儿童尿路感染的临床分析与治疗

目的 分析我院147例泌尿系感染住院患儿的临床及治疗情况,并结合国内外新的研究进展,为临床诊治提供参考依据。方法 应用描述性方法对我院2016年5月至2020年5月住院的147例泌尿系感染病例进行回顾性分析。结果 147例患儿中,男性88例(59.86%)。婴儿期人数最多,共63例(42.86%)。尿培养中以屎肠球菌及大肠埃希菌多见。治疗上有136例(92.52%)选用头孢菌素类抗生素,其中三代头孢有132例(89.80%);45例行排泄性膀胱输尿管造影的患儿中有22例(48.89%)存在膀胱输尿管返流。结论 泌尿系感染是儿童的常见病,由于它与泌尿系畸形特别是膀胱输尿管返流密切相关,易导致感染反复,因此早期诊治并寻找其潜在的畸形,可预防复发,改善预后。     

Xanthogranulomatous Pyelonephritis: A Clinical Analysis

Xanthogranulomatous pyelonephritis (XGP) is an inflammatory form of chronic renal disease with the characteristics of pyelonephritis. It is associated with staghorn nephrolithiasis, kidney tissue damage, renal function loss, and a nonfunctional kidney. XGP can be confused with neoplastic or inflammatory renal conditions due to its indistinguishable imaging and its vague clinical presentation. The treatment of choice is nephrectomy. Only a few cases of XGP have been treated medically. XGP should be managed by urology and nephrology providers. The nurse practitioner should refer patients with recurrent or persistent urinary tract infections, renal stones, staghorn calculi, or pyelonephritis to nephrology and urology specialists for further evaluation and management.     

尿中性粒细胞明胶酶相关脂质运载蛋白对儿童急性肾盂肾炎诊断价值的探讨

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对儿童急性肾盂肾炎（APN）的诊断价值。方法 研究对象为 2016 年 12 月—2017 年 5 月收治的尿路感染（UTI）患儿 104 例,包括急性肾盂肾炎 61 例（APN 组）及下尿路感染 43 例（非 APN 组）,均检测血清 β2 微球蛋白（β2-MG）、胱抑素 C（CysC）、C 反应蛋白（CRP）、降钙素原（PCT）和尿 NGAL 的水平,对比 2 组各指标的水平,并进行统计学分析;采用受试者工作特征（ROC）曲线分析各指标对 APN 的诊断价值。结果 APN 组血 CRP、PCT、β2-MG 及尿 NGAL 的水平均高于非 APN 组,差异有统计学意义（P＜0.05）;血 CysC 水平差异无统计学意义。血 CRP、PCT 及尿 NGAL 诊断儿童 APN 的 ROC 曲线下面积（AUC）分别为 0.838、0.898、0.963;血 CRP 最佳临界值为 22.6 mg/L 时,敏感度为 75.4%,特异度为 83.7%;PCT 最佳临界值为 0.285 μg/L 时,敏感度为 77.0%,特异度为 93.0%;当尿 NGAL 最佳临界值为 473 μg/L 时,敏感度为 82.0%,特异度为97.7%。结论 尿 NGAL 对儿童 APN 具有诊断价值,有助于临床对儿童 APN 的早期识别。     

杞菊地黄丸联合环丙沙星治疗慢性肾盂肾炎的疗效观察

目的探讨杞菊地黄丸联合环丙沙星治疗慢性肾盂肾炎的临床效果。方法选取日照市妇幼保健院在2015年12月—2016年12月收治的慢性肾盂肾炎患者141例,随机分成对照组(70例)和治疗组(71例)。对照组患者口服盐酸环丙沙星片,1片/1次,3次/d;治疗组在对照组的基础上口服杞菊地黄丸,8丸/次,3次/d。所有患者均经过规律治疗4周。观察两组患者临床疗效,比较治疗前后两组患者主要症状积分、肾功能指标和不良反应情况。结果治疗后,对照组患者临床总有效率为85.71%明显低于治疗组的98.59%,停药半年内对照组和治疗组的重新感染率分别为12.86%、2.82%,两组比较差异具有统计学意义(P0.05)。治疗后,两组主要症状积分明显降低(P0.05);且治疗组积分明显低于对照组(P0.05)。治疗后,两组患者的血清肌酐、血尿素氮和尿微量白蛋白水平均显著降低(P0.05);且治疗组患者肾功能指标水平明显低于对照组(P0.05)。治疗期间,治疗组患者不良反应发生率为4.23%,明显低于对照组患者的17.14%,两组比较差异具有统计学意义(P0.05)。结论杞菊地黄丸联合环丙沙星治疗慢性肾盂肾炎疗效显著,可降低停药半年内重新感染率,具有一定的临床推广应用价值。     

急性肾盂肾炎应用左氧氟沙星的临床干预效果分析

目的：观察急性肾盂肾炎应用左氧氟沙星的临床干预效果。方法将我院2010年4月~2013年11月确诊并收治的110例急性肾盂肾炎患者随机分为临床组和参照组各55例。临床组应用左氧氟沙星静脉滴注进而口服治疗,参照组应用氨苄青霉素静脉滴注治疗进而用磺胺甲恶唑口服治疗。比照两组症状体征消失时间、临床疗效及治疗时间。结果两组用药完成后,症状体征逐渐改善,临床组其症状体征消失速度均显著好于参照组,差异有统计学意义（P＜0.05）。临床组总有效率为98.18%,参照组为96.36%,两组比较差异无统计学意义（P＞0.05）。但临床组其平均治疗时长显著低于参照组,差异有统计学意义（P＜0.05）。临床组1例发生恶心、呕吐,1例头晕,1例皮肤瘙痒;参照组4例发生恶心、呕吐。两组相比不良反应率差异无统计学意义（P＞0.05）。结论急性肾盂肾炎应用左氧氟沙星疗效确切,迅速缓解症状体征、疗程短、安全性好。     

Urinary endometriosis: MR Imaging appearance with surgical and histological correlations

ObjectivesThe goals of the study were to describe the MR imaging features of endometriosis of the urinary tract and identify those that suggest intrinsic involvement of ureteric wall.Materials and methodsThirty-five women with proven urinary tract endometriosis and who had preoperative MR imaging between 2001 and 2011 were included retrospectively. MR images were intrepreted by one junior and one senior radiologists. To characterize the intrinsic parietal involvement, the ureteric circumference involved by the lesion of endometriosis was noted.ResultsThirty-eight ureteric and 13 bladder lesions were analyzed. They were found in association in nine women. Ureteric lesions were bilateral in seven women. Of the 38 ureteric lesions, 27 were extrinsic and 11 intrinsic at histopathological analysis. Sixteen women with extrinsic lesions and 10 with intrinsic ones were correctly identified on MR imaging. When the ureter was included less than 360° in the lesion, extrinsic involvement was confirmed in 80% of cases.ConclusionMR imaging appears to be more sensitive (91%vs 82%) but less specific (59% vs 67%) than surgery for the diagnosis of intrinsic form of ureteric location.     

Urinary tract infections in children

Urinary tract infection (UTI) is a common bacterial infection that can affect infants and children. The severity of illness depends on microbial virulence and host susceptibility.It has a number of different ways to manifest itself clinically ranging from a mild cystitis to a presentation with systemic symptoms such as a nonspecific fever, vomiting, failure to thrive or irritability or with significant dehydration and electrolyte imbalance which can be seen in infants in the first 3 months of life. It is therefore a ubiquitous differential diagnosis in many children presenting both in primary care and in the hospital setting.In most children urinary infections are isolated acute infections from which they recover quickly. In a small minority of children urinary infections can be associated with underlying significant pathology: either they are associated with congenital renal tract malformations such as renal dysplasia and/or hydronephrosis or if they have recurrent infections this may lead to renal scarring, particularly if the infections are associated with systemic symptoms.