小儿原发性膀胱输尿管反流的临床研究

Primary vesicoureteric reflux in children

目的 探讨小儿原发性膀胱输尿管反流的发病机制、临床特点、肾损害评价、治疗及预后。方法 回顾性研究 1990～ 2 0 0 2年复旦大学附属儿科医院 5 0例小儿原发性膀胱输尿管反流 ,对反流程度、尿路感染、肾疤痕形成、尿液分析及血管紧张素转化酶 (ACE)基因型进行了分析 ,并将药物和手术治疗组的随访结果进行比较。结果 5 0例中双侧反流者 2 2例 (44 % ) ,单侧反流者 2 8例 (5 6 % ) ;39例行膀胱尿道造影检查发现反流Ⅰ度2 9 5 % (2 3/ 78) ,Ⅱ度 7 7% (6 / 78) ,Ⅲ度 14 1% (11/ 78) ,Ⅳ度 4 1 0 % (32 / 78) ,Ⅴ度 7 7% (6 / 78)。尿液 β2 微球蛋白、尿视黄醇结合蛋白、N乙酰半胱氨酸异常升高与肾疤痕形成相关 (P <0 0 5 ) ,血ACE基因型ID或DD型与肾疤痕形成相关 (P <0 0 5 )。药物与手术治疗组尿路感染复发率、肾疤痕形成率及反流有效控制率无显著差别。结论 小儿原发性膀胱输尿管反流需要及早诊断 ,同时通过对尿液微量蛋白及血ACE基因型检测 ,对肾损害作出预测 。

Objective To investigate the pathogenesis,clinical features,the damage to renal function,treatment and prognosis of primary vesicoureteric reflux in children.Methods 50 cases of children were enrolled in the retrospective study.VUR grades,urinary tract infection(UTI),the development of renal scars,urinalysis and angiotensin converting enzyme gene (ACE I/D) polymorphism were evaluated.We compared medical with surgery management in children with VUR.Results There were 22 (44%)cases of bilateral reflux,and 28 (56%)cases of unilateral reflux,with 23(29 5%) gradeⅠ,6(7.7%) gradeⅡ,11(14.1%) gradeⅢ,32(41.0%) gradeⅣ and 6(7.7%) gradeⅤ.There were associations between renal scars and β 2 microglobulin or RBP NAG in urine(P<0.05).Multivariate analysis revealed that the DD genotype is a risk factor for parenchymal destruction,which was independent of gender or VUR grades.There were no differences in UTI recurrence,renal scars and the control of reflux between medical and surgery management of children with VUR.Conclusion Children with primary vesicoureteric reflux need diagnosis at early age;at the same time the damage to renal function should be predicted by microproteinuria analysis and ACE (I/D) gene polymorphism,then treatment managements should be established individually.