53例无症状小儿肾结石随访和预后分析

Follow-up and prognosis analysis of 53 asymptomatic children with renal calculi

摘要:

目的：评估无症状小儿肾结石的中远期预后。方法：以我院泌尿系统超声筛查发现的75例无症状小儿肾结石为研究对象，其中三聚氰胺相关肾结石（melamine-associated renal calculi，MARC）37例，非三聚氰胺肾结石（non melamine-associated re－nal calculi，NMARC）38例。随访28～45月（平均41月），通过泌尿系统超声和尿常规检查进行评估。结果：随访患儿53例，其中MARC患儿34例，NMARC患儿19例；结石自发排出率为58.49%（31/53）。婴幼儿，直径≤5 mm结石最易自发排出；而3岁以上，直径≥10 mm的结石自发排出率较低（P=0.003，P=0.000）。尿常规显示，41月后总体异常检出率为15.38%明显低于初诊时41.03%（P=0.010）；其中MARC患儿蛋白尿全部消失，其缓解率高于NMARC患儿（P=0.030）。结论：41月后无症状小儿肾结石自发排出率较高，结石直径和发病年龄是影响其排出的主要因素；总体预后良好，MARC患儿预后比NMARC相对较好；其长期预后尚需继续随访。

Abstract:

Objective：To evaluate the prognosis of asymptomatic children with renal stones. Methods：Totally 75 asymptomatic children with renal stones were followed up for 28-45 moths averaged 41 months after the initial diagnosis，including 37 melamine-associated renal calculi（MARC） children and 38 non melamine-associated renal calculi（NMARC） children. Urinary system ultrasound and uri－nalysis were examined at the end of follow-up. Results：Follow-up was completed in 53 children（34 MARC children and 19 NMARC children） and renal calculi were excreted in 31 children（58.49%）. Spontaneous discharge occurred more often in infants and in chil－dren with stone of diameter no than 5 mm，while unlikely occurred in children aged older than 3-year-old and in children with stone of diameter larger than 10 mm（P=0.003，P=0.000）. At the end of follow-up，urinalysis showed that the total abnormal rate（15.38%） at 41 months after the initial diagnosis was lower than that（41.03%） at initial diagnosis，with statistically significant differences（P=0.010）. No MARC child had proteinuria，significantly better than that of NMARC children（P=0.030）. Conclusions：Most asymptomatic children with renal calculi discharged spontaneously at the end of follow-up. Stone size and suffering age are two risk factors of dis－charge. Overall prognosis is fine and prognosis of MARC children is superior to that of NMARC. Long term prognosis of NMARC children needs further follow-up.