体位改变对胡桃夹现象患儿血尿的影响

目的观察胡桃夹现象（NCP）患儿不同体位时血尿的变化。方法经彩色多普勒超声检查确诊的伴NCP的无症状血尿患儿25例，采取胸膝卧位和直立挺腰位后留尿，分别用位相显微镜检测尿红细胞形态和数量。以28例无NCP的无症状血尿患儿作对照。结果NCP组患儿胸膝卧位时尿正形红细胞数量（中位数500个／ml）显著低于直立挺腰位（中位数4500个／ml，P=0．00）；而尿畸形红细胞计数差异无统计学意义（中位数分别为8000个／ml和2500个／ml，P=0．233）。对照组患儿胸膝卧位时尿正形红细胞（中位数2000个／ml）与直立挺腰位（中位数1000个／ml）差异无统计学意义（P=0．537）；畸形红细胞数量（中位数分别为10500个／ml和12500个／ml）差异也无统计学意义（P=0．134）。结论NCP患儿在胸膝卧位时尿中排出正形红细胞数量显著低于直立挺腰位，提示不同体位可影响NCP患儿血尿定量；体位试验有可能作为胡桃夹现象的辅助诊断。

Effect of posture change on asymptomatic hematuria in children with nut cracker phenomenon

Objectives To observe the fluctuation of hematuria followed by posture changes in children with nut cracker phenomenon. Methods Twenty-five asymptomatic hematuria children diagnosed as nut cracker phenomenon (NCP) by Doppler ultrasound were included in the study, and 28 without NCP were served as control. The amount and configuration of red blood cells in urine were detected with phase microscope when the chest-knee position and stand straight position were taken. Results In NCP patients, orthomorphic red blood cells in urine was significantly higher when in stand straight position (median 4 500/ml) than that in chest-knee position (median 500/ml, P = 0.00), but the difference of urine diastrophic red blood cells between two positions was not significant (median 8 000/ml in chest -knee position and 2 500 /ml in stand straight position, P = 0.233) . While the differences of orthomorphic red blood cells (median 2 000/ml in chest-knee position, 1 000/ml in stand straight position respectively, P = 0.537) and diastrophic red blood cells (median 10 500/ml in chest-knee position, 12 500/ml in stand straight position respectively, P = 0.134) between two positions were not significant in control. Conclusions The amount of urine orthomorphic red blood cells in chest-knee position was significantly lower than that in stand straight one, suggesting that posture change could change the excretion of urine orthomorphic red blood cells in children with NCP and posture test might be used as an auxiliary diagnosis of NCP in future.