三聚氰胺污染奶粉喂养婴幼儿致双肾结石50例分析

Clinical analysis of bilateral renal calculus in 50 infants fed melamine-contaminated milk powder

目的:分析三聚氰胺污染奶粉喂养婴幼儿双肾结石的临床诊疗特点。方法:回顾性分析2008年8月至10月郑州大学第一附属医院依据卫生部推荐的《与食用受污染三鹿牌婴幼儿配方奶粉相关的婴幼儿泌尿系结石诊疗方案》诊治的50例(年龄50d～7岁)因食用三聚氰胺污染奶粉而导致双肾结石儿童的临床资料。患儿均用B超测定结石的大小、数目、形态、部位以及有无肾积水和输尿管扩张等。分析尿常规及肾功能的变化。并对所有患儿采取相应的治疗措施。结果:双肾结石患儿的男女比例为3.1:1。发病高峰年龄为6～18个月,占所有患儿的58%。超声结果显示42例(84%)为单纯双肾结石,4例双肾结石合并双输尿管结石,2例双肾结石合并膀胱结石,2例双肾结石合并单侧输尿管结石。66%的患儿双肾结石直径大于4mm。其中左、右侧肾脏同时出现单发结石9例,同时出现多发结石18例。结石呈松散块状。7例患儿尿常规显示白细胞+～,10例患儿红细胞+～。入院时尿液pH值5.0～7.5。肾功能检测显示11例患儿有肾功能衰竭,其左右侧肾脏结石直径明显大于非肾功能衰竭患者(P<0.05)。并发肾积水17例,其中11例为双肾积水,左侧肾脏集合系统分离范围为(18.4±6.4)mm,右侧肾脏为(15.0±5.8)mm。未出现肾功能衰竭的双肾结石患儿均接受内科保守治疗,碱化尿液。出现肾功能衰竭的双肾结石患儿则采用血液透析治疗配合内科保守治疗。50名患儿经治疗,符合卫生部规定的出院标准后允许出院,住院时间为(8±1)d。出院时完全排出结石的患儿21例。结论:6～18个月婴儿为三聚氰胺污染奶粉引起双肾结石的主要发病人群。B超为诊断婴儿泌尿系双肾结石的主要手段。三聚氰胺致双肾结石有较高的肾功能损害发生率,应给予高度关注。按卫生部推荐的诊疗方案效果良好。

Aim ： To investigate the clinical feature of bilateral renal calculus in infants who were fed with melaminecontaminated milk powder. Methods： The clinical data of 50 infants with bilateral renal calculus who had the history of feeding melaminecontaminated milk powder were retrospectively analyzed. All cases received ultrasound examination measuring size, number, shape and location of stone, and hydronephrosis and ureterectasia. Urine routine test and renal function were monitored. All children suffered from bilateral renal calculus were treated according to the treatment guideline from Chinese Ministry of Health. Resutls：The male and female ratio was 3. 1 ： 1. The incidence peak of bilateral renal calculus was found in the age of 6 months - 18 months, which occurred in 58% of cases. Among these patients, bilateral renal calculus was found in 42 cases. The diameter of calculus ranged from 4 mm - 10 mm in 66% infants. Multiple stones occurred in 18 cases, and single stone in 9 cases. Most of kidney stones appeared blocky-shaped. Urine routine tests showed that WBC was ＋ - ＋＋＋- in 7 cases and RBC was also ＋ - ＋＋＋ in 10 cases. The scope of urinary pH value was between 5.0 and 7.5, most of urine appeared weak acid. Renal function tests showed that 11 cases diagnosed as renal failure, whose stone diameters of bilateral kidneys were significantly bigger than others who appeared no renal failure （P 〈 0.05）. Moreover, 17 hydronephrotic cases were found, of them 11 cases suffered from bilateral hydronephrosis, dilatation of renal pelvis and calyces in left kidney was （ 18.4 ± 6.4） mm, and the right kidney was （ 15.0 ± 5.8） mm. All cases accepted noninvasive treatment, and discharged after staying at the hospital treatment （8 ± 1 ） days. The stone discharged in 21 cases during the hospitalization. Conclusion： The melamine calculus occurred most likely in infants at 6 months to 18 months after feeding melamine-contaminated milk powder. Ultrasound study was still the main methods to diagnose bilateral renal calculus of urinary stone in infants. Patients with calculus occurred in bilateral kidneys display a higher risk of impairment of renal function. Noninvasive management has shown a good treatment response.