妊娠合并急性肾盂肾炎的临床特点及影响因素研究

摘要

目的：了解妊娠合并急性肾盂肾炎的临床特点，并探讨其影响因素。方法以2010年8月—2014年8月在宁波市第一医院就诊的182例妊娠期急性肾盂肾炎患者为观察组，以同时期在该院就诊但未合并感染性疾病的164例妊娠期妇女为对照组。通过查阅电子病历的方法，收集两组患者临床资料，包括年龄、职业、文化程度、妊娠分期、合并症、实验室检查指标；同时收集观察组患者的临床表现、超声检查结果、治疗与转归情况。结果（1）观察组182例患者均有畏寒发热、寒战、头痛、全身酸痛等感染中毒症状，伴腰痛的患者数为135例（占74.2％），无尿路刺激症状的患者数为97例（占53.3％）；116例（占63.7％）患者的血红蛋白（ Hb）≤110 g/L；所有患者的尿常规检查均呈白细胞阳性；9例（占4.9％）患者的血培养呈阳性，其中大肠埃希菌6株（占66.7％）；41例（占22.5％）患者的尿培养呈阳性，其中大肠埃希菌19株（占46.3％）；85例（占46.7％）患者合并肾积水；86例（占47.2％）患者采用头孢曲松进行抗感染治疗，完成随访的175例患者均治愈。（2）两组平均年龄、职业、文化程度、妊娠分期、合并症、Hb、清蛋白（Alb）比较，差异有统计学意义（P﹤0.05）；而血肌酐（SCr）和总胆固醇（TC）比较，差异无统计学意义（P﹥0.05）。Logistic回归分析显示，年龄、妊娠分期、合并症及Alb对妊娠合并急性肾盂肾炎的影响有统计学意义（P﹤0.05）。结论妊娠合并急性肾盂肾炎的起病较急，多伴高热和腰痛症状，半数以上患者无尿路刺激症状，致病菌主要为大肠埃希菌，头孢曲松等三代头孢菌素、半合成广谱青霉素、碳青霉烯类药物的治疗效果较好，治愈率较高。年龄、妊娠分期、合并症及Alb是妊娠合并急性肾盂肾炎的影响因素。%Objective To investigate the clinical features and risk factors of acute pyelonephritis during pregnancy. Methods We included 182 patients with acute pyelonephritis during pregnancy who received treatment in the First Hospital of Ningbo from August 2010 to August 2014 as observation group,and we included 164 pregnant women who received treatment in the hospital in the same period but had no complications of infectious diseases as control group. Through the review of electronic medical records,we collected clinical data of the subjects,including age,occupation,education level,staging of gestation,complications and laboratory indicators. And data about clinical symptoms,ultrasound examination results,treatment and outcomes were also collected. Results (1) In observation group,all the 182 patients had intolerance of cold,fever, shiver,headache,sore feeling all over the body and other infectious and toxic symptoms,among which 135(74. 2%)patients were complicated with loin pain and 97(53. 3%)patients had no urinary irritation symptoms;116(63. 7%)patients had hemoglobin(Hb)≤110 g/L;all patients showed positive in white blood cells by routine urine examination;9(4. 9%) patients showed positive in blood culture, among which escherichia coli was found in 6 ( 66. 7%) patients;41 ( 22. 5%) patients showed positive in urine culture,among which escherichia coli was found in 19(46. 3%)patients;85(46. 7%) patients were complicated with hydronephrosis;86(47. 2%)patients took ceftriaxone in anti-infection treatment,and the 175 patients who completed follow - up were all cured. ( 2 ) The two groups were significantly different ( P ﹤ 0. 05 ) in age, occupation,education level,staging of gestation,complications,Hb and Alb;the two groups were not significantly different (P﹥0. 05)in SCr and TC. The logistic regression analysis showed that age,staging of gestation,complications and Alb had significant influence on acute pyelonephritis during pregnancy(P﹤0. 05). Conclusion Acute pyelonephritis during pregnancy usually has a sudden onset with fever and loin pain. More than half of the patients have no urinary irritation symptoms. The major pathological bacterium is escherichia coli. Ceftriaxone and other third generation cephalosporins,semisynthetic broad-spectrum penicillin and carbapenems are effective and have high cure rate. Age,staging of gestation,complications and Alb are influencing factors for acute pyelonephritis during pregnancy.