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。

Large sample follow-up of single centre and assessment of pediatric urolithiasis caused by melamine-contaminated milk powder

Objective To assess the prognosis and effect on renal function of pediatric urolithiasis caused by melamine-contaminated milk powder (PUMMP) in a long-term follow-up.Methods One hundred and two of 8335 children (≤ 6-year-old) with history of consuming melamine-contaminated milk powder screened in our hospital were followed up for eighteen months after diagnosis. Urinary system ultrasonography, urinalysis, urinary microprotein profiles [microalbumin (ALBU), immunoglobulin G (IgG), and N-acetyl-β-D-glucosidase (NAG)], urinary melamine and cyanuric acid were examined in the first visit and at the end of follow-up. Results Follow-up was completed in 91 children and the stone was excreted in 82 children (90.1%).Stones less than 5 mm in diameter were most vulnerable to discharge, and stones larger than 10 mm could not be expelled without interventions. At the end of follow-up, no melamine or cyanuric acid was found in the urine samples of 74 patients. Urinalysis showed that incidences of proteinuria, microscopic hematuria and leukocyturia were 0%, 5.1% and 2.0%, which were significant different from those in the first visit (Pproteinutria=0.123, Phemnatuna=0.038 and Pleukocyhuris=0.005).Urinary microprotein profiles revealed that some children whose urinalysis was normal still presented glomerular and renal tubular injury and the abnormal rates were 8.8% and 12.1%respectively. The glomerular injury was mainly related to persistent stone, male and younger.Conclusions 90.1% of children with PUMMP passes urinary stones at the end of follow-up.Stone size is the major risk factor of discharge. No melamine or cyanuric acid is found in the urine of children. After eighteen months, glomerular and renal tubular injury is still found in some patients. Further follow-up is necessary.