三聚氰胺污染奶粉喂养儿童泌尿系统结石并发症的特点及其高危因素

Clinical Features and High Risk Factors in Complications of Melamine Urinary Stones in Children Fed by Melamine-Contaminated Milk Powder

目的分析三聚氰胺污染奶粉喂养儿童泌尿系统结石并发症的特点及其高危因素。方法回顾性分析163例食用三聚氰胺污染奶粉致泌尿系统结石患儿的临床资料,根据有无并发症,分为并发症组和无并发症组;进一步将存在并发症的患儿分为肾衰竭组、尿路梗阻组和尿路感染组。同时,选取纯母乳喂养泌尿系统结石有并发症的患儿20例作为对照组。比较各组相关参数变化。结果 41.0%(67例)的泌尿系统结石患儿出现并发症,其中肾衰竭占9.8%(16例),尿路梗阻占25.8%(42例),尿路感染占5.5%(9例)。并发症组血尿酸(SUA)显著高于无并发症组和对照组,而尿pH值显著低于上述2组,结石位置与无并发症组比较差异有统计学意义,结石形态、结石数目与对照组比较差异均有统计学意义(Pa<0.05)。肾衰竭组患儿年龄显著低于尿路梗阻组和尿路感染组(P<0.05),食用奶粉时间与上述2组比较差异无统计学意义(P>0.05)。肾衰竭组中双肾积水占62.5%(10例),主要表现为无尿(81.3%,13例)、少尿(18.7%,3例)。尿路梗阻组中上尿路梗阻占85.7%(36例),下尿路梗阻占14.3%(6例),其中无临床症状者占47.6%(20例),血尿7.1%(3例),排尿困难占14.3%(6例),腹痛占31.0%(13例)。尿路感染组主要表现为发热、血尿(66.7%,6例),尿频、尿急(22.2%,2例)。结论三聚氰胺污染奶粉喂养儿童泌尿系统结石并发症具有自身的发病特点,SUA、尿pH值和结石位置与并发症发生有关,年龄较小者易并肾衰竭。

Objective To investigate the clinical features and high risk factors in complications of melamine urinary stones in children due to feeding melamine-contaminated milk powder.Methods One hundred and sixty-three children with melamine urinary stones due to melamine-contaminated milk powder feeding were analyzed retrospectively.All children were divided into complication group and non-complication group.The complication group was further divided into 3 subgroups：renal failure group,urinary obstruction group and urinary tract infection group.Meanwhile,20 children（without feeding melamine-contaminated milk powder） were followed up with urolithiasis as control group.The results were compared among the 3 groups.Results There were 41.0%（67 cases） complications among the feeding melamine history children,9.8%（16 cases） of them with renal failure,25.8%（42 cases） with urinary obstruction and 5.5%（9 cases） with urinary tract infection.Serum uric acid（SUA） increased and urinary pH value decreased significantly in the complication groups compared with those of the non-complication group and control group（Pa0.05）.Furthermore,there was a significant difference in the position of calculi and in the stone structure pattern and quantity in the complication groups compared with the non-complication group（Pa0.05）.The age of renal failure subgroup was younger compared with other 2 subgroups（P0.05）.In the renal failure subgroup,62.5%（10 cases） showed bilateral hydronephrosis,81.3%（13 cases） anuria and 18.7%（3 cases） oliguria.In the urinary obstruction subgroup,85.7%（36 cases） showed upper urinary tract obstruction,14.3%（6 cases） lower urinary tract obstruction,47.6%（20 cases） had no clinical symptoms,14.3%（6 cases） had dysuria,and 31.0%（13 cases） had infantile colic and 7.1%（3 cases） hematuria.In the urinary tract infection group,66.7%（6 cases） showed hematuria and fever,and 22.2%（2 cases） had urinary frequency and urgency.Conclusions The children with melamine stone pre-sent a unique clinical features.SUA,urinary pH value,position of calculi and the age at melamine-contaminated milk powder are predictive factors in complications.