53例无症状小儿肾结石随访和预后分析

Follow-up and prognosis analysis of 53 asymptomatic children with renal calculi

目的：评估无症状小儿肾结石的中远期预后。方法：以我院泌尿系统超声筛查发现的75例无症状小儿肾结石为研究对象，其中三聚氰胺相关肾结石（melamine—associatedrenalcalculi，MARC）37例，非三聚氰胺肾结石（nonmelamine-associatedre—nalcalculi，NMARC）38例。随访28～45月（平均41月），通过泌尿系统超声和尿常规检查进行评估。结果：随访息儿53例，其中MARC患儿34例．NMARC患儿19例；结石自发排出率为58．49％（31／53）。婴幼儿，直径≤5mm结石最易自发排出；而3岁以上．直径≥10mm的结石自发排出率较低（P=0．003，P=O．000）。尿常规显示，41月后总体异常检出率为15．38％明显低于初诊时41．03％（P=-0．010）；其中MARC患儿蛋白尿全部消失，其缓解率高于NMARC患儿（P=-O．030）。结论：41月后无症状小儿肾结石自发排出率较高，结石直径和发病年龄是影响其排出的主要因素；总体预后良好，MARC患儿预后比NMARC相对较好；其长期预后尚需继续随访。

Objective：To evaluate the prognosis of asymptomatic children with renal stones. Methods：Totally 75 asymptomatic children with renal stones were followed up for 28-45 moths averaged 41 months after the initial diagnosis,including 37 melamine-associated renal calculi（MARC） children and 38 non melamine-associated renal calculi（NMARC） children. Urinary system ultrasound and uri- nalysis were examined at the end of follow-up. Results：Follow-up was completed in 53 children （34 MARC children and 19 NMARC children） and renal calculi were excreted in 31 children（58.49%）. Spontaneous discharge occurred more often in infants and in chil- dren with stone of diameter no than 5 mm, while unlikely occurred in children aged older than 3-year-old and in children with stone of diameter larger than 10 ram（P=0.003 ,P-0.000）. At the end of follow-up,urinalysis showed that the total abnormal rate （15.38%） at 41 months after the initial diagnosis was lower than that（41.03%） at initial diagnosis,with statistically significant differences（P= 0.010）. No MARC child had proteinuria,significantly better than that of NMARC children（P=0.030）. Conclusions ：Most asymptomatic children with renal calculi discharged spontaneously at the end of follow-up. Stone size and suffering age are two risk factors of dis- charge. Overall prognosis is fine and prognosis of MARC children is superior to that of NMARC. Long term prognosis of NMARC children needs further follow-up.