三聚氰胺致婴幼儿泌尿系统结石保守治疗效果评价

Evaluation of Conservation Treatment of Melamine-Induced Urinary Stones in Infants

目的评价三聚氰胺致婴幼儿泌尿系统结石保守治疗的疗效,为临床诊治提供参考。方法收集2008年4-12月甘肃省20家医院行保守治疗的68例泌尿系统结石患儿(男42例,女26例)的临床资料、实验室检查、超声结果,对其进行为期1a的随访调查,同时行双肾B超、肾功能检查(包括BUN、Cr、尿酸、α1-微球蛋白、微量清蛋白、β2-微球蛋白)及尿常规检查,进行治疗前与治疗1a后的对照研究。另选取82例健康婴幼儿作为健康对照组,行以上检查,且与治疗组1a后的结果进行比较。结果进行保守治疗共68例。其中14例(21%)无效改为外科治疗;54例保守治疗患儿随访1a,痊愈51例(75%,51/68例),3例(4%,3/68例)残留结石。患儿治疗前与治疗1a后B超检查结果比较差异有统计学意义(P<0.05)。治疗1a后尿红细胞水平高于健康对照组(P<0.05);肾功能检查各项指标治疗前与治疗1a后比较,治疗1a后与健康对照组比较,差异均无统计学意义(Pa>0.05)。结论三聚氰胺致泌尿系统结石患儿保守治疗效果较好,长期观察对肾功能无明显影响。

Objective To evaluate the efficacy of conservative treatment on children with melamine - induced urolithiasis. Methods A total of 68 children with melamine - induced urinary stones （42 male and 26 female） treated conservatively in 20 hospitals from Apr. to Dec. 2008 in Gansu province were collected as the treatment group. Age - matched 82 healthy children without exposure to melamine - contamina- ted formulas were enrolled as the healthy control group. Clinical signs, laboratory data and uhrasonography in the treatment group were analyzed before treatment and compared with those in the control group after one - year treatment. The data of ultrasonography, urinalysis and biochemistry analysis （ including blood urea nitrogen, serum creatinine, serum urea acid, α1 - mieroglobulin, urine mieroalbumin, β2 - microglobulin） were analyzed and compared between treatment group and the healthy control group during one - year follow up study. Results Fourteen of 68 children（21% ） were treated by surgical intervention when the conservative treatment failed, and 54 patients treated conservatively were followed up. One -year follow up study indicated that 51/68 cases （75%） patients were cured and 3/68 cases （4%） patients had residual stones. The finding of uhrasonography in 54 children were statistically different after one - year treatment compared with those before treatment （P 〈 0.05 ）. After one - year treatment, there was no significant difference in blood and urine biochemistry analysis between the treatment group and the healthy control group （P 〉 0.05 ）, but significant difference of the incidence of hematuria was found between the treatment group and the healthy control group （ P 〈 0.05 ）. Conclusions Conservative treatment for children with melamine - induced urinary stones was effective. Outcome of one - year follow up showed no damages to renal function.