【摘要】 目的探讨儿童先天性肾积水(CH)早期筛查的临床意义及对其早期随访的临床价值。方法选择2019年8月1日至2020年7月31日,在中山市博爱医院产科出生,于生后7 d内接受泌尿系统超声筛查,并且临床病例资料完整的4 811例新生儿为研究对象(男性新生儿为2 566例,女性为2 245例)。对其中符合CH诊断标准者进行随访,观察CH患儿生后6个月肾积水部位及分度变化、并发症发生情况。本研究遵循的程序经中山市博爱医院伦理委员会批准(审批文号:KY-2019-002-17),与受试儿监护人均签署泌尿系统超声筛查知情同意书。结果 (1)本组4 811例受试儿中,生后7 d内新生儿泌尿系统超声筛查结果提示,先天性肾脏尿路发育异常(CAKUT)者为268例(5.6%),其中CH患儿为248例。本组CAKUT新生儿的肾积水阳性率为92.5%(248/268)。248例CH患儿中,男性患儿为164例,女性为84例;轻、中、重度肾积水患儿分别为213、19、16例。(2)本组4 811例受试儿中,产前胎儿超声筛查肾积水阳性率为2.3%(111/4 811),显著低于生后7 d内新生儿泌尿系统超声筛查阳性率(5.2%,248/4 811),并且差异有统计学意义(χ~2=99.408、P<0.001)。(3)对248例CH患儿随访至3个月时,肾积水恢复正常患儿为125例(50.4%),好转为37例(14.9%),维持原状为61例(24.6%),加重为18例(7.3%),7例发生发热性尿路感染(UTI)。(4)随访至6个月,213例轻度肾积水患儿中,170例肾积水恢复正常,4例加重;19例中度肾积水患儿中,11例恢复正常或好转;16例重度肾积水患儿中,无一例恢复正常,12例好转。15例发生发热性UTI。对本组16例重度肾积水和4例肾积水加重患儿进行磁共振泌尿系水成像(MRU)或多层螺旋CT尿路造影(CTU)检查发现,先天性肾盂输尿管连接部梗阻(UPJO)和尿道瓣膜症(PUV)分别为15、1例,无一例患儿由单侧肾积水发展为双侧。(5)6个月的随访期内,248例CH患儿中,19例(7.7%,19/248)出现发热性UTI中,男性为14例,女性为5例。16例重度肾积水患儿的发热性UTI发生率为31.2%(5/16),显著高于轻度肾积水患儿(6.6%,14/213),并且差异有统计学意义(χ~2=411.776、P<0.001)。这19例出现发热性UTI患儿中,对13例进行MCU检查,7例被确诊膀胱输尿管反流(VUR),均为轻度肾积水患儿。(6)其中12例重度肾积水患儿接受外科手术后好转,5例VUR患儿随访结束时,尚需继续预防性长期口服小剂量抗菌药物治疗。对重度肾积水、肾积水加重和发生并发症患儿进行肾小球滤过率(eGFR)等检查,均提示正常。结论生后新生儿早期泌尿系统超声筛查CH具有重要临床意义。多数轻、中度肾积水患儿于生后6个月内可自行恢复正常,重度及随访中呈加重趋势的轻、中度肾积水患儿多为因发生UPJO所致。更多还原

【Abstract】 Objective To investigate the early onset and screening implications of congenital hydronephrosis(CH) in neonates. Methods From August 1, 2019 to July 31, 2020, a total of 4 811 newborns, 2 566 boys and 2 245 girls, were born in Boai Hospital of Zhongshan. Urological ultrasound screening was performed within 7 d after birth, and children with CH who met the diagnostic criteria were followed up and observed for disease changes and complications in 6 months after birth. The procedures followed in the study were approved by the Ethics Committee of Boai Hospital of Zhongshan(approval No.KY-2019-002-17), and guardians of the subjects all signed the informed consent forms for urinary ultrasound screening. Results(1)From August 1, 2019 to July 31, 2020, 4 811 cases were born in the Department of Obstetrics and had ultrasonographic information recorded, and 268 cases(5.6%) were screened for congenital anomalies of renal urogenital development(CAKUT), of which 248 cases(92.5%) were CH.(2)Among 248 neonates with CH, 164 were boys and 84 were girls. And 213, 19, and 16 were mild, moderate, and severe cases, respectively. A total of 111 of 4 811 newborns(2.3%, 111/4 811) had CH suggested by prenatal examination, which was significantly lower than those of screening within 7 d after birth(5.2%, 248/4 811), and the difference between them was statistically significant(χ~2=99.408, P<0.001).(3) After 3 months of follow-up, 125 cases(50.4%) hydronephrosis returned to normal, 37 cases(14.9%) improved, 61 cases(24.6%) remained unchanged, 18 cases(7.3%) got worse, and 7 cases had febrile urinary tract infection(UTI).(4)After 6 months of follow-up, among 213 mild hydronephrosis children, 164 cases returned to normal, and 4 cases of renal pelvis separation became worse. Of 19 children with moderate hydronephrosis, 11 returned to normal or improved. None of the 16 cases of severe hydronephrosis returned to normal and 12 cases improved. Febrile UTI occurred in 15 cases. 16 cases of severe hydronephrosis and 4 cases of aggravated were examined by magnetic resonance urography(MRU) or computed tomography urography(CTU), and found that ureteropelvic junction obstruction(UPJO) and posterior urethral valves(PUV) were 15 cases and 1 case, respectively. None of them developed from unilateral to bilateral.(5) Febrile UTI occurred in 19 children(7.7%, 19/248), including 14 boys and 5 girls. The incidence of febrile UTI in children with severe hydronephrosis(31.2%, 5/16) was higher than that in children with mild hydronephrosis(6.6%, 14/213), and the difference was statistically significant(χ~2=411.776, P<0.001). Of the 19 children, 13 were examined by MCU, and 7 were diagnosed with VUR, all of which were mild hydronephrosis.(6) Twelve children with severe hydronephrosis improved after surgery, and five children with VUR needed preventive long-term oral administration of low-dose antibiotics. estimated glomerular filtration rate(eGFR) examination in children with severe hydronephrosis, aggravated renal pelvis separation and complications all indicated normal. Conclusions Ultrasound screening of CH in early postnatal period is of great significance. Most neonates with mild and moderate hydronephrosis return to normal within 6 months after birth, and most of them with severe and moderate hydronephrosis are pathological obstruction.更多还原