加强对儿童尿路感染和膀胱输尿管反流的认识

儿童尿路感染是婴儿和儿童中一种常见的细菌性感染,6岁以内儿童泌尿道感染(UTI)累计发病率女孩为6.6%,男孩为1.8%.UTI与膀胱输尿管反流(VUR)的关系复杂,共同存在是导致持续性的肾脏损害和疤痕化的重要因素.UTI诊断明确后最常应用的影像学检查有肾脏和尿路超声检查、排泄性膀胱尿道造影和核素肾静态显像(DMSA),其中DMSA为目前公认的诊断肾瘢痕的金标准.尽管对在不同年龄、性别和临床表现的患儿中如何正确选择相关的影像学检查有较大的争议,但多数推荐对所有2岁以下的儿童进行超声、VCUG和DMSA检查.研究还显示VUR有其一定的遗传基础,在同胞中的发病率显著高于健康儿童.随时间推移发育逐渐成熟,有部分反流可自行痊愈,大都不需要手术治疗.大多数VUR的病例,尤其是5岁以下的儿童建议使用低剂量持续性抗生素预防治疗.反流性肾病长期的并发症是发生终末期慢性肾功能衰竭.

Urinary tract infection and vesicoureteric reflux

Urinary tract infection(UTI)is a common bacterial infection disease in young children. Approximately 1.8% of boys and 6.6% of girls will have suffered at least one episode of UTI by age 6 years. The relationship between urinary tract infection,vesicoureteric reflux and reflux nephropathy is complex and controversial. There is no doubt that UTI is the most potent cause of renal scarring,if VUR co-exists. The most commonly used imaging examinations for children with UTI include renal ultrasound,micturating cystogram and DMSA scan. DMSA scan is now regarded as the gold standard for detecting renal scarring. It is recommended that all children with UTI(especially < 2 years old=should undergo some of imaging examination,such as ultrasound,VCUG,and DMSA, although the protocols may vary depending on a number of factors including age and sex of child and clinical circumstances. Further,the inheritance of VUR is well recognized:the prevalence of VUR in siblings is much higher than in general population. The natural history of VUR is of spontaneous resolution over time,and surgical correction is,therefore,not necessary in most cases. Prophylactic antibiotics in low dose are generally given to children with VUR under the age of 5 years. Long-term complications of reflux nephropathy are development of end-stage renal failure in later life.