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.

One year follow-up study of urolithiasis in infants exposed to melamine-tainted powdered formula

Objective To investigate the condition of infants with urolithiasis caused by melaminetainted powdered formula at one-year follow-up. Methods Eighty-one young children with melamine-induced urolithiasis were followed up,which included urinalysis,renal-function tests,urinary tests for biochemical markers of renal glomerular and tubular function,and ultrasonography.Eighty-one age-matched healthy infants without exposure to melamine-contaminated formulas were enrolled as controls. Results Fifty-one of the patients were male and 30 female,with a mean age of 26 months (range 13 -48 months).The 81 children were divided into 2 groups according to treatment protocols.Group 1 received conservative treatment ( n =54 ) and Group 2 received surgical treatment ( n =27 ).In Group 1,3 patients (5.6％) had stone-residual:1 girl had calculus of 0.4 cm in diameter in the left kidney and 2 girls had calculus of 0.3 cm in diameter in the right kidney.In Group 2,2 patients (7.4％) had stone-residual,1 boy had crystallization of 0.2 cm in diameter in the right kidney and 1 boy had calculus of 1.5 cm in diameter in the left kidney,positive stone was confirmed by X-ray and accepted percutaneous nephrolithotomy.Urinary microalbumin levels were significantly increased in the children with melamine-induced urolithiasis compared with the control group (P ＜0.01 ).Blood urea nitrogen and serum creatinine were within the normal range with no significant difference between the 2 groups. Conclusions At one-year follow-up most of the children exposed to melamine-tainted infant formula in both treatment groups had returned to a healthy state,suggesting a satisfactory outcome for both treatment options.However,surgery is recommended in patients with stoneresidual ＞ 10 mm.