Fu Q, Fan L R, Shen Y, Zhou G J, Yi H Z, Sun N, Wang J M, Jia L Q, Wang X M, Wang H
Department of Nephrology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Chronic Kidney Disease and Blood Purification, Beijing 100045, China.
Zhonghua Er Ke Za Zhi. 2018 Jan 2;56(1):53-57. doi: 10.3760/cma.j.issn.0578-1310.2018.01.014.
To explore the prognosis and risk factors of pyelectasis in high-risk infants. This was a retrospective study. Totally 960 high-risk infants, who accepted type B ultrasonic examination for fetus at 28th week of gestation and for newborns in 48 hours after birth, were included in the study in departments of obstetrics and eonatology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital during May 2012 to April 2013. The degree of pyelectasis was classified using Grignon grade and the paients were followed up for 3 years. The factors of epidemiology, high risk pregnant women, fetus and high-risk newborns that relate to pyelectasis were summarized. High-risk factors were analyzed by using logistic multivariate regression analysis. Of 960 high-risk infants, 103 had abnormal urinary ultrasound results, 87 (9.1% of high-risk infants) were diagnosed with pyelectasis, 16 (1.7% of high-risk infants) were diagnosed with congenital anomalies of the kidney and urinary tract. According to the degree of pyelectasis, 68 infants were Grignon grade Ⅰ, male:female ratio=5.8∶1, left side:right side ratio=1.91∶1; 19 infants were Grignon grade Ⅱ, male:female ratio=5.33∶1, left side:right side ratio=2.12∶1. Postnatal follow-up results showed that pyelectasis disappeared in 48 cases (55% of pyelectasis cae), 40 infants were Grignon grade Ⅰ (59% of all Grignon grade Ⅰ patients), 8 infants were Grignon grade Ⅱ (42% of all Grignon grade Ⅱ patients); The result of risk factors analysis showed that the risk of pyelectasis in males was 4.368 times that of females (95% 2.33-8.189, 0.05); the risk of pyelectasis in low birth weight infants was 22.434 times that of non low birth weight infants (95% : 5.883-85.547, 0.05). The incidence of pyelectasis in high-risk infants was 9.1%. The mitigation rate of pyelectasis in Grignon grade Ⅰ to Ⅱ in fetal or newborn period is high. Patients in Grignon grade Ⅲ and above in fetal or new born period had high risk of congenital anomalies of the kidney and urinary tract. The risk of pyelectasis of male was higher than that of female; the risk of pyelectasis of low birth weight infant was higher than appropriate for gestational age infants.
探讨高危儿肾盂扩张的预后及危险因素。本研究为回顾性研究。选取2012年5月至2013年4月在北京儿童医院顺义妇儿医院产科及新生儿科就诊的960例高危儿，这些患儿在孕28周时接受胎儿B超检查，出生后48小时内接受新生儿B超检查。采用Grignon分级法对肾盂扩张程度进行分类，并对患儿进行3年随访。总结与肾盂扩张相关的流行病学、高危孕妇、胎儿及高危新生儿因素。采用多因素logistic回归分析高危因素。960例高危儿中，103例超声检查泌尿系统结果异常，87例（占高危儿的9.1%）诊断为肾盂扩张，16例（占高危儿的1.7%）诊断为先天性肾及泌尿系统畸形。根据肾盂扩张程度，GrignonⅠ级68例，男女比例为5.8∶1，左侧∶右侧比例为1.91∶1；GrignonⅡ级19例，男女比例为5.33∶1，左侧∶右侧比例为2.12∶1。产后随访结果显示，48例（占肾盂扩张患儿的55%）肾盂扩张消失，其中GrignonⅠ级40例（占所有GrignonⅠ级患儿的59%），GrignonⅡ级8例（占所有GrignonⅡ级患儿的42%）；危险因素分析结果显示，男性肾盂扩张风险是女性的4.368倍（95%可信区间：2.33 - 8.189，P<0.05）；低出生体重儿肾盂扩张风险是非低出生体重儿的22.434倍（95%可信区间：5.883 - 85.547，P<0.05）。高危儿肾盂扩张发生率为9.1%。胎儿期或新生儿期GrignonⅠ - Ⅱ级肾盂扩张缓解率较高。胎儿期或新生儿期GrignonⅢ级及以上患儿先天性肾及泌尿系统畸形风险高。男性肾盂扩张风险高于女性；低出生体重儿肾盂扩张风险高于适于胎龄儿。
