早产儿肾钙质沉着症临床特征分析

Clinical characteristics of nephrocalcinosis in preterm infants

目的探讨早产儿肾钙质沉着症的临床特点及相关影响因素。方法回顾性选择2021年3月至2021年8月北京协和医院新生儿重症监护病房收治的胎龄<34周早产儿为研究对象,根据泌尿系统超声结果分为肾钙质沉着组与非肾钙质沉着组,比较两组患儿胎龄、出生体重、营养支持、并发症等情况。结果共纳入早产儿40例,其中肾钙质沉着组9例,非肾钙质沉着组31例。与非肾钙质沉着组相比,肾钙质沉着组早产儿出生体重[(1167±214)g比(1586±215)g]更低,住院期间钙[6.9(5.1,8.7)比3.3(2.1,6.8)g]、维生素D[3.2(2.5,4.2)万U比1.7(1.1,3.2)万U]总摄入量更高,但两组血钙、磷及25-羟维生素D水平、喂养方式、达足量喂养时间、呋塞米用量、呼吸支持时间比较差异无统计学意义(P>0.05)。9例患儿发现肾钙质沉着的中位日龄为40.0(30.0,52.5)d,5例双侧受累;5例患儿行肾小管功能检查,其中4例尿β2微球蛋白升高,2例尿α1微球蛋白升高;9例患儿中7例尿钙水平升高。随访显示肾钙质沉着症消失时间为生后3~9个月。结论早产儿肾钙沉着症与出生体重、住院期间钙、维生素D总摄入量相关,肾钙质沉着症的早产儿多数合并尿β2微球蛋白升高及尿钙水平升高。

Objective To study the clinical characteristics and risk factors of nephrocalcinosis in preterm infants.Methods From March 2021 to August 2021,all preterm infants admitted to NICU of our hospital were retrospectively analyzed.The infants were assigned into nephrocalcinosis group and non-nephrocalcinosis group according to urinary tract ultrasound.Clinical data including gestational age,birth weight(BW),nutritional support strategy and complications were reviewed.Results A total of 40 preterm infants(<34 weeks)were enrolled.9 cases were in the nephrocalcinosis group and 31 cases in the non-nephrocalcinosis group.The nephrocalcinosis group had lower BW[(1167±214)g vs.(1586±215)g],higher calcium[6.9(5.1,8.7)g vs.3.3(2.1,6.8)g]and vitamin D intake[3.2(2.5,4.2)×104U vs.1.7(1.1,3.2)×104U]during hospitalization.No significant differences existed between the two groups on the following items:blood calcium and phosphate,25-hydroxyvitamin D,feeding strategy,time to reach full enteral feeding(TFF),furosemide dosage and respiratory support duration(P>0.05).In the nephrocalcinosis group,the median age of diagnosing nephrocalcinosis was 40.0(30.0,52.5)d after birth.5 cases showed bilateral nephrocalcinosis.5 cases in the nephrocalcinosis group received renal tubule function examination,4 cases had increased urineβ2 microglobulin and 2 cases had increased urineα1 microglobulin.7 cases had elevated urine calcium in the nephrocalcinosis group.Follow-up showed that nephrocalcinosis disappeared 3-9 months after birth.Conclusions BW,total calcium and vitamin D intake are risk factors for nephrocalcinosis in preterm infants.Increased urineβ2 microglobulin and calcium levels are common co-morbidities in preterm infants with nephrocalcinosis.