儿童急性肾盂肾炎临床及预后分析

摘要

目的 分析儿童急性肾盂肾炎的临床特点及预后转归.方法 选择2009年1月-2010年12月在温州医学院附属第二医院育英儿童医院肾内科诊断为急性肾盂肾炎的患儿共230例,分析其临床特征、病原学、细菌耐药情况及预后,并采用Logistic回归分析儿童急性肾盂肾炎后肾疤痕形成的危险因素.结果 230例急性肾盂肾炎患儿中,男性93例,女性137例,男女比1∶1.47,其中＜1岁99例,男女比为1.30∶1；1～5岁75例,男女比为1∶2.75；＞5岁56例,男女比为1∶2.29.在230例APN患儿中,共检出病原菌106株,其中革兰阴性菌91株,革兰阳性菌13株,真菌2株；居前3位病原菌分别为大肠埃希菌65株(61.32％),肺炎克雷伯杆菌13株(12.6％)和屎肠球菌9株(8.49％).65株大肠埃希菌产ESBLs有44株,均对氨苄西林耐药,对头孢菌素及复方磺胺甲噁唑、氨曲南等中等耐药,而对阿米卡星、阿莫西林/克拉维酸、呋喃妥因、亚胺培南等敏感.52例患儿于出院后6-12月进行双肾发射单光子计算机断层(ECT)复查,其中31例有肾疤痕形成(59.62％),21例好转(40.38％).泌尿系统畸形或膀胱输尿管返流是儿童急性肾盂肾炎肾疤痕形成的独立危险因素(OR值6.89,P＜0.05).结论 儿童急性肾盂肾炎的发病率随年龄的增加而逐渐下降,≤1岁以男性患儿为主,而＞1岁则好发于女性.大肠埃希菌仍是主要的致病菌,且存在着多重耐药.伴有泌尿系统畸形或膀胱输尿管返流的急性肾盂肾炎患儿更易有肾疤痕形成.%Objective To analyze the clinical characteristics and prognosis of acute pyelonephritis (APN) in children.Methods A retrospective analysis was performed in 230 pediatric patients with APN admitted from January 2009 to December 2010.The clinical characteristics,etiology,drug-resistant and prognosis were reviewed,and logistic regression analysis was performed to identify the risk factors of renal scarring after APN.Results Among 230 patients with APN,93 were boys and 137 were girls with a malefemale ratio of 1∶ 1.47.Ninety-nine patients were younger than 1 year with a male-female ratio of 1.30∶1 ;75 patients were 1 to 5 year with a male-female ratioof 1 ∶ 2.75 ; 56 patients were older than 5 year with a male-female ratio of 1∶2.29.A total of 106 strains were detected,in which 91 strains were Gram-negative bacteria,13 strains were Gram-positive bacteria and 2 strains were fungus.The most frequent bacteria were Escherichia coli (65 strains,61.32％),Klebsiella pneumonia (13 strains,12.6％) and Enterococcus faecium (9 strains,8.49％).Forty-four strains of Escherichia coli produced ESBLs,and all of them were resistant to ampicillin,part of them resistant to cephalosporin,compound sulfamethoxazole and aztreonam,but all were sensitive to amikacin,amoxicillin/clavulanic acid,nitrofurantoin,and imipenem.Renal emission computed tomography (ECT) was performed again in 52 children who were followed up for 6-12 months,in which 31 cases (59.62％) developed renal scar,and 21 cases (40.38％) were recovered.Abnormalities in urinary system or vesicoureteric reflux were identified as the risk factors for renal scarring after APN (OR =6.89,P ＜ 0.05).Conclusions The incidence of APN in children drops with age,which is frequently in the males younger than 1 year,and in the females older than 1 year.Escherichia coli is the most frequent pathogen of APN in children,and most strains are multidrug resistant.Children with abnormalities in urinary system or vesicoureteric reflux are prone to develop renal scarring.