神经源性膀胱患儿清洁间歇导尿致复发性尿路感染的危险因素

摘要

Objective To identify the risk factors associated with recurrent urinary tract infection (RUTI) in children with neurogenic bladders (NB) who received clean intermittent catheterization (CIC) in order to provide recommendations for reducing the risk of RUTI.Methods Records of 184 children with NB managed by CIC at the Department of Urology Surgery,the First Affiliated Hospital of Zhengzhou University from July 2011 to September 2015 were reviewed and analyzed.According to UTI incidence,they were divided into 2 groups as occasional UTI group (0-1 time/year,OUTI group) and RUTI group (＞ 1 time/year).The clinical and urodynamic data were compared between 2 groups,and the risk factors were identified by regression analysis.Results Of the total patients,147 patients (79.9％) were diagnosed as OUTI and 37 cases (20.1％) as RUTI.Median follow-up lasted for average 27 months (12-39 months).The characteristics of RUTI group was indicated significantly in the study,which included increasing age(7.4 years old vs.5.9 years old),a higher level of spinal lesions,and more vesicoureteral reflux(VUR),and there were significant differences in bladder wall thickness(4.7 cm vs.3.6 cm) and lower bladder compliance compared with RUTI group (all P ＜ 0.05).But there was no statistical significance in gender,antibiotics,hydronephrosis,incontinence,bladder capacity,detrusor overactivity,detrusor sphincter dyssynergia and detrusor leakage point pressure between 2 groups (all P ＞ 0.05).Increasing age,increased bladder wall thickness,lower bladder com-pliance and the presence of VUR were independent risk factors associated with RUTI group (all P ＜ 0.05).Conclusions Increasing age,increasing bladder wall thickness,lower bladder compliance and VUR are the risk factors for RUTI in NB children managed with CIC.It is necessary to follow up video-urodynamic and ultrasound findings in order to identify the high-risk patients and provide the evidence for preventing RUTI.%目的 探讨神经源性膀胱(NB)患儿清洁间歇导尿(CIC)后出现复发性尿路感染(RUTI)的相关危险因素,为临床降低RUTI提供参考.方法 对2011年7月至2015年9月在郑州大学第一附属医院泌尿外科门诊接受CIC的NB患儿184例随访资料进行分析.根据UTI发生频率把患儿分为偶发性UTI(OUTI)组(0～1次/年)和RUTI组(＞1次/年),对2组患儿临床表现和尿动力检查结果进行比较,通过回归分析鉴定相关危险因素.结果 OUTI组患儿147例(79.9％),RUTI组37例(20.1％),平均随访27个月(12 ～ 39个月).RUTI组较OUTI组患儿年龄大(7.4岁比5.9岁)、脊髓受损水平面高、膀胱输尿管反流(VUR)更多见、膀胱壁厚度增加(4.7 cm比3.6 cm)、膀胱顺应性减小,2组比较差异均有统计学意义(均P＜0.05);2组患儿性别、预防性抗生素应用、肾积水、尿失禁、膀胱容量、逼尿肌过度活跃、逼尿肌括约肌协同失调和逼尿肌漏尿点压比较差异均无统计学意义(均P＞0.05).年龄较大、膀胱壁厚度增加、膀胱顺应性减小和存在VUR是RUTI风险增加的独立预测因素(均P＜0.05).结论 年龄较大、膀胱壁厚度增加、膀胱顺应性减小和存在VUR是NB患儿行CIC治疗发生RUTI的危险因素.行CIC治疗的NB患儿定期进行影像尿动力学和超声检查很有必要,有利于发现RUTI的危险因素,为采取预防RUTI提供参考.