14256名无症状小儿泌尿系统超声筛查分析

Ultrasound screening of urinary system in 14256 asymptomatic children

目的:分析本市市区及其周边地区无症状小儿泌尿系统患病特点及超声在筛查无症状小儿泌尿系统异常中的作用。方法:对2008年9月至2008年10月集中在我院进行泌尿系统超声筛查的14256名无症状小儿按年龄、性别、发病部位及病变程度分组进行统计分析。结果:共筛查泌尿系统异常患儿409例,总患病率为2.87%;其中明显异常284例,依次包括肾积水、肾结石、输尿管扩张、肾发育异常、肾囊性病变、重复肾等;以肾积水最多,130例,占45.77%(130/284),男性患病率1.18%(92例),而女性为0.59%(38例),男性高于女性,差异有统计学意义(u=13.51,P<0.001)。诉食用三聚氰胺污染奶粉致小儿泌尿系结石机率是未食用三聚氰胺污染奶粉的5.17倍,其总体相对危险度的95%CI为[3.28,8.14]。结论:①超声筛查是发现无症状小儿泌尿系统异常的有效方法;对小儿开展泌尿系统超声筛查,有利于CAKUT、泌尿系结石等疾病的早期诊断及早期治疗,从而减少肾功能衰竭发生的机率;②无症状小儿肾积水男性患病率高于女性;③三聚氰胺是小儿泌尿系结石高发的一个危险因素。

Objective：To investigate the clinical characteristics of urinary system abnormalities in Chongqing and its surrounding area, and to assess the role of the large-scale urinary system ultrasound screening in the asymptomatic children with kidney and urinary tract abnormalities. Methods：We performed urinary system ultrasound on Screening 14 256 children from September 2008 to October 2008 in Chongqing Children’s Hospital. The total samples were allocated into five groups as follows：less than 1 year group;1 to 3 years group;3 to 5 years group;5 to 10 years group ;more than 10 years group. Then according to each group’s age,sex,disease location,severity difference,we performed statistical analysis. Results：409（2.87%）of 14 256 children had abnormalities,284 of whom was diagnosed with significant anomalies,including hydronephrosis,renal maldevepment （aplastic,dysplastic,hypoplastic,ectopic kidneys）and renal agensis,nephrolithiasis,simple renal cyst,multicystic dysplastic kidneys （MCKD）,ureter dilation,duplex kidneys and so on. Among these anomalies,the most prevalent abnormal finding was hydronephrosis accounting for 130 cases,almost a half of 284 （45.77%）,92 cases in males,38 cases in femal. The prevalence of melamine related urinary calculus was as 5.17 times as that of others and its 95% confidence interval（CI）of population relative risk was [3.28,8.14]. Conclusion：① Ultrasonography in the diagnosis of diseases of the urinary system can play an important role,especially for congenial anomalies of kidney and urinary tract（CAKUT）and /or hydronephrosis and so on. Therefore,an early diagnosis of these defects allows to realize as fast as possible the best medical and/or surgical treatment, preventing or at least slowing down the progression to chronic renal failure. ② The prevalence rate of hydronephrosis in male is higher than female. ③Exposure to melamine- contaminated formula is associated with urinary stones.