急性肾小球肾炎合并尿路感染患儿病原学及实验室指标的研究

Etiology and laboratory indexes in patients with acute glomerulonephritis complicated with urinary tract infections

目的分析小儿急性肾小球肾炎合并尿路感染患者的病原学特点和相关实验室指标变化。方法选取医院2014年10月-2016年5月收治的254例小儿急性肾小球肾炎病例,根据是否合并尿路感染分为尿路感染组130例和单纯肾炎组124例,比较两组在实验室检测指标上的差异,并对尿路感染组进行病原菌鉴定,分析病原菌的分布情况。结果急性肾小球肾炎患者合并尿路感染130例,感染率51.18%,尿路感染组患儿年龄、性别、高血压、下肢浮肿、血尿、尿蛋白水平、红细胞形态、颗粒管型与单纯肾炎患儿相比无统计学差异,尿路感染组患儿尿频74.62%、尿急76.15%、尿痛79.23%、肾区疼痛44.62%、小腹疼痛45.38%、高烧46.92%、白细胞计数升高81.54%、细胞管型54.62%显著高于单纯肾炎组(P<0.05);急性肾小球肾炎合并尿路感染患儿共检测出病原菌174株,其中革兰阴性杆菌120株占68.97%,以大肠埃希菌为主;革兰阳性菌48株占27.59%,以屎肠球菌、粪肠球菌为主;真菌6株占3.45%。结论急性肾小球肾炎合并尿路感染并无特异性临床表现,早期进行实验室指标联合检测极为重要,且急性肾小球肾炎合并尿路感染主要病菌分布广泛,以革兰阴性杆菌感染为主。

OBJECTIVE To analyze the etiological characteristics of acute glomerulonephritis with urinary tract infections and the changes of related laboratory indexes.METHODS A total of 254 children with acute glomerulonephritis from Oct.2014 to May 2016 were chosen.According to whether the merger of urinary tract infections,they were divided into urinary tract infection group（n=130）and simple nephritis group（n=124）.The differences of the laboratory test indexes between the two groups were compared,urinary tract infection group was taken for pathogens identification,and the distribution of pathogens were analyzed.RESULTS There were 130 cases of urinary tract infections in the patients with acute glomerulonephritis,and the infection rate was 51.18%.The age,gender,hypertension,lower extremity edema,hematuria,urinary protein levels,red blood cell morphology and granular tube type in children with urinary tract infection had no significant differences compared with simple nephritis group.The urinary frequency（74.62%）,urgency（76.15%）,dysuria（79.23%）,kidney area pain（44.62%）,abdominal pain（45.38%）,high fever（46.92%）,white blood cell count increasing（81.54%）and cell type（54.62%）in urinary tract infection group were significantly higher than those in simple nephritis group（P〈0.05）.There were 174 strains of pathogens in patients withacute glomerulonephritis complicated with urinary tract infection,including 120 strains of gram-negative bacteria（68.97%）,which were mainly Escherichia coli,48 strains of gram-positive bacteria（27.59%）,which were mainly Agrobacterium tuberculosis and Enterococcus faecium,and 6strains of fungi（3.45%）.CONCLUSION Acute glomerulonephritis combined with urinary tract infections has no specific clinical manifestations.It is very important to carry out early detection of laboratory indicators.The main pathogens of acute glomerulonephritis with urinary tract infections are widely distributed,which are mainly gram-negative bacteria infection.