医院肾脏内科诊断为上尿路感染，且同时接受过腹部B超和增强CT检查35例住院患者的临床资料。根据影像学结果分为急性局灶细菌性肾炎组（AFBN组，18例），急性肾盂。肾炎组（非AFBN组，17例），比较分析两组患者的临床特点、实验室及影像学检查结果。结果两组患者在白细胞计数、中性粒细胞百分比、血沉、空腹血糖、尿N-乙酰-β-葡萄糖苷酶／肌肝（NAG／Cre）、抗生素联合使用及疗程等方面的差异有统计学意义（P〈0．05）。两组的尿病原微生物阳性率差异无统计学意义，均以大肠杆菌为主，AFBN组尿病原学菌种类较非AFBN组复杂。腹部增强CT结果示：AFBN组肾脏病变为多发或单发不规则或楔形的低密度影，以单侧肾脏为主（11／18）。双侧。肾脏受累组患者尿NAG／Cre高于单侧。肾脏受累组，也高于非AFBN组（P〈0．05）。AFBN组症状缓解时间（3．4±2．9）d，非AFBN组为（3．0±1．8）d；AFBN组半年内临床复发比例（2／18），非AFBN组半年内临床复发比例（2／17）。结论AFBN患者临床症状缺乏特异性，ESR、白细胞计数及尿NAG／Cre可能是预测AFBN发生的指标。经合理及足疗程抗生素治疗，AFBN与急性肾盂肾炎的临床疗效及预后满意。
Objective To improve standards of diagnosis and therapy for acute focal bacterial nephritis by comparing the characters of acute focal bacterial nephritis and acute pylonephritis. Methods Thirty-five patients of upper urinary tract infection whoever accepted ultrasonographic and computed tomographic （CT） examinations in Beijing Hospital from January 2007 to January 2013 were studied retrospectively. Eighteen patients were diagnosed as acute focal bacterial nephritis （AFBN） according to CT imaging features, the other 17 patients were diagnosed as acute pyelonephritis （non- AFBN）. The clinical feature, laboratory and imaging examination were compared between the two groups. Results Leukocyte count, percentage of neutrophil, fasting blood-glucose, ESR, NAG/Cre of urine, the combination of more than one kind of antibiotics and duration of antibiotic treatment were higher or much more in AFBN group patients than non AFBN patients, the differences between two groups were statistical signifieance（P 〈 0.05）. Urine microorganism culture was mainly Escherichia coli no matter in AFBN group or non-AFBN group, microorganism species of AFBN patients were more complex than non-AFBN patients. The most common contrast-enhanced CT feature of AFBN included local distribution of inflammatory area, wedge- shaped or unregular-shaped hypodense lesions on bilateral or single kidney, and mass-like hypodense lesions in more severe cases. NAG/CRE of urine was higher in AFBN group patients with bilateral kidney lesions than with single kidney lesions and non AFBN patients. The remission time of AFBN and non- AFBN was （3.4±2.9） d, （3.0±1.8）d respectively. The relapsing rate of AFBN and non- AFBN within half a year was 2/18, 2/17, respectively. Conclusions The symptoms of acute focal bacterial nephritis are not specific. Abdominal contrast-Enhanced CT, ESR, leukocyte count, urine NAG/CRE are probably a predictor of AFBN. Antibiotic treatment with appropriate usage and sufficient duration could bring satisfactory outcomes and prognosis in acute focal bacterial nephritis and pyelonephritis patients.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2013年第8期600-604,共5页
Chinese Journal of Nephrology
基金
留学人员回国启动基金（20111568）
关键词
急性局灶细菌性肾炎
急性肾盂肾炎
腹部CT
增强
Acute focal bacterial nephritis
Acute pylonephritis
Contrast-Enhanced CT, Abdominal
