香港儿童服用低剂量三聚氰胺后肾脏并发症的现况调查研究

Renal screening in children after exposure to low dose melamine in Hong Kong： cross sectional study

目的 调查香港儿童服用小剂量三聚氰胺后的肾脏并发症。 设计 横断面调查方法。 机构 香港专业评估中心。 调查对象 根据全港初级医疗保健中心的记录，研究包括3170例（1748例男童，1422例女童）≤12岁、连续1个月或以上服用被三聚氰胺污染奶制品的儿童。 主要评估指标 是否存在肾结石和血尿。 结果 1例儿童存在肾结石，7例儿童肾脏内可疑存在三聚氰胺结晶，应用尿试纸检查发现208例（6．6％）儿童存在血尿。这些儿童在专业评估中心进一步检查后，仅有7．4％的儿童确实存在显微镜下血尿，所以总体儿童血尿出现率低于1％。 结论：在曾服用小剂量三聚氰胺的儿童中，没有急性肾功能衰竭或尿路梗阻等严重不良事件发生。我们的研究结果与全港调查一致。即使将7例肾内可疑存在三聚氰胺结晶的患儿包括在内，应用超声检查发现的可疑三聚氰胺相关不良事件发生率也仅为0．2％，且这些患儿尚不需要进一步治疗。应用尿试纸检测是否存在血尿，可能会过高估计血尿的发生率。研究结果提示对于曾服用小剂量三聚氰胺的儿童进行大范围、积极的检查可能并不会得到更多有意义的资料，所以不值得投入更多的经费去进行这种检查。

Objective To investigate the renal outcomes of children after exposure to low dose melamine in Hong Kong. Design Cross sectional study. Setting Special assessment centres, Hong Kong. Participants 3170 children （1422 girls and 1748 boys） aged 12 years or less referred from territory-wide primary care chnics after daily consumption for one month or more of milk products tainted with melamine. Main outcome measures Presence of renal stones and haematuria. Results One child had a confirmed renal stone, seven were suspected of having melamine related renal deposits, and 208 （6. 6% ） were positive for blood in urine by reagent strip. A proportion of these children were followed up at the special assessment centre, but only 7.4% of those positive for blood on reagent strip were confirmed by microscopy, suggesting an overall estimated prevalence of less than 1% for microscopic haematuria. Conclusions No severe adverse renal outcomes, such as acute renal failure or urinary tract obstruction, were detected in children after exposure to low dose melarrfine. Our results were similar to territory-wide findings in Hong Kong. Even including the seven children with suspected renal deposits, the prevalence of suspected melamine related abnormalities on altrasonography was only 0. 2%. None of these children required specific treatment. The prevalence of microscopic haematuria was probably overestimated by the reagent strip. These data suggest that large scale and urgent screening programmes may not be informative or cost effective for populations who have been exposed to low dose melamine.