儿童泌尿道感染中膀胱输尿管反流发生率的临床研究

Relationship of vesicourethral reflux(VUR) with urinary tract infection in children

目的回顾性分析儿童泌尿道感染中膀胱输尿管反流(VUR)的发生情况,以加强对VUR的认识,提高检出率。方法选择2000年1月到2006年11月因泌尿道感染收治入院的患儿106例,根据年龄分为≤2岁组、～5岁组、>5岁组三组,通过排泄性膀胱尿道造影(VCUG)和直接放射性核素造影诊断VUR;通过肾皮质静态显像(DMSA)检查,了解肾疤痕的形成情况。分析不同年龄组的VUR发病情况、不同等级VUR的程度和肾疤痕的形成分布情况。结果106例中VUR共40例,不同年龄组VUR的所占比例分别是77.78%、46.67%、27.90%(χ2=12.994,P=0.002),差异具有统计学意义。106例中有40例作了DMSA检查,14例形成肾疤痕,三组间肾疤痕的分布情况依次是66.7%、30.77%、28.57%,≤2岁组肾疤痕发生率高。另外,从VUR的等级分布和单、双侧VUR发生的情况来看,≤2岁组中VUR患儿主要是Ⅲ、Ⅳ、Ⅴ级,而～5岁组和>5岁组则随着年龄的逐渐增加Ⅰ、Ⅱ级的例数增加,Ⅲ、Ⅳ、Ⅴ级的例数减少;而且≤2岁组的VUR患儿双侧VUR的例数也较后两组多。结论≤2岁的泌尿道感染患儿最易形成肾疤痕,VUR的发病率高,且高级别、双侧VUR的发生率高,应及时行VCUG和DMSA,及早发现VUR和肾疤痕。

Objectives To review retrospectively clinical data for the better realization of vesicourethral reflux （VUR） and the improvement of detection rate for VUR in children with urinary tract infection. Methods Clinical data were retrospectively reviewed in 106 children with urinary tract infection admitted during Jan. 2000 to Nov. 2006. Based on the age, these children were divided into three groups consisting of 0 - 2 years old group, 2 ～ 5 years old group and 〉 5 years old group. VUR was diagnosed by voiding cystourethrography （VCUG） and direct isotope cystography, and renal scarring was identified by renal cortical scintigraphy （DMSA） . The occurrence of VUR, the grades of VUR and renal scarring were compared among three groups. Results Forty patients of 106 children with urinary tract infection were diag- nosed as VUR. The incidences of VUR and renal scarring were 77.78% and 66.7% in 0 ～ 2 years old group, 46.67% and 30.77% in 2 ～5 years old group, and 27.9% and 28.57% in 〉 5 years old group, respectively, and there was the significantly difference in the incidence of VUR among three groups （x^2 = 12.994, P = 0.002）. The grade Ⅲ～Ⅴ VUR was common seen in children under two years old, and the grade Ⅰ ～ Ⅱ VUR was usually occurred in older children. Furthermore, the incidence of bilateral VUR in children under two years old was higher than those in older children of other two groups. Conclusions There are the high risk of renal scarring, higher incidence of bilateral VUR and more severe grades of VUR in children under two years old （including two years old） comparing to older children with urinary tract infection. It is recommended to perform VCUG and DMSA early for the identification of VUR and renal scarring timely in children with urinary tract infection.