[1]李琦,蔡淼,吴盛德,等.神经源性膀胱上尿路损害的危险因素分析[J].临床小儿外科杂志,2022,21(03):253-257.[doi:10.3760/cma.j.cn101785-202108049-010]
　Li Qi,Cai Miao,Wu Shengde,et al.Analysis of risk factors for upper urinary tract injury in children with neurogenic bladder[J].Journal of Clinical Pediatric Surgery,2022,21(03):253-257.[doi:10.3760/cma.j.cn101785-202108049-010]
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神经源性膀胱上尿路损害的危险因素分析

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第21卷 期数: 2022年03期 页码: 253-257 栏目: 论著 出版日期: 2022-03-28
Title:
Analysis of risk factors for upper urinary tract injury in children with neurogenic bladder
作者:
李琦;  蔡淼;  吴盛德;  刘星;  张德迎;  华燚;  刘丰;  陆鹏;  林涛;  何大维;  魏光辉
重庆医科大学附属儿童医院泌尿外科, 儿童泌尿生殖发育与组织工程重点实验室, 儿童发育疾病研究教育部重点实验室, 国家儿童健康与疾病临床医学研究中心, 儿童发育重大疾病国家国际科技合作基地, 儿科学重庆市重点实验室, 重庆 400010
Author(s):
Li Qi;  Cai Miao;  Wu Shengde;  Liu Xing;  Zhang Deying;  Hua Yi;  Liu Feng;  Lu Peng;  Lin Tao;  He Dawei;  Wei Guanghui
Department of Urology;Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering Ministry of Education;Key Laboratory of Child Development and Disorders;National Clinical Research Center for Child Health and Disorders;China International Science and Technology Cooperation base of Child development and Critical Disorders;Children’s Hospital of Chongqing Medical University, Chongqing, 400010, China
关键词:
膀胱; 神经原性/病理生理学; 肾/损伤; 肾/病理学; 输尿管/损伤; 危险因素
Keywords:
Urinary Bladder;  Neurogenic/PP; Kidney/IN; Kidney/PA; Ureter/IN; Risk Factors
DOI:
10.3760/cma.j.cn101785-202108049-010
摘要:
目的 探讨神经源性膀胱（neurogenic bladder，NB）患儿发生上尿路损害的危险因素。方法 以2021年1月至2021年5月重庆医科大学附属儿童医院151例诊断为NB的住院患儿为研究对象，根据是否发生上尿路损害分为上尿路损害组（n=88）和上尿路正常组（n=63），比较两组一般特征（性别、年龄、住院时间、病程、排尿方式、既往脊柱手术史）、临床症状（是否伴有尿频尿急、排尿困难、尿失禁，是否伴有膀胱直肠综合征）、实验室检查结果（尿常规、腰骶部X线片）、尿动力学检查结果[膀胱顺应性、是否伴有膀胱过度活动（overactive bladder，OAB）]之间的差异，对差异有统计学意义的指标行多因素Logistic回归分析，筛选导致NB患儿出现上尿路损害的危险因素。结果 以P<0.2为单因素方差分析筛选标准，结果显示入院时伴有发热、泌尿系感染、腹压/其他排尿方式、膀胱顺应性差、伴有OAB，是导致NB患儿发生上尿路损害的危险因素。对以上指标进行多因素分析发现：腹压/其他排尿方式、膀胱顺应性差、伴有OAB是NB患儿发生上尿路损害的独立危险因素（P<0.05），其中膀胱顺应性较差的NB患儿发生上尿路损害的风险是膀胱顺应性正常患儿的2.712倍（OR=2.712，95%CI：1.182~6.224）；存在腹压/其他排尿方式的NB患儿发生上尿路损害的风险是采用清洁间歇导尿患儿的2.160倍（OR=2.160，0，95%CI：1.182~6.224）；伴有OAB的患儿发生上尿路损害的风险是不伴有OAB患儿的2.265倍（OR=2.265，95%CI：1.077~4.763）。结论 膀胱顺应性差、腹压/其他排尿方式、伴有OAB是NB患儿发生上尿路损害的危险因素，在对NB患儿进行膀胱管理时应使其膀胱保持低压状态，以减轻对上尿路的损害。
Abstract:
Objective To explore the related risk factors of upper urinary tract damage in patients with neurogenic bladder (NB).Methods A total of 151 inpatients diagnosed with NB in Children’s Hospital Affiliated to Chongqing Medical University were selected as the research objects, and the patients were divided into upper urinary tract damage group and upper urinary tract normal group according to whether upper urinary tract damage occurred.The general characteristics (gender, age, length of hospital stay, course of disease, urination pattern, history of previous spinal surgery), clinical symptoms (whether frequency/urgency, dysuria, urinary incontinence, and bladder-rectal syndrome), laboratory results (urine routine, lumbosacral X-ray) and urodynamic results (bladder compliance, with or without OAB) were compared between the two groups.Multivariate Logistic regression analysis was performed on the indicators with statistically significant differences, and the risk factors for upper urinary tract damage in NB patients were screened.Results Using P<0.2 as the screening criteria for one-way ANOVA, it can be found that fever, urinary tract infection, abdominal pressure/other urination patterns, poor bladder compliance, and OAB are the risk factors for upper urinary tract damage in patients with NB. Multivariate analysis of the above indicators showed that abdominal pressure/other urination methods, poor bladder compliance, and OAB were independent risk factors for upper urinary tract damage in patients with upper urinary tract NB (P<0.05).The risk of upper urinary tract damage in patients with poor bladder compliance was 2.712 times that of patients with normal bladder compliance (OR=2.712, 95%CI:1.182-6.224); patients with abdominal pressure/other urination patterns had upper urinary tract damage The risk of CIC was 2.160 times (OR=2.160, 95%CI:1.182-6.224); the risk of upper urinary tract damage in patients with OAB was 2.265 times that of patients without OAB (OR=2.265, 95%CI:1.077-4.763).Conclusion Poor bladder compliance, abdominal pressure/other urination patterns, and OAB are risk factors for upper urinary tract damage in patients with NB.During bladder management, the bladder should be kept in a low pressure state to reduce damage to the upper urinary tract.

参考文献/References:

[1] 文建国, 李云龙, 袁继炎, 等.小儿神经源性膀胱诊断和治疗指南[J].中华小儿外科杂志, 2015, 36(3):163-169.DOI:10.3760/cma.j.issn.0253-3006.2015.03.002.Wen JG, Li YL, Yuan JY, et al.Guidelines for diagnosing and treating neurogenic bladder in children[J].Chin J Pediatr Surg, 2015, 36(3):163-169.DOI:10.3760/cma.j.issn.0253-3006.2015.03.002.
[2] Hopps CV, Kropp KA.Preservation of renal function in children with myelomeningocele managed with basic newborn evaluation and close followup[J].J Urol, 2003, 169(1):305-308.DOI:10.1097/01.ju.0000040590.35948.bc.
[3] Austin PF, Bauer SB, Bower W, et al.The standardization of terminology of lower urinary tract function in children and adolescents:Update report from the standardization committee of the International Children’s Continence Society[J].Neurourol Urodyn, 2016, 35(4):471-481.DOI:10.1002/nau.22751.
[4] 廖利民, 吴娟, 鞠彦合, 等.脊髓损伤患者泌尿系管理与临床康复指南[J].中国康复理论与实践, 2013, 19(4):301-317.DOI:10.3969/j.issn.1006-9771.2013.04.001.Liao LM, Wu J, Ju YH, et al.Guidelines for urinary system management and clinical rehabilitation of patients with spinal cord injury[J].Chin J Rehabil Theory Pract, 2013, 19(4):301-317.DOI:10.3969/j.issn.1006-9771.2013.04.001.
[5] 中华医学会小儿外科学分会泌尿外科学组.儿童原发性膀胱输尿管反流专家共识[J].临床小儿外科杂志, 2019, 18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002.Group of Pediatric Urology, Branch of Pediatric Surgery, Chinese Medical Association:Expert Consensus on Managing Primary Vesicoureteral Reflux in Children[J].J Clin Ped Sur, 2019, 18(10):811-816.DOI:10.3969/j.issn.1671-6353.2019.10.002.
[6] 罗娟, 徐加龙, 刘倩, 等.神经源性膀胱括约肌功能障碍患儿下尿路尿动力学表现的研究[J].临床小儿外科杂志, 2018, 17(7):506-509.DOI:10.3969/j.issn.1671-6353.2018.07.007.Luo J, Xu JL, Liu Q, et al.Urodynamic performance of lower urinary tract in children of neuropathic bladder sphincter dysfunction[J].J Clin Ped Sur, 2018, 17(7):506-509.DOI:10.3969/j.issn.1671-6353.2018.07.007.
[7] Frontera JE, Mollett P.Aging with spinal cord injury:an update[J].Phys Med Rehabil Clin N Am, 2017, 28(4):821-828.DOI:10.1016/j.pmr.2017.06.013.
[8] 廖利民.神经源性膀胱的治疗现状和进展[J].中国康复医学杂志, 2011, 26(3):201-205.DOI:10.3969/j.issn.1001-1242.2011.03.001.Liao LM.Current status and recent advances in the treatment of neurogenic bladder[J].Chin J Rehabil Theory Pract, 2011, 26(3):201-205.DOI:10.3969/j.issn.1001-1242.2011.03.001.
[9] D’Ancona C, Haylen B, Oelke M, et al.The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction[J].Neurourol Urodyn, 2019, 38(2):433-477.DOI:10.1002/nau.23897.
[10] 李延伟, 文一博, 何翔飞, 等.早期清洁间歇导尿在NB患者中的应用[J].中华泌尿外科杂志, 2017, 38(4):295-298.DOI:10.3760/cma.j.issn.1000-6702.2017.04.015.Li YW, Wen YB, He XF, et al.Early application of clean intermittent catheterization in children with neurogenic bladder[J].Chin J Urol, 2017, 38(4):295-298.DOI:10.3760/cma.j.issn.1000-6702.2017.04.015.
[11] 靖华芳, 廖利民, 付光, 等.脊髓损伤患者上尿路功能损害的危险因素分析——横断面研究[C].第十一届北京国际康复论坛论文集.2016:178-179.Jing HF, Liao LM, Fu G, et al.Analysis of risk factors for upper urinary tract injury in patients with spinal trauma:a cross-sectional study[C].XI Beijing International Rehabilitation Forum:Collections of Papers.2016:178-179.
[12] 张国贤, 何翔飞, 张艳, 等.NB患者清洁间歇导尿致复发性尿路感染的危险因素[J].中华实用儿科临床杂志, 2018, 33(11):812-815.DOI:10.3760/cma.j.issn.2095-428X.2018.11.004.Zhang GX, He XF, Zhang Y, et al.Risk factors for recurrent urinary tract infection in children with neurogenic bladders treated by clean intermittent catheterization[J].Chin J Appl Chin Pediatr, 2018, 33(11):812-815.DOI:10.3760/cma.j.issn.2095-428X.2018.11.004.
[13] Stein R, Bogaert G, Dogan HS, et al.EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment[J].Neurourol Urodyn, 2020, 39(1):45-57.DOI:10.1002/nau.24211.
[14] Liu JS, Dong C, Casey JT, et al.Quality of life related to urinary continence in adult spina bifida patients[J].Cent European J Urol, 2015, 68(1):61-67.DOI:10.5173/ceju.2015.01.494.
[15] 文建国, 何翔飞, 吴军卫, 等.NB伴输尿管反流的尿动力学研究[J].中华小儿外科杂志, 2016, 37(8):612-615.DOI:10.3760/cma.j.issn.0253-3006.2016.08.012.Wen JG, He XF, Wu JW, et al.Urodynamics of neurogenic bladder with vesicoureteral reflux[J].Chin J Pediatr Surg, 2016, 37(8):612-615.DOI:10.3760/cma.j.issn.0253-3006.2016.08.012.
[16] Dray EV, Cameron AP.Identifying patients with high-risk neurogenic bladder:beyond detrusor leak point pressure[J].Urol Clin North Am, 2017, 44(3):441-452.DOI:10.1016/j.ucl.2017.04.010.
[17] 刁宏旺, 李守林.诱导型一氧化氮合酶(iNOS)与NB的关系研究[J].临床小儿外科杂志, 2017, 16(6):612-616.DOI:10.3969/j.issn.1671-6353.2017.06.020.Diao HW, Li SL.Relationship between inducible nitric oxide synthase (iNOS) and neurogenic bladder[J].J Clin Ped Sur, 2017, 16(6):612-616.DOI:10.3969/j.issn.1671-6353.2017.06.020.

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备注/Memo

收稿日期:2021-08-25。
基金项目:国家儿童健康与疾病临床医学研究中心临床医学研究一般项目（NCRCCHD-2020-GP-04）
通讯作者:魏光辉,Email:u806806@cqmu.edu.cn

更新日期/Last Update: 1900-01-01