Jiang Dapeng,Wang Qi,Shi Zhengzhou,et al.Pathogenic characteristics of primary vesicoureteral reflux in infants aged under 2 months with febrile urinary tract infection[J].Journal of Clinical Pediatric Surgery,2019,18(10):825-829.[doi:10.3969/j.issn.1671-6353.2019.10.005]
原发性膀胱输尿管反流在2月龄以下婴儿发热性尿路感染人群中的临床特点
- Title:
- Pathogenic characteristics of primary vesicoureteral reflux in infants aged under 2 months with febrile urinary tract infection
- 分类号:
- R726.9;R693;R695
- 摘要:
- 目的 对原发性膀胱输尿管反流（vesicoureteral reflux，VUR）在2月龄以下婴儿发热性泌尿道感染（urinary tract infection，UTI）人群中的发病特点进行分析，进一步探讨对于这部分患儿行排尿性膀胱尿道造影（voiding cystourethrography，VCUG）检查的必要性。方法 回顾性收集2013年12月至2018年12月由上海交通大学医学院附属上海儿童医学中心收治的2月龄以下发热性UTI婴儿的临床资料。总结病例的临床特点，为其临床诊治提供理论基础。结果 本研究共纳入2月龄以下的发热性UTI婴儿72例。UTI最常见的致病菌是大肠埃希氏菌。有28（38.9%）例患儿泌尿系统超声提示异常，但仅3例表现为输尿管扩张。最常见的超声异常为轻中度肾积水。共有38例患儿接受了VCUG的检查，有10例确诊为原发性VUR。大肠埃希氏菌、屎肠球菌及肺炎克雷伯菌感染的患儿中VUR的检出率分别为5.6%、37%及42.9%，大肠埃希氏菌与非大肠埃希氏菌感染致UTI病例中VUR的检出率差异有统计学意义（P=0.03）。单次UTI和多次UTI发作患儿中VCUG检出VUR率分别为14.3%及29.0%，差别无统计学意义（P=0.650）。结论 2月龄以下的发热性UTI患儿中VCUG检查的阳性率较低，在初次UTI发作日龄偏小（<1个月）的患儿及超声提示严重泌尿系统异常的病例中行VCUG检查的临床意义较大。对于非大肠埃希氏菌引起的2月龄以下婴儿发热性UTI，在选择是否行VCUG检查时应更加积极。
- Abstract:
- Objective To explore the pathogenic characteristics of primary vesicoureteral reflux (VUR) in febrile urinary tract infection (UTI) infants aged under 2 months and evaluate the necessity of voiding cystourethrography (VCUG).Methods Children aged under 2 months with febrile UTI between December 2013 to December 2018 were reviewed.The clinical data were collected and the clinical characteristics summarized for providing theoretical rationales for clinical diagnosis and treatment of VUR.Results A total of 72 infants (<2 months) with febrile UTI fulfilling the inclusion criteria were collected.Escherichia coli was the most common organism.Ultrasound hinted at abnormal urinary system in 28 (38.9%) cases and there were 3 cases of ureteral dilatation.Mild to moderate hydronephrosis was the most common ultrasonographic manifestation.A total of 38 children received VCUG and there were 10 cases of primary VUR.The detection rate of VUR in children infected with Escherichia coli, Enterococcus faecium and Klebsiella pneumoniae was 5.6%, 37% and 42.9%, respectively. There was a significant difference between the detection rate of VUR in UTI cases infected with Escherichia coli and non-Escherichia coli (P=0.03). There was no significant difference (P=0.650).Conclusion Infants (< 2 months) with febrile UTI are less likely to have an abnormal VCUG.The clinical significance of VCUG is great in infants with ultrasonic evidence of severe renal abnormalities and neonates aged <1 month during the first UTI attack.Febrile UTI in infants aged under 2 months caused by non-Escherichia coli should be more active in choosing whether VCUG should be performed or not.
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备注/Memo
收稿日期:2019-09-16。
基金项目:上海市自然科学基金（编号：19ZR1432800）
通讯作者:孙杰,Email:sunjie@scmc.com.cn