三聚氰胺致婴幼儿泌尿系结石一年随访研究

One year follow-up study of urolithiasis in infants exposed to melamine-tainted powdered formula

目的调查因三聚氰胺污染奶粉致泌尿系结石婴幼儿1年后康复情况。方法三聚氰胺致泌尿系结石婴幼儿8l例，男51例，女30例。随访时年龄13—48个月，平均26个月。对患儿进行了1年后B超复查，血BUN、SCr、尿酸含量检测，并行尿常规检查，同时检测尿液中α1-微球蛋白（α1，-MG）、β2-微球蛋白（β2-MG）、微量白蛋白（UMA）的含量。81例同年龄段未食用污染奶粉的健康婴幼儿作为对照组，行尿常规检查及尿α1-MG、β2-MG、UMA检测。结果内科治疗组54例，结石残留3例，直径分别为0．3、0．3、0．4cm；外科治疗组27例，结石残留2例，直径为1．5、0．2cm，1．5cm残留结石为阳性结石，行经皮。肾镜取石治疗。患儿UMA水平明显升高，中位数（四分位间距）为5．4（8．0）mg／L，对照组为2．3（4．9）mg／L，两组比较差异有统计学意义（P〈0．01）；血BUN、SCr、尿酸均在正常范围，不同治疗组间差异无统计学意义（P〉0．05）。结论大多数三聚氰胺致婴幼儿泌尿系结石采用内科或外科治疗效果确切，结果满意，如果1年后残留结石直径〉1．0cm建议手术治疗。

Objective To investigate the condition of infants with urolithiasis caused by melamine- tainted powdered formula at one-year follow-up. Methods Eighty-one young children with melamine-induced urolithiasis were followed up, which included urinalysis, renal-function tests, urinary tests for biochemical markers of renal glomerular and tubular function, and ultrasonography. Eighty-one age-matched healthy infants without exposure to melamine-contaminated formulas were enrolled as controls. Results Fifty-one of the patients were male and 30 female, with a mean age of 26 months （range 13 -48 months）. The 81 children were divided into 2 groups according to treatment protocols. Group 1 received conservative treatment （ n = 54） and Group 2 received surgical treatment （ n = 27）. In Group 1, 3 patients （5.6%） had stone-residual： 1 girl had calculus of 0.4 cm in diameter in the left kidney and 2 girls had calculus of 0.3 cm in diameter in the right kidney. In Group 2, 2 patients （7.4%） had stone-residual, 1 boy had crystallization of 0.2 em in diameter in the right kidney and 1 boy had calculus of 1.5 em in diameter in the left kidney, positive stone was confirmed by X-ray and accepted percutaneous nephrolithotomy. Urinary microalbumin levels were significantly increased in the children with melamine-induced urolithiasis compared with the control group （P 〈 0.01 ）. Blood urea nitrogen and serum ereatinine were within the normal range with no significant difference between the 2 groups. Conclusions At one-year follow-up most of the children exposed to melamine-tainted infant formula in both treatment groups had returned to a healthy state, suggesting a satisfactory outcome for both treatment ootions. However. surgery is recommended in Patients with stone-residual 〉 10 mm.