输尿管支架管相关尿路感染患者的临床特征及其肾脏形态学改变分析

Clinical features and renal morphological changes of the patients with urinary tract infection associated ureteral stent

目的 探讨输尿管支架管相关尿路感染患者的临床特征及其肾脏形态学变化.方法 对2012年10月至2013年5月收治的留置输尿管支架管伴发热性尿路感染的男性患者（A组,n=7）进行前瞻性研究,选取同期、同年龄段的留置输尿管支架管不伴发热的男性患者（B组,n=7）及因留置导尿管、膀胱造瘘管或间歇自家清洁导尿等出现发热性尿路感染的男性患者（C组,n=7）作为对照.A组年龄53～69岁,平均（61.0±5.5）岁;B组年龄52～65岁,平均（60.2±6.2）岁;C组年龄34 ～ 79岁,平均（66.4±18.3）岁,3组间比较差异无统计学意义（P＞0.05）.A组出现发热性尿路感染时留置输尿管支架管的时间为7～90 d,平均（30.3±29.5） d;B组为7～70 d,平均（27.4±26.8）d,两组间比较差异无统计学意义（P＞0.05）.比较3组的实验室检查、99 Tcm-二巯基琥珀酸（DMSA）肾静态显像结果. 结果 A、B、C组的血白细胞分别为13.2× 109/L、6.8× 109/L和11.9× 109/L,差异有统计学意义（P＜0.05）;超敏C反应蛋白分别为172.2、11.2和78.2 mg/L,差异有统计学意义（P＜0.05）.脓尿患者比例分别为A组7/7,B组5/7,C组7/7.尿细菌培养阳性比例分别为A组7/7,B组3/7,C组7/7.A组的99Tcm-DMSA肾静态显像检查示留置输尿管支架管侧的肾脏点状或片状吸收区减少,B、C组的肾脏均未见异常. 结论 99Tcm-DMSA肾静态显像可以用于判断输尿管支架管相关感染的部位.输尿管支架管相关感染患者如出现发热寒战,提示有可能出现肾实质受累,应给予足够的重视,及时处理.

Objective To evaluate the clinical features and renal morphological changes of the patients with urinary tract infection associated ureteral stent.Methods From Oct.2012 to May.2013,21 patients were divided into three groups depending on the different conditions：Group A （n=7）：patients who had febrile urinary tract infections associated with ureteral stents; Group B （n =7）：patients with ureteral stents but no fever; Group C （n=7）：patients who had febrile urinary tract infections but no ureteral stent.The clinical data,laboratory data and 99Tcm-dimercaptosuccinic acid （DMSA） renal scintigraphy results were recorded prospectively and analyzed.Results In Group A,there were two patients had flank pain and positive costovertebral angle percussion tcnderness.The mean value of white blood cells and Hs-CRP of Group A and Group C were obviously higher than Group B （P〈0.05）.The ratios of pyuria were 100.0%,71.4% and 100.0% in Group A,B and C.The ratios of positive urine bacteuria culture were 100.0%,42.9% and 100.0% in Group A,B and C.The results of 99Tcm-DMSA renal scintigraphy demonstrated the decreased uptake in the different portion of the kidneys on the sides of ureteral stents inserted in all the patients in Group A but no such changes in Group B and Group C.Conclusions 99Tcm-DMSA renal scintigraphy can be used to judge the status of urinary tract infection associated ureteral stent.The febrile urinary tract infection associated with ureteral stents always means pyelonephritis occurs and prompt treatment must be given.