新生儿泌尿系统发育异常的影响因素及预后的临床追踪研究

A clinical follow-up study on risk factors and prognosis of congenital anomalies of the kidney and urinary tract in newborns

目的探讨新生儿先天性肾脏与尿路畸形(CAKUT)的影响因素,并随访预后情况。方法回顾性收集于2018年1月至2019年5月在深圳市妇幼保健院新生儿科住院的CAKUT患儿179例,按1∶3匹配医院同期分娩的537名健康新生儿作为对照组,分析CAKUT的影响因素,按病种分类并随访患儿诊治预后情况。结果调查发现住院新生儿中CAKUT阳性率为2.25%(179/7956),其中肾积水123例。CAKUT组中初产妇、早产、双胎妊娠、男婴、小于胎龄儿比例较高(χ^(2)=17.939、11.575、8.633、14.257、9.647,P<0.05)。多因素回归分析发现高龄初产妇的新生儿发生CAKUT的风险高于经产妇(OR=2.32,95%CI:1.08~4.98,P<0.05)。相对于足月儿,早产胎儿风险显著上升(OR=1.94,95%CI:1.11~3.40,P<0.05),男婴风险显著高于女婴(OR=2.22,95%CI:1.51~3.27,P<0.001),小于胎龄儿发生CAKUT的风险显著高于适于胎龄儿(OR=2.18,95%CI:1.21~3.91,P<0.05)。随访结果显示约10%CAKUT患儿需要手术干预,90%以上患儿预后良好。结论早产、小于胎龄儿、男婴、孕妇高龄初产妇可能是CAKUT发生的危险因素,多数CAKUT患儿通过及时随访治疗后预后良好。

Objective To explore risk factors of congenital anomalies of the kidney and urinary tract(CAKUT)in newborns and to follow up prognosis of the disease.Methods A retrospective study was conducted.A total of 179 newborns with CAKUT who hospitalized in Department of Neonatology,Shenzhen Maternal and Child Health Hospital from January 2018 to May 2019 were selected.According to 1∶3 matching ratio,537 healthy newborns who gave birth in the same period in our hospital were as the control group.The risk factors of CAKUT were analyzed,and the diagnosis,treatment and prognosis of the infants were followed up according to classification of the disease type.Results The positive detection rate of CAKUT among the hospitalized newborns was 2.25%(179/7956),including 123 cases of hydronephrosis.The proportions of primipara,preterm delivery,twin,male infant and small for gestational age(SGA)infant in the CAKUT group were higher(χ^(2)=17.939,11.575,8.633,14.257 and 9.647 respectively,all P<0.05).Multivariate regression analysis showed that the risk of CAKUT was higher in the older primiparae than in the multiparae(OR=2.32,95%CI:1.08-4.98,P<0.05).Compared with the full term infants,the risk of CAKUT was significantly higher in those premature infants(OR=1.94,95%CI:1.11-3.40,P<0.05).The risk of CAKUT in the male infants was significantly higher than that in the female infants(OR=2.22,95%CI:1.51-3.27,P<0.001).And the risk of CAKUT in the SGA infants was significantly higher than that in those appropriate for gestational age(AGA)infants(OR=2.18,95%CI:1.21-3.91,P<0.05).The follow-up results showed that about 10%of the infants with CAKUT required surgical intervention,and more than 90%of the infants had good prognoses.Conclusion Premature delivery,SGA,male infant,and advanced maternal age are risk factors for CAKUT.Through timely treatment and follow-up,the most infants with CAKUT have good prognoses.