与食用三聚氰胺污染奶粉相关的婴幼儿泌尿系统结石139例临床特征及随访分析

Analysis of Clinical Features and Follow-up of Urolithiasis in 139 Infants Fed by Melamine-Contained Powdered Formula

目的探讨与食用三聚氰胺污染奶粉相关的婴幼儿泌尿系统结石的发病特征、影响因素及预后。方法回顾性分析2008年9-10月在江西省儿童医院住院的139例与食用三聚氰胺污染奶粉相关的婴幼儿泌尿系统结石的临床特点、治疗效果及随访资料。按年龄将其分为1~6个月组（8例）,〉6~12个月组（60例）,〉12~24个月组（58例）,〉24~36个月组（13例）。结果泌尿系统结石婴幼儿139例的男女比例为1.5 1,奶粉喂养时间1~36个月,有临床症状者69例（49.64%）,主要表现为排尿困难/哭闹、尿量减少、尿色异常。泌尿系统多个结石发生率各年龄组比较差异有统计学意义（P〈0.05）,以〉6~12个月组最高（60%）。肾积水发生率各年龄组比较差异无统计学意义（P〉0.05）。碱化水化治疗28 d后评价内科溶石治疗效果：治愈76例（54.67%）,好转41例（29.50%）,无效22例（15.83%）。1 a后有完整随访资料131例,121例（92.37%）未检出泌尿系统结石,10例（7.63%）泌尿系统残留结石,其中并肾积水2例（1.53%）。结论泌尿系统结石可发生在婴幼儿服用三聚氰胺污染奶粉4~6周。〉6~12个月组患儿泌尿系统多个结石发生率高,发生梗阻性肾衰竭需手术缓解的概率大。碳酸氢钠静脉碱化水化治疗2~4周安全有效,停止服用三聚氰胺污染奶粉后大部分结石可在1 a内排出。

Objective To explore the clinical features,influencing factor and prognosis of urolithiasis in infants fed by melamine-contained powdered formula.Methods The clinical features,curative effects and follow-up data of urolithiasis in 139 infants fed by melamine-contained powdered formula,diagnosed from Sep.2008 to Oct.2008 in Jiangxi Children′s Hospital,were retrospectively analyzed.Among the children,less than 6 months were 8 cases,6-12 months were 60 cases,12-24 months were 58 cases,24-36 months were 13 cases.Results Of the 139 children,the ratio between male and female was 1.51,and the duration of feeding melamine-powdered was 1 month to 36 months,and 49.64%（69 cases） appeared symptoms included dysuria,crying on urination,hypourocrinia,abnormal color of urine.The morbidity of multiple urinary stones was 60% in 6-12 months group,higher than other age groups（P0.05）.The morbidity of hydronephrosis were similar at different age groups（P0.05）.After the treatment of intravenous sodium bicarbonate and fluid infusion for stones dissolution for 28 days,the effect was evaluated,76 cases（54.67%） were cured,41 cases（29.50%） got better,22 cases（15.83%） were unrecovered.One-year follow-up study among 131 of 139 cases,121 cases（92.37%） didn′t have stones,and 10 cases（7.63%） remained urinary stones,and 2 cases（1.53%） had hydronephrosis.Conclusions Urinary stones would be detected in infants for 4-6 weeks feeding melamine-contained powdered formula.The morbidity of multiple urinary stones and obstructive renal failure are high and the ratio of surgical treatment is increased in 6-12 months group.Treatment of intravenous sodium bicarbonate and fluid infusion are effective and safe.After the infants stop taking melamine-contained powdered formula,most of urinary stones are discharged in 1 year.