与食用受三聚氰胺污染配方奶粉相关儿童泌尿系统结石的现况调查

摘要

Objective To investigate the relationship between melamine-contaminated powdered formula and urolithiasis of children in China. Methods We administered a questionnaire including sex, age, melamine content, physical examination, urinalysis, ultrasonography in urinary system, renal function, liver function, blood, urinary tests for biochemical markers and so on to the doctors and parents of children aged from 0 to 14 years who were screened for a history of exposure to melamine-contamin atedpowdered formula- Symptoms and possible predisposing factors of urinary tract stones were collected as well. Melamine-contaminated contaminated powdered formula, the children were divided into two groups, more than 30 days group and less than 30 days group. The morbidity of urolithiasis was analyzed in different melamine content and different feeding period children including less than 1 year old, -2 years old, -3 years old, -6 years old and -14 years old. The clinical symptoms, laboratory results and recovery rate were also analyzed. SPSS 11.5 was used for statistical analysis. Results 22 091 children were screened and urinary stones were found in 374 children,including 223 boys and 151 girls(P <0. 001 ). The high melamine content group had a higher morbidity of urinary tract stones than the low melamine content group in children less than 3 years old children( P <0. 001 ). Similar tread was seen in children aged 3 to 6 years old children(P <0. 05), but no difference in children aged from 6 to 14 years old children(P > 0. 05 ). Within the high melamine content group, the morbidity of urinary tract stones was similar with each other at different ages (P > 0. 05 ). Within the low melamine content group, the morbidity of urinary tract stones was also similar with each other at different ages( P >0. 05 ) except for children aged less than 12 months and 12 to 24 months old children( P > 0.05 ). Among the total of 374 cases that were found urinary tract stones,369 were kidney stenes(309 in one side and 60 in both sides) ,8 w ere ureterstones(6 in one side and 2 in both sides) ,4 were cystolith and 2 were urethral calculus. 93 patients were admitted to the ho spital,of them 8 cases had hematuria (8. 6% ), 7 cases had leukocyturia, 3 cases had proteinuria (3.2%), 5 cases had crying on urination (5.4%), 2 cases had edema (2. 2% ) . Laboratory tests:2S eases had elevated blood β<,2>-MG (26. 9% ), 4 had elevated urineβ<,2>-MG(4. 3% ) , 2 had elevated serum creatinine and urea nitrogen(2. 2% ). There was no patient with elevated levels of CK-MB and ALT. 9 of the 93 patients received surgical treatment. 34 patients were cured, 55 got better, and 2 were unrecovered. Conclusions Melamine-contaminated powdered formula was associated with urinary tract stones in children. The morbidity of urolithiasis might not be associated with age. The urolithiasis was prohable harmful to kidney function.%目的 探讨食用受三聚氰胺污染配方奶粉与儿童泌尿系统结石发生的关系.方法 对0～14岁食用受三聚氰胺污染配方奶粉的儿童,通过其家长填写调查问卷、临床问诊、体格检查、尿常规、泌尿系统B超、肾功能、肝功能及其他血、尿生化指标等检查,筛查是否存在泌尿系统结石及其他损害.将受三聚氰胺污染的配方奶粉分为三聚氰胺高含量组和三聚氰胺低含量组,将食用受三聚氰胺污染配方奶粉的时间分为≤30 d和>30 d,依据年龄分为≤1岁、～2岁、～3岁、～6岁和～14岁组.分析性别、年龄、配方奶粉中不同三聚氰胺含量和用奶时间对泌尿系统结石发生的影响.分析泌尿系统结石患儿的临床表现、实验室检查结果及病情转归.结果 接受筛查儿童22 091名,患泌尿系统结石374名,其中男性223名,女性151名,男:女约为1.5∶1.①泌尿系统结石发生率:≤3岁各年龄组,三聚氰胺高含量组均高于三聚氰胺低含量组(P<0.001);～6岁组,三聚氰胺高含量组高于三聚氰胺低含量组(P<0.05);～14岁组,三聚氰胺高含量组与三聚氰胺低含量组差异无统计学意义(P>0.05).三聚氰胺高含量组各相邻年龄组儿童泌尿系统结石发生率差异均无统计学意义(P>0.05);三聚氰胺低含量组除≤1岁组与～2岁组泌尿系统结石发生率差异有统计学意义外(P<0.05),其余各相邻年龄组差异均无统计学意义(P>0.05).②单侧肾结石309例,双侧肾结石60例,单侧输尿管结石6例,双侧输尿管结石2例,膀胱结石4例,尿道结石2例.③93例住院治疗的泌尿系统结石患儿中,血尿8例(8.6%)、脓尿7例(7.5%)、蛋白尿3例(3.2%)、尿痛或尿哭5例(5.4%)、少尿或无尿2例(2.2%)、水肿2例(2.2%)、血β<,2>-微球蛋白(β<,2>-MG)增高25例(26.9%)、尿β<,2>-MG增高4例(4.3%);BUN和SCr增高各2例(2.2%),均无磷酸激酶同工酶和ALT升高.9例需外科治疗,其余内科保守治疗.治愈34例,好转55例,未愈2例,自动出院或转院2例.结论 食用受三聚氰胺污染配方奶粉与儿童泌尿系统结石的发生有关,泌尿系统结石发生可能与年龄无关,与食用受三聚氰胺污染配方奶粉相关的泌尿系统结石可能对肾脏有一定损害.