小儿神经源性膀胱伴膀胱输尿管反流临床特点分析

Clinical features of neurogenic bladder with vesicoureteral reflux in children

摘要:

目的 探讨神经源性膀胱（NB）患儿伴膀胱输尿管反流（VUR）的临床特征，为其临床早期诊断及治疗提供参考依据。方法 收集2014年1月至2019年12月于儿童肾内科收治并诊断为NB伴尿路感染的26例患儿的临床资料，根据有无VUR分为反流组（11例）与无反流组（15例），分析比较两组的临床特点。结果 相比无反流组，反流组患儿更易出现非大肠杆菌性尿路感染、肾积水（反流等级越高肾积水越严重）、锝[^99mTc]二巯丁二酸肾脏核素扫描异常（P < 0.05）。反流组患儿尿白蛋白/肌酐、尿IgG/肌酐、尿转铁蛋白/肌酐高于无反流组（P < 0.05）。与无反流组比较，反流组患儿残余尿量增多，逼尿肌漏尿点压力升高（P < 0.05）。结论 当NB患儿出现非大肠杆菌性尿路感染、肾积水、锝[^99mTc]二巯丁二酸肾脏核素扫描异常、肾小球性蛋白尿、膀胱残余尿增多及逼尿肌漏尿点压力升高等临床表现时，患儿可能已出现VUR，应及早明确诊断与干预治疗。

Abstract:

Objective To study the clinical features of vesicoureteral reflux(VUR)in children with neurogenic bladder(NB),and to provide a reference for its early diagnosis and treatment.Methods Clinical data were collected from 26 children with NB and urinary tract infection who were admitted to the Department of Pediatric Nephrology from January 2014 to December 2019.According to the presence or absence of VUR,the children were divided into a VUR group with 11 children and a non-VUR group with 15 children.Clinical features were compared between the two groups.Results Compared with the non-VUR group,the VUR group had a significantly higher proportion of children with non-Escherichia coli urinary tract infection,hydronephrosis(the severity of hydronephrosis increased with the grade of VUR),abnormal ^99mTc-DMSA renal scanning findings,elevated ratios of urinary albumin,urinary IgG and urinary transferrin to creatinine,increased residual urine volume,and increased detrusor leak point pressure(P<0.05).Conclusions When NB children have the clinical manifestations of non-Escherichia coli urinary tract infection,hydronephrosis,abnormal ^99mTc-DMSA renal scanning findings,glomerular proteinuria,increased bladder residual urine volume,and high detrusor leak point pressure,such children may already have VUR,and so diagnosis and intervention should be performed as early as possible.