学龄期儿童不典型泌尿道感染的临床特点研究

摘要

目的 探讨学龄期儿童不典型泌尿道感染(UTI)的临床特点,为及时确诊和改善患儿预后提供参考.方法 选取2011-2016年在中国人民解放军第八一医院住院并确诊的UTI患儿81例.根据患儿是否存在UTI典型症状,将纳入患儿分为典型组和不典型组.通过查阅病历的方法,收集两组患儿的临床资料,包括性别、年龄、临床症状、辅助检查结果、并存病、诊断、治疗及预后.结果 81例患儿中,典型组45例(55.6％),不典型组36例(44.4％).两组患儿性别、年龄比较,差异均无统计学意义(P＞0.05).不典型UTI临床症状中,两组患儿腹痛、呕吐、外阴瘙痒、内裤上有异常分泌物发生率比较,差异均有统计学意义(P＜0.05);两组患儿发热发生率比较,差异无统计学意义(P＞0.05).两组患儿入院时白细胞尿、血尿及蛋白尿发生率,白细胞计数、C反应蛋白、尿素氮及血肌酐水平比较,差异均无统计学意义(P＞0.05).两组患儿尿细菌培养结果显示均以大肠埃希菌为主要致病菌,两组菌种总体分布比较,差异无统计学意义(P＞0.05);两组对头孢他啶、头孢曲松、哌拉西林钠他唑巴坦钠、氨曲南的敏感率比较,差异均无统计学意义(P＞0.05).典型组被误诊的患儿例数为0例;不典型组最初被误诊的患儿例数为10例(27.8％),两组误诊率比较,差异有统计学意义(P＜0.05).结论 学龄期儿童不典型UTI临床上并不罕见,腹痛、呕吐、外阴瘙痒及内裤上有异常分泌物发生率及误诊率更高.临床医生应提高对不典型UTI临床特点的认识,减少误诊.%Objective To investigate the clinical features of atypical urinary tract infection (UTI) in school-age children,in order to provide a reference for timely diagnosis and improvement of the prognosis of the disease.Methods Eighty-one school-age children who were diagnosed as UTI and received inpatient treatment in The 81st Hospital of PLA from 2011 to 2016 were enrolled and divided into typical group and atypical group based on whether they had typical UTI symptoms or not.Through reviewing the medical records,we collected the clinical data of the two groups,including sex,age,clinical symptoms,auxiliary examination results,comorbidity,diagnosis,treatment and prognosis.Results In the participants,the prevalence of typical UTI symptoms was higher than that of atypical UTI symptoms [55.6％ (45/81) vs 44.4％ (36/81)].Patients with typical UTI symptoms and those without had no significant differences in male to female ratio and age distribution (P ＞0.05).The incidence of atypical UTI symptoms (abdominal pain,vomiting,vulvar itching,abnormal discharge on the underpants) differed significantly between the typical group and atypical group (P ＜ 0.05),but the incidence of fever,prevalence of leukocyturia,hematuria and albuminuria,levels of white blood cell count,C-reactive protein,urea nitrogen and serum creatinine detected on admission,main pathogenic bacteria (Escherichia coli) and overall distribution of the pathogenic species,sensitivity to ceftazidime,ceftriaxone,tazobactam sodium and aztreonam showed by urine culture results did not (P ＞ 0.05).Furthermore,patients with atypical UTI symptoms were more likely to be misdiagnosed compared with those with atypical UTI symptoms [27.8％ (10/36) vs 0] (P ＜ 0.05).Conclusion Atypical urinary tract infections in school-age children is not uncommon.These patients have increased rates of abdominal pain,vomiting,vulvar itching,abnormal discharge on the underpants and misdiagnosis.Therefore,clinicians should improve their understanding of the clinical features of atypical UTI in order to reduce the rate of misdiagnosis.