成都市6615例中小学生尿液筛查及随访分析

Urinary screening and follow - up analysis of 6615 school children in Chengdu city

目的了解成都地区中小学生尿液异常情况，探讨尿液筛查的意义。方法2013年1－12月以尿液试纸法对成都地区6 615例中小学生进行晨尿筛查，初次尿液筛查阳性者2周后复查，2次阳性者到当地医院行尿液常规检查，阳性者定为尿检异常，对其中符合转诊条件者转诊至三级医院接受治疗，并建立随访档案。结果参加筛查的6 615例中小学生中，小学一年级2 624例（39.67%），初中一年级3 991例（60.33%）；初次筛查隐血阳性323例（4.88%），蛋白尿43例（0.65%），隐血合并蛋白尿20例（0.30%），白细胞尿103例（1.56%）。再次筛查隐血阳性62例（0.94%），蛋白尿6例（0.09%），隐血合并蛋白尿2例（0.03%），白细胞尿46例（0.70%）。初中生尿隐血、尿蛋白质、尿隐血合并蛋白质以及尿白细胞阳性率[1.38%（55/3 991例）、0.13%（5/3 991例）、0.05%（2/3 991例）、0.70%（28/3 991例）]均高于小学生[0.27%（7/2 624例）、0.04%（1/2 624例）、0（0/2 624例）、0.69%（18/2 624例）]，差异均有统计学意义（χ2＝64.16、168.53、178.09、98.16，均P〈0.05）。转诊至三级医院进一步诊治的儿童中，4例为IgA肾病，1例为肾小球轻微病变，12例为尿路感染。结论尿液筛查是发现儿童肾脏疾病尤其是泌尿系统感染的有效办法，且需要加强随访。

ObjectiveTo investigate the prevalence of urine abnormalities for school children in Chengdu city and to evaluate the significance of urinary screening.MethodsDuring January to December 2013, morning urine of 6 615 students were collected and screened by urine reagent paper.Two weeks later, the repeated screening was conducted in the children whose urine samples were positive for the first screening.Urine samples with positive testing results for twice were submitted to urine routine tests at local hospital, and the children with the urine positive results were defined as urine abnormalities.The children with urine abnormalities were transferred to a tertiary hospital and given treatment and follow-up.ResultsThere were 6 615 cases receiving urine screening, including 2 624 cases （39.67%） of the grade I, and 3 991 cases（60.33%） at junior middle school.During the first screening, 323 cases （4.83%） children had urinary occult blood positive, 43 cases （0.65%） had urinary protein, 20 cases （0.30%） had occult blood positive and proteinuria, and 103 cases （1.56%） had white cells in urine.During the second urine screening, 62 cases （0.94%） had occult blood positive, 6 cases （0.09%） had urinary protein, 2 cases （0.03%） had proteinuria and occult blood positive, 46 cases （0.70%） had white cells in urine.The incidence of urine abnormalities with occult blood positive, proteinuria, occult blood positive and proteinuria, and white cells in urine of children at junior middle school [1.38%（55/3 991 cases）, 0.13%（5/3 991 cases）, 0.05%（2/3 991 cases）, 0.70%（28/3 991 cases）]were significantly higher than those of children at primary school[0.27%（7/2 624 cases）, 0.04%（1/2 624 cases）, 0（0/2 624 cases）, 0.69%（18/2 624 cases）], and all the differences were statistically significant（χ2=64.16, 168.53, 178.09, 98.16, all P〈0.05）. In children transferred to a tertiary hospital for treatment, there were 4 cases with IgA nephropathy, 1 case with minor glomerular abnormalities, and 12 cases with urinary tract infection.ConclusionUrinary screening is an effective way to find out kidney disease and urinary tract infection in children.Follow-ups should be strengthened.