【作者】 常庆龙；

【导师】 文建国；

【作者基本信息】 郑州大学 ， 泌尿外科学， 2011， 博士

【摘要】 目的探讨2008年三聚氰胺污染奶粉导致泌尿系结石(MUS)的住院婴幼儿的临床特点与两年后对患儿肾脏与膀胱形态、功能以及对生长发育的近期影响。方法选取2008年8至11月在我院住院治疗的186例患儿,均明确诊断为三聚氰胺污染奶粉导致泌尿系结石的婴幼儿,通过写信、电话与门诊方式进行出院后第2年随访。随访内容包括血常规、尿常规、肾功能检查、泌尿系超声、病情转归、生长发育情况,同时记录患儿的体重、身高、临床症状与是否并发肾功能衰竭、泌尿系肿瘤等。选取150例同期非纯母乳喂养与无三聚氰胺污染奶粉喂养的正常儿童作为对照组(CG)。分析186例住院患儿的临床资料,把有关的参数与对照组比较。结果169例患儿随访成功,92例带石患儿出院后在院外进行保守治疗,76例随访时结石消失,1例增大,4例无明显变化,11例变小。肾功能衰竭的患儿尿量正常,肾功能完全恢复正常。患儿的血常规、尿常规、肾和膀胱的形态与功能均未见异常。随访没有发现泌尿系占位病变的发生。患儿的体重和对照组比较无显著性差异(p>0.05),患儿身高偏低的人数显著高于对照组(p<0.05),MUS患儿补钙的比例明显低于CG。患儿女性41例,男性145例,住院时年龄2-52个月,平均(13.8±9.2)个月,随访时年龄(30.4±10.2)个月。平均住院(10±4)天,临床症状全部消失,23例无明显变化,69例结石变小94例结石完全消失。34例患儿肾积水程度减轻,36例肾积水完全消失,5例没有明显变化,无一例患者死亡。三聚氰胺泌尿系结石主要以肾结石为主,68例患儿的91侧肾脏肾盂集合系统分离。三聚氰胺泌尿系结石多呈泥沙样,临床上常常多发,超声检查具有特征性表现。治疗前患儿的尿pH显著低于对照组患儿,然而,对照组、中度组和轻度组患儿的SUA、Scr与BuN和重度组患儿进行比较的话,数值明显降低。169例MUS患儿成功随访,其中包括92例带石出院的患儿。我们经过随访观察到,发生肾积水的34名婴幼儿完全痊愈,大约半年内这当中的24名患者肾积水消失,肾积水变化不明显的有1名患儿,4名肾积水婴幼儿的积水程度有所缓解。婴幼儿的肾结石有所变大者1名,1名婴幼儿出院时没有结石随访时被发现了一侧肾结石,3名婴幼儿的结石由出院时的拍片不显影成了现在拍片可以显影的结石。在内科保守治疗情况下,有88例婴幼儿的结石完全排出,大约6个月内这当中的82名婴幼儿的结石被排出。全部患儿的实验室检查(包括血、尿常规与肾功能)结果在正常范围内,我们没有发现婴幼儿泌尿系统发生肿瘤。患儿的体重和对照组婴幼儿进行统计学比较没有明显差异,对照组婴幼儿身高偏高的人数明显多于患儿组。结论三聚氰胺可以导致婴幼儿产生泌尿系结石,2岁以内为患儿发病高峰年龄,常常喂养6～12个月后发现该病,泌尿系结石以上尿路为主,肾结石多见。结石多呈泥沙样,结石一般多发。临床症状常常不明显,非手术内科保守治疗效果非常好。三聚氰胺与尿酸是三聚氰胺结石的主要成分。在内科保守治疗的情况下,半年左右,婴幼儿的结石可以排出,肾积水可以消失。但是,一些三聚氰胺结石可以转化为X线不透光结石。2年后随访,我们没有发现三聚氰胺污染奶粉导致泌尿系结构、功能异常变化与肿瘤的发生和对患儿的生长发育产生明显不良影响。更多还原

【Abstract】 Objective To investigate hospitalized infants and children with urinary calculi (MUS)induced by melamine contamination milk the clinical characteristics in 2008 and immediate impact on form and function of kidney and bladder and on the growth and development of infants after two years.Methods 186 cases of children were Selected and diagnosed with urinary calculi caused by melamine tainted milk powder in First Affiliated Hospital of Zhengzhou University from August to November,2008, following-up by letter, telephone and outpatient after 2 years. Follow-up including tests of blood, urine, renal function, urinary tract ultrasound, disease outcome, growth and development, recording children’s weight, height, the clinical symptoms and complications of acute renal failure and urinary tract tumors. Selecting 150 cases of normal children as controls (CG) fed non-exclusive breastfeeding with no melamine contaminated milk powder in the same period. Analysising clinical data of 186 hospitalized patients and comparing the relevant parameters with the control group. Results 169 cases of children followed up successfully, and 92 cases of children with stones were treated conservatively outside the hospital, the stone of 76 patients disappeared when follow-up, and 1 case increased, no significant changes in 4 cases,11 cases smaller. Output of urine and renal function of children with renal failure returned to normal level. Tests of children’s blood, urine, form and function of kidney and bladder were normal. Follow-up found no incidence of urinary tract lesions. Threre was no significant difference (p> 0.05)in weight between patients and control group. The comparison showed the number of patients with low height increased significantly (p<0.05), and the number of infants with calcium in CG was greatly higher than in MUS.41 cases of female children, male 145 cases, at the age of 2-52 months in hospital, mean (13.8±9.2) months, the age (30.4±10.2) months of follow-up.The average hospital staying (10±4) days, all clinical symptoms disappeared, no significant changes in 23 patients,69 patients with smaller stones, stones of 94 cases disappeared completely.The degree of hydronephrosis in 34 cases reduced. Hydronephrosis in 36 cases disappeared and did not change significantly in 5 patients, with no patients died. Urinary Stones Melamine based mainly in kidney, and there were separations of 91 sides of the renal pelvis collecting system in 68 cases. Mostly Urinary Stones Melamines were sediment and often multiple, and ultrasound has the characteristic performance. pH of urinary in patients was significantly lower than the control group before treatment and BUN, Scr, SUA in the control group, moderate group and mild group were greatly lower than in severe group.169 cases of MUS children with successful follow-up, including 92 cases of children with a stone.Stones in 88 patients followed up disappeared without surgical intervention, and stones in 82 cases were resolved within six months, and stones in 3 patients tured into opaque stones,1 case of kidney stones increased, and the stone discovery of new generation of unilateral kidney in 1 case.34 cases of hydronephrosis disappeared, of which 24 cases occurred within six months, and 4 reduced, no significant change in 1 case. Urinary tract tumor no found, tests of urine, blood and kidney function showed no obvious abnormalities. The number of patients with low height increased significantly (p<0.05), but body weight compared with the control group, no significant difference (p> 0.05). Conclusions Feeding of infants and children with melamine contaminated milk can lead to urinary calculi, the peak age of onset in 2 years, the disease found often after 6 to 12 months, kidney stones more common,mostly stones muddy and usually multiple. Clinical symptoms are often not obvious, and a conservative non-surgical medical treatment was very good. Melamine melamine and uric acid are the main ingredients of stones.Through conservative treatment, stones can be discharged in about six months,and hydronephrosis can disappear. However, some melamine stones can be turned into X-opaque stones. After 2 years follow-up, we found no abnormal changes of structure and function in urinary tract and tumor and significant adverse effects on growth and development of children because of melamine contaminated milk powder.更多还原