生长激素治疗对烧烫伤小儿生长发育的影响

目的：评价短期应用重组人生长激素（rhGH）对小儿烧烫伤的治疗效果及治疗后对其生长发育的影响。方法：选取82例住院烧烫伤患儿,随机分为rhGH治疗组58例和对照组24例。rhGH治疗组在常规治疗的基础上给予rhGH皮下注射0．3IU／kg,每晚1次,连续使用10d。对照组只给予常规治疗,于相应时间皮下注射2m1生理盐水。另选30例发育正常的整形患儿作为正常对照。动态观察应用rhGH（或生理盐水）前1d、应用后5d后,出院时及出院后6、12、18、24个月两组患儿血生长激素、血糖水平;患儿于入院时测量身高、体重,计算体质指数（BMI）,出院后6～24个月进行追踪性观察,与同时期同年龄段北京市正常小儿生长指标进行对比,评价影响。结果：rhGH治疗组创面愈合速度较对照组明显加快;创面愈合后瘢痕增生及痛痒程度明显轻于对照组,差异有显著性（P〈O．05）。rhGH治疗前两组血生长激素水平均明显低于正常水平。rhGH治疗第5天患儿的生长激素水平明显高于正常组水平和对照组（P〈0．001）,至出院时两组均趋于正常。伤后两组血糖水平均有轻度升高,激素治疗第5天恢复正常,但差异无显著性,两组之间各时间比较差异均无显著性。两组出院时体重和BMI均低于北京市儿童正常标准,但两组间身高、体重和BMI差异均无显著性。结论：临床短期小剂量使用生长激素治疗小儿烧烫伤能够加速创面愈合,提高创面愈合质量。创面愈合后小剂量短期应用的生长激素不会对小儿的生长发育造成后续影响。     

婴幼儿三聚氰胺致泌尿系结石诊疗分析

目的 探讨食用受三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石患儿的临床特点、诊断和治疗方法.方法 分析兰州军区兰州总医院泌尿外科2008年收治的35例因食用三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石的患儿其流行病学、临床表现及影像学特点,总结两种不同的治疗方法及疗效.结果 10名患儿均存在急性肾衰竭,血尿素氮(26.1±7.5)mmol/L,血肌酐(370.5±198.5)μmol/L.对留取的10例结石标本分析证实,结石是三聚氰胺和尿酸的合成体.输尿管镜下内支架置入术后,治疗组血肌酐降至正常的平均时间为(4.0±2.0)d;25名患儿内科保守治疗.经治疗10例患儿急性肾衰竭全部治愈,泌尿系结石完全或部分排出;25名患儿内科保守治疗;泌尿系结石完全或部分排出.结论 三聚氰胺污染婴幼儿配方奶粉可以导致婴幼儿泌尿系结石,治疗方法可对急性肾功能衰竭患儿尽快通过内、外科方法解除梗阻引流尿液.患儿预后尚可.     

三聚氰胺对婴幼儿肝肾功能损害的随访研究

目的初步了解三聚氰胺对婴幼儿肝肾功能有无长期的损害。方法随访已确诊的三聚氰胺结石患者,通过对比治疗前后的尿常规、肝肾功能和泌尿系B超变化,根据结果初步判断三聚氰胺对婴幼儿的肝肾脏是否有长期的损害。结果治疗前37例患者全部有肾结石,治疗后只有3例仍有结石,两者相比有统计学差异（P〈0.05）,大部分患者肾结石消失;治疗前有17例患者尿潜血试验阳性,治疗后尿潜血试验阳性者只有3例,治疗前有10例患者尿白细胞（WBC）阳性,治疗后全部患者尿白细胞为阴性;两者前后比较提示尿液常规明显改善（P〈0.05）;治疗前血清肌酐（Cr）为（38.47±9.60）μmol/L、治疗后为（33.38±5.24）μmol/L,血清尿酸（UA）在治疗前为（296±104）μmol/L,治疗后为（227±60）μmol/L,两者治疗前后比较提示肾功能有所改善（P〈0.05）;治疗前后血清谷丙转氨酶（GPT）分别为（21.45±15.70）U/L和（15.16±6.35）U/L,治疗后GPT较治疗前明显降低（P〈0.05）。结论三聚氰胺对婴幼儿的肝肾功能无明显的长期损害。     

三聚氰胺致婴幼儿泌尿系结石一年随访研究

目的 调查因三聚氰胺污染奶粉致泌尿系结石婴幼儿1年后康复情况. 方法 三聚氰胺致泌尿系结石婴幼儿81例,男51例,女30例.随访时年龄13～48个月,平均26个月.对患儿进行了1年后B超复查,血BUN、SCr、尿酸含量检测,并行尿常规检查,同时检测尿液中α1-微球蛋白(α1-MG)、β2-微球蛋白(β2-MG)、微量白蛋白(UMA)的含量.81例同年龄段未食用污染奶粉的健康婴幼儿作为对照组,行尿常规检查及尿α1 -MG、β2-MG、UMA检测. 结果 内科治疗组54例,结石残留3例,直径分别为0.3、0.3、0.4 cm;外科治疗组27例,结石残留2例,直径为1.5、0.2 cm,1.5cm残留结石为阳性结石,行经皮肾镜取石治疗.患儿UMA水平明显升高,中位数(四分位间距)为5.4(8.0) mg/L,对照组为2.3(4.9) mg/L,两组比较差异有统计学意义(P＜0.0l);血BUN、SCr、尿酸均在正常范围,不同治疗组间差异无统计学意义(P＞0.05). 结论 大多数三聚氰胺致婴幼儿泌尿系结石采用内科或外科治疗效果确切,结果满意,如果1年后残留结石直径＞1.0 cm建议手术治疗.     

三聚氰胺所致婴幼儿尿路结石的微创外科治疗

目的 总结三聚氰胺所致婴幼儿尿路结石的微创外科治疗经验. 方法 回顾性分析36例三聚氰胺所致尿路结石患儿资料.男23例,女13例.年龄8～36个月,平均15个月.患儿均有受三聚氰胺污染奶粉喂养史,喂养时间为6～12个月.上尿路结石左侧11例、右侧6例、双侧18例,合并尿道结石4例,单纯膀胱结石1例.分别采用微创经皮肾镜碎石(MPCNL)5例、输尿管镜下碎石14例,输尿管支架管置入17例治疗. 结果 36例患儿均顺利完成手术.无大出血、穿孔或周围脏器损伤等严重并发症.术后住院3～10 d.患儿随访1～12个月,结石无复发,肾盂、输尿管积水消失或减轻,生长发育良好. 结论 微创内镜外科手术可以安全、有效地治疗三聚氰胺所致婴幼儿尿路结石,尤其适用于引起尿路梗阻的结石.     

谷胱甘肽S—转移酶与膀胱癌关系的研究

目的：探讨谷胱甘肽S－转移酶（GST）与膀胱癌的关系。方法：检测58例膀胱癌患者（膀胱癌组）、80例泌尿系非肿瘤患者（泌尿系非肿瘤组）和40例正常对照者（正常对照组）血清中GST活性及24例膀胱癌患者癌组织、配对癌周正常组织和13例正常膀胱组织中GST活性。结果：膀胱癌组织血清中GST活性明显高于泌尿系非肿瘤组和正常对照组（P＜0．01）,泌尿系非肿瘤组与正常对照组之间GST活性差异无显著性意义（P＞0．05）,膀胱癌组癌组织中GST活性明显高于癌周正常组织及正常膀胱组织（P＜0．01）,癌周正常组织与正常膀胱组织之间,GST活性差异无显著性意义（P＞0．05）。各级和各期膀胱癌之间血清中 GST活性及各级膀胱癌组织之间GST活性差异均无显著性意义（P＞0．05）,而Ⅱ-Ⅳ期膀膛癌周期组织中GST活性较I期增高（P＜0．05）。结论：膀胱癌患者GST活性明显增高,GST活性在癌组织中随着癌分期的增高而增加,提示GST与膀胱癌的发生及发展有关。     

儿童特发性高钙尿症52例临床分析

目的探讨特发性高钙尿症（IH）的临床特点及与泌尿系结石的关系。方法分析52例确诊为IH患儿的临床资料特点,并结合文献讨论其与泌尿系结石发生的关系。结果52例患儿均有不同程度血尿。其中41例患儿行腹部B超和X线平片检查及静脉肾盂造影检查,发现肾结石5例。调查52例患儿家族史发现15例家族中有泌尿系结石患者,6例同胞中有类似血尿患者,较正常对照组家族的尿结石发病率明显增高（P〈0．05）。52例患儿进行钙负荷试验,其中肠道吸收亢进型29例．肾脏漏出型23例。结论除血尿外,泌尿系结石也是IH的常见临床表现,尤其见于高钙尿状态持续时间较长者。IH与家族泌尿系结石的发病有密切关系,有遗传倾向。     

三聚氰胺致婴幼儿泌尿系结石的诊断和治疗

三聚氰胺（melamine）又名氰尿酰胺,俗称蜜胺,是一种重要的氮杂环有机化工原料,主要合成生产三聚氰胺-甲醛树脂,用于木材加工、塑料、涂料等行业,是目前重要的尿素后加工产品。2007年3月,美国发生多起猫、狗宠物中毒死亡事件,美国食品药品管理局调查发现初步认为宠物食品中含有的三聚氰胺是导致猫、狗中毒死亡的原因。2008年9月,多家媒体报道婴幼儿食用受三聚氰胺污染奶粉导致肾结石,作者所在的医院和科室成功收治多名该类疾病患儿。作者结合文献介绍三聚氰胺的有关知识及其与泌尿系结石的关系及诊治情况。     

小儿双金清热口服液治疗疱疹性咽峡炎的临床观察

目的探讨小儿双金清热口服液治疗疱疹性咽峡炎的临床疗效。方法选择2012年3月～2013年6月收治的80例疱疹性咽峡炎患儿的临床资料,其中对照组40例患儿采取西医常规治疗,而观察组40例患儿在常规西医治疗基础上加用小儿双金清热口服液进行治疗,比较两组患儿的治疗效果。结果所有患儿治疗后,观察组的总有效率为95．00％,明显优于对照组,具有统计学差异（P〈0．05）,而且观察组患儿退热时间、流涎消失时间、口腔疱疹消失时间、总病程分别为（1．04±0．63）d、（1．32±0．54）d、（2．14±0．43）d、（3．50±0．64）d,均明显短于对照组患儿,组间差异具有明显统计学意义（P〈0．05）。结论小儿双金清热口服液治疗疱疹性咽峡炎具有十分显著的疗效,可明显改善患儿的临床不适症状,其疗效明显优于单纯西医治疗措施,有利于患儿的预后恢复,值得临床应用。     

经皮肾镜下应用双频双导管超声碎石系统与单导管超声碎石系统治疗肾结石的比较（附138例报告）

目的：比较超声引导下经皮肾镜应用双频双导管碎石术勺单导管超声碎石系统治疗肾结石的优缺点。方法：2008年1月～2012年7月收治138例肾结石患者,对其中63例患者采用双频双导管碎石系统（Cyber-wand）治疗（观察组）,对75例患者采用瑞士EMS公司的单导管超声碎石系统治疗（对照组）,比较两组的碎石时间、手术时间、结石取净率、平均住院日以及术中出血量等指标。结果：138例患者均获得手术成功,观察组63例患者60例单侧取石,3例双侧取石（均先行单侧取石,术后1个月行另一侧取石）,一共66侧取石,平均碎石时间（32．1±15．4）min;对照组73例单侧取石,2例双侧取石,共77侧取石,平均碎石时间（44．7±21．2）min,观察组平均碎石时间明显短于对照组,差异有统计学意义（P〈0．05）;观察组平均手术时间（68．7±32．8）min短于对照组（77．8±43．5）min（P〈0．05）;结石取净率95．45％（63／66）明显高于对照组84．42％（65／77）（P〈0．05）。两组的术中平均出血量、平均住院日差异无统计学意义（P〉0．05）。结论：经皮肾镜应用双频双导管碎石系统治疗肾结石碎石效率高、手术时间短、结石取净率高且并发症较少,值得临床推广。     

三聚氰胺相关结石患儿单中心、大样本随访和预后分析

目的 评估三聚氰胺相关泌尿系统结石患儿的长期预后和三聚氰胺对肾功能的长期影响。 方法 以我院8335名≤6岁的筛查儿童中确诊为三聚氰胺相关泌尿系统结石的102例患儿为研究对象,随访18个月,通过泌尿系统超声、尿三聚氰胺（三聚氰酸）、尿常规及尿微量蛋白系列检测进行评估。 结果 18个月后随访患儿91例,其中82例（90.1%）已排出结石。直径小于5 mm的结石最易排出,而直径大于10 mm的结石自然排石率较低,需通过干预排石。74例患儿尿液中未检测有三聚氰胺和三聚氰酸的残留。尿常规显示,18个月后蛋白尿全部消失,镜下血尿和白细胞尿的检出率分别为5.1%和2.0%,明显低于初诊时的检测结果（P蛋白尿=0.123,P血尿=0.038,P白细胞尿=0.005）。尿微量蛋白系列检测结果提示,本次随访尿常规正常的患儿仍有部分存在肾小球和肾小管的损伤,其异常检出率分别为8.8%和12.1%,而结石未排出、男性和患病年龄小是肾小球受损的主要因素。 结论 18个月后90.1%的患儿已排出结石,而结石直径是影响其排出的主要因素;患儿体内已无三聚氰胺和三聚氰酸的残留。少数患儿在18个月后仍然存在肾小球和肾小管的损伤,其恢复情况还需长期的随访监测。     

Four years follow-up of 101 children with melamine-related urinary stones

The melamine-contaminated milk powder incidence occurred in China in 2008. Many studies have been published regarding the epidemiology, clinical symptoms, diagnosis and treatment of melamine-related urinary stones. The objective of this study is to follow-up the effects of melamine-contaminated milk powder consumption on kidney and body growth in children with melamine-related urinary stones 4 years ago. One hundred and one children with melamine-related urinary stones were followed up by urinalysis, renal function tests and urinary ultrasonography. The data of body weight and height, clinical signs and complications were collected. Eighty normal children without the history of consuming melamine-contaminated milk powder were collected as controls. Eighty-one children with melamine-related urinary stones were successfully followed up. Of 45 cases with melamine-related urinary stones treated conservatively after discharge, 34 disappeared completely, 6 dissolved partially, 1 increased in size and 4 did not change at 4 years follow-up. The percentages of under-height and under-weight infants were significantly higher in melamine-related urinary stones group compared to the controls, respectively (p < 0.05). Routine blood, renal and bladder function tests as well as urinalysis were normal in all children. No urological tumors were detected. No noticeable impact of melamine-related urinary stones on kidney and bladder was found at 4 years follow-up. However, whether or not melamine-related urinary stones had effect on body growth needs follow-up in future.     

问题奶粉事件中婴幼儿泌尿系统结石成分鉴定

目的 通过对婴幼儿泌尿系统结石的成分分析,探讨结石成因,以利于预防和治疗.方法 收集婴幼儿泌尿系统结石标本16例,均有同一品牌问题奶粉喂养史.结石组分用高效液相色谱分离制备,电喷雾质谱、电子轰击质谱和傅里叶变换红外光谱进行结构鉴定,并用高效液相色谱对结石中的主要组分进行定量测定.结果 通过分离和组分结构鉴定及定量测定.结石中的主要组分为三聚氰胺和尿酸,尿酸和三聚氰胺的比例约为2:1(摩尔比).结石中尿酸平均含量为(53.9±11.7)%,三聚氰胺为(23.2±5.7)%.结论 因食用问题奶粉而导致婴幼儿泌尿系统结石的主要原因是三聚氰胺与尿酸形成了不溶性盐而导致结石形成.     

One year follow up of the outcomes of child patients with melamine-related kidney stones in Beijing and surrounding provinces in China

Aim: To evaluate their prognosis, the damage by melamine on children's kidney and other organs, and its influence on the children's development, was investigated. Methods: Nine hundred and sixty‐two Chinese children were divided into three groups: group A, 265 children diagnosed with melamine‐associated urolithiasis; group B, 197 children with a history of melamine‐contaminated milk powder consumption but without urolithiasis; and group C, 500 healthy children. They were examined at 0, 1, 3, 6 and 12 months. The factors influencing the prognosis were investigated. The stone discharge was monitored by ultrasonography. Overt renal and liver damage and underlying renal injury markers were analyzed. Results: The stone discharge rates 1, 3, 6 and 12 months after the diagnoses were 52.5%, 67.2%, 88.3% and 95.5%, respectively. Stone size was a stable influencing factor for the stone discharge rate. Additionally, the values of the potential renal injury markers in children with stones already discharged is equivalent to normal children. Conclusion: This 12 month follow up of early renal injury markers indicated that the damage to the kidney is temporary with no persistent negative outcomes being found till now. Additionally, the gross development of the children seemed not yet jeopardized by melamine. Longer‐term follow up will be conducted.     

肾盂内灌注碱性药物溶石治疗三聚氰胺所致婴儿双肾结石

目的 探讨经输尿管导管或肾造瘘管肾盂内直接灌注碱性药物溶石治疗三聚氰胺所致婴儿双肾结石的有效性和安全性. 方法双肾结石合并急性肾后性肾功能衰竭婴儿15例.年龄5～12个月,平均9个月.结石直径0.4～1.5 cm,平均0.8 cm.15例患儿均长期食用受三聚氰胺污染的奶粉,经影像学和实验室检查诊断为急性肾后性肾功能衰竭.13例经尿道输尿管镜下通过输尿管导管行肾盂内碱性药物灌洗,20 m1 5%NaHCO3于10 min内缓慢冲洗,然后置入双J管.2例经皮肾穿刺留置肾造瘘管,术后间歇碱性药物灌洗,100 ml 1.4%NaHCO3于4～6 h内持续低压滴注,1次/d,持续2周. 结果 15例患儿均成功实施碱性药物肾盂内灌洗溶石治疗.术后2～5 d尿量恢复正常,2～3 d SCr、BUN恢复正常.13例术中经输尿管导管直接肾盂内灌注5%NaHCO3者,术中均观察到大量混浊液体自输尿管口喷涌而出.术后2周复查CT,结石消失13例,结石直径缩d~>50%者2例. 结论 经输尿管导管或肾造瘘管进行肾盂内直接碱性药物化学溶石治疗三聚氰胺所致婴儿肾结石安全、有效.     

Ultrasound of urinary system and urinary screening in 14 256 asymptomatic children in China

Aim: The aim of this study is to assess the characteristics of urinary system diseases and the role of the ultrasound screening and urinalysis screening for chronic kidney disease (CKD) in asymptomatic children in China. Methods: Between September 2008 and November 2008, 14 256 children excluding those with obvious symptoms and signs were enrolled in our study. All the subjects accepted ultrasound and urinary screening. A case–control study was performed to evaluate the relative risk of having stones in those children exposed to melamine formula. Results: Of the enrolled children, 6.10% (869 of 14 256) showed abnormalities, of which 409 (2.87%) were established by ultrasound, 572 (4.01%) by urinalysis and 112 (0.79%) by both ultrasound screening and urinalysis. The abnormalities included congenital anomalies of kidney and urinary tract, urinary stones and/or hydronephrosis, leucocyturia and haematuria and/or proteinuria. Children exposed to melamine formula were 5.17 times as likely to have kidney stones as children exposed to no‐melamine formula (95% confidence interval, 3.28–8.14; P < 0.001); the probability of kidney stones in melamine‐fed infants were 6.28 times as likely as those no melamine‐fed (95% confidence interval, 3.71–10.65; P < 0.001). Conclusion: Ultrasonography and urinalysis could complement each other and play important roles in the early diagnosis of anomalies of the urinary system, but urinalysis is a more cost‐effective screening tool for CKD in children in China. Exposure to melamine‐contaminated formula associated with urinary stones, especially in infants, was significantly higher than the control group.     

Melamine-induced infant urinary calculi: a report on 24 cases and a 1-year follow-up

Melamine has been the main factor leading to infant urinary calculi occurring on a rather wide scale in China in 2008, which were the results of a rapid aggradation of metabolites such as cyanuric acid diamide, cyanuric acid, etc., causing uric acid stone to accumulate. Here, we present a report on 24 infants who were admitted to our department, their ages ranging from 3 to 10 months. All of these infants had a confirmed history of having been fed with the “Sanlu” brand milk powder, which contained excessive levels of melamine, with the highest being 2,563 mg/kg. The diagnosis, medical treatment and follow-up by ultrasonography at 1, 3, 6, 12 months were reported. 22 cases of these infants were rehabilitated after medical treatment and 1 infant underwent pyelolithotomy for relieving an obvious ureter obstruction. No recurrence was found in these babies thereafter. Another infant died from rapidly worsening renal failure. Therefore, this series of cases have demonstrated that melamine contained in the “Sanlu” milk powder was the main cause of these urinary stones. Urine alkalinization and stone liberalization were the most effective treatments. Fast diagnosis and treatment of acute obstructive urolithiasis may prevent the development of acute renal failure, which is associated with high morbidity and mortality rates.     

问题奶粉致尿路结石形成机制初探及诊治建议

目的：问题奶粉中所含的三聚氰胺是引发婴幼儿泌尿系结石形成的主要有毒物质,但其导致结石形成的机制至今未明。目前已知,这种结石的成分主要是二水尿酸和尿酸铵,所以本文通过这两种成分的代谢过程来逆向推导这种特殊结石形成的过程,同时也提出一些相关的诊断和治疗上的建议。