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目的回顾性分析儿童泌尿道感染中膀胱输尿管反流(vesicoureteric reflux,VUR)的发生情况,了解肾损害情况及其预后。方法选择2010年1月至2012年12月因尿路感染在无锡市儿童医院住院后确诊为VUR的42例患儿为研究对象,回顾性分析反流发生情况、肾瘢痕形成、随访其反流转归情况,其中有20例获得了完整随访资料。结果尿路感染中膀胱输尿管反流的发生率35.9%(42/117),反复尿路感染患儿中的VUR的发生率(62.2%)明显高于首次尿路感染(23.7%),在不同年龄段中,婴儿期(≤1岁)VUR的发生率高(61.9%),且以重度反流为主(48.6%)。有完整随访资料的20例中包括轻度反流2例,中度反流7例,重度反流11例;随访1~2年均重复第二次X线排尿期膀胱尿路造影检查,发现各反流等级均有不同程度改变:完全缓解为3例,部分缓解6例,无变化10例,加重1例。有7例肾瘢痕,5例在首次放射性核素肾静态扫描检查中即已发现,2例在随访过程中发现,均发生于中重度反流患儿,6例发现肾瘢痕时年龄均小于2岁。42例VUR患儿中2例在确诊后即转外科治疗,20例内科随访患儿中有2例转为外科治疗。结论 VUR需要及早诊断和治疗,特别对婴儿期加强重视,对肾损害及时评估,合理调整治疗方案,加强宣教,做好长期随访和正规治疗,有效保护好肾脏。
Objective To retrospectively analyze the incidence of vesicoureteric reflux (VUR) in children with urinary tract infection and to understand the renal damage and its prognosis. Methods From January 2010 to December 2012, 42 children with VUR diagnosed as urinary tract infection after hospitalization in Wuxi Children’s Hospital were enrolled in this study. The incidence of reflux and renal scar formation were retrospectively analyzed. Attributed to the situation, of which 20 cases were complete follow-up information. Results The incidence of vesicoureteral reflux in urinary tract infection was 35.9% (42/117), and the incidence of VUR in children with recurrent urinary tract infection was significantly higher than that of first urinary tract infection (62.2%, 23.7%) In the age group, the incidence of VUR in infancy (≤1 years) was high (61.9%) and mainly in severe reflux (48.6%). There were 2 cases of mild reflux, 7 cases of moderate reflux and 11 cases of severe reflux in the 20 cases with complete follow-up data. The second X-ray urinary bladder urography was followed up for 1 to 2 years follow-up and found The levels of reflux had varying degrees of change: complete remission in 3 cases, partial remission in 6 cases, no change in 10 cases, an increase of 1 case. There were 7 cases of renal scar, 5 cases were found in the first time of radionuclide renal static scanning examination, 2 cases were found in the follow-up process, all occurred in children with moderate and severe reflux, 6 cases found when the age of renal scar were less than 2 year old. Two of the 42 VUR infants were surgically treated after diagnosis, and two of 20 infants with medical follow-up were converted to surgery. Conclusions VUR needs to be diagnosed and treated as soon as possible. Especially for infants, we should pay more attention to it, evaluate the damage of kidney in time, reasonably adjust the treatment plan, strengthen the propaganda and education, make long-term follow-up and formal treatment, and effectively protect the kidneys.