儿童肉眼血尿63例临床分析

Clinical Analysis of 63 Children with Gross Hematuria

目的探讨儿童肉眼血尿的病因和临床意义。方法对63例首次以肉眼血尿为主要症状患儿的病因进行回顾性分析。结果 63例患儿中肾小球性血尿50例(79.37%),非肾小球性血尿13例(20.63%)。急性肾小球肾炎7例(11.11%)、Ig A肾病20例(31.75%)、原发性肾病综合征3例(4.76%)、紫癜性肾炎9例(14.28%)、狼疮性肾炎3例(4.76%)、药物性血尿7例(11.11%)、Alport综合征1例(1.58%),泌尿系感染6例(9.52%)、泌尿系结石3例(4.76%)、肾肿瘤1例(1.58%)、白血病1例(1.58%)、脓毒症并弥漫性血管内凝血(DIC)2例(3.17%)。结论小儿肉眼血尿病因复杂,必须通过认真分析病史、伴随症状体征和特异的实验室指标,并结合尿红细胞形态来确定肉眼血尿来源。当肉眼血尿排除了非肾小球血尿,而且迁延不愈、反复发作、难以明确病因时,应动员对患儿尽早行肾活检术。

Objective To investigate the causes and the clinical significance of the children with gross hematuria.Methods Restrospective analysis of the causes of 63 children with gross hematuria.Results Among 63 children with gross hematuria,50 cases were with glomerular hematuria（79.3%） and 13 cases were with non-glomerular hematuria（20.63）.The causes of hematuria of 63 cases included 7 cases of acute glomerulonephritis（11.11%）,20 cases of Ig A renopathy（1.58%）,3 cases of primary nephrotic syndrome（4.76%）,9 cases of anaphylactic purpura nephritis（14.28%）,3 cases of lupus nephritis（4.76%）,7 cases of drug-induced hematuria（11.11%）,1 case of Alport Syndrome（1.58%）,6 cases of urinary tract infection（9.52%）,3 cases of urinary calculus（4.76%）,1 case of renal tumor（1.58%）,1 case of leukemia（1.58%）,2 cases of sepsis with disseminated intravascular coagulation（3.17%）.Conclusion The causes of gross hematuria of children are complex,so the history,symptoms,signs and lab investigations of the patients should be analyzed carefully.If the nonglomerular hematuria has been ruled out,hematuria are delayed healing and the causes of the gross hematuria can not be confirmed,renal biopsy should be suggested.