Email Alert | RSS

北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (6): 1062-1066. doi: 10.19723/j.issn.1671-167X.2019.06.015

• 论著 • 上一篇    下一篇

新生儿先天性肾脏和泌尿道畸形的超声筛查及随访

李宁宁1,季丽娜1,△(),晁爽1,袁珂1,孟洪1,黄振宇2,张华斌3   

  1. 1. 清华大学附属北京清华长庚医院,清华大学临床医学院 儿科,北京 102218
    2. 清华大学附属北京清华长庚医院,清华大学临床医学院 妇产科,北京 102218
    3. 清华大学附属北京清华长庚医院,清华大学临床医学院 超声科,北京 102218
  • 收稿日期:2019-05-15 出版日期:2019-12-18 发布日期:2019-12-19
  • 通讯作者: 季丽娜 E-mail:lnji008@sina.com
  • 基金资助:
    北京清华长庚医院精准医学研究基金(12015C4006)

Ultrasound screening and follow-up study of congenital anomalies of the kidney and urinary tract in neonates

Ning-ning LI1,Li-na JI1,△(),Shuang CHAO1,Ke YUAN1,Hong MENG1,Zhen-yu HUANG2,Hua-bin ZHANG3   

  1. 1. Department of Pediatrics, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing 102218, China
    2. Department of Gynecology and Obstetrics, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing 102218, China
    3. Department of Ultrasound, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing 102218, China
  • Received:2019-05-15 Online:2019-12-18 Published:2019-12-19
  • Contact: Li-na JI E-mail:lnji008@sina.com
  • Supported by:
    Supported by the Beijing Tsinghua Changgung Hospital Precision Medicine Fund(12015C4006)

RICH HTML

   

PDF (PC)

摘要：

目的 探讨新生儿先天性肾脏和泌尿道畸形(congenital anomalies of the kidney and urinary tract,CAKUT)的发病情况,评价出生后早期行泌尿系超声筛查的价值。方法 对2016年1月至2018年12月于清华大学附属北京清华长庚医院出生和就诊的新生儿行泌尿系超声筛查并随访,同时对母孕产期资料进行分析,筛选与CAKUT发病相关的危险因素。结果 (1)本次筛查的2 655例新生儿中,CAKUT阳性82例(男60例,女22例),阳性率为3.1%(82/2 655), 其中肾积水66例,重复肾6例,多发性肾囊肿2例,肾囊性发育不良2例,髓质海绵肾1例,小肾脏3例,孤立肾1例,马蹄肾1例。(2)66例肾积水患儿中有4例失访;8例目前随访尚不足6个月,肾积水无明显变化,继续随访观察中;54例完成随访1年,1年内恢复正常32例,减轻3例,加重7例,无变化12例,其中1例因反复泌感、肾功能下降接受手术治疗。(3)CAKUT高危因素以孕晚期胎儿泌尿系超声异常最多,胎儿泌尿系超声异常的高危新生儿有44例,生后筛查发现CAKUT病例35例,发生率为79.5%(35/44)。(4)本次筛查的2 655例新生儿中,有2 611例新生儿产前泌尿系超声检查是正常的,这些产前泌尿系超声检查正常的新生儿中,有47例出生后泌尿系B超筛查符合CAKUT诊断,发生率为1.8%(47/2 611)。结论 新生儿最常见的CAKUT为肾积水,多数预后良好,但应定期随访;对新生儿尤其是母孕期胎儿泌尿系超声异常的高危新生儿行泌尿系统超声筛查,对于早期发现CA KUT有重要的临床意义。

关键词: 畸形, 肾脏和泌尿道, 先天性, 超声检查, 新生儿

Abstract:

Objective: To investigate the incidence of congenital anomalies of the kidney and urinary tract (CAKUT) in neonates, and to evaluate the value of urinary ultrasound screening in the early postnatal period.Methods: The neonates born or treated in Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University between January 2016 and December 2018 accepted the urinary ultrasound scree-ning, and the neonates with problem were followed up. In the meanwhile, the maternal pregnancy data were analyzed to screen out the risk factors associated with the onset of CAKUT.Results: (1)A total of 2 655 neonates were screened by ultrasonography,of whom 82 neonates had been diagnosed with CAKUT(male: 60 cases,female: 22 cases),the positive rate was 3.1%(82/2 655).There were 66 cases of hydronephrosis, 6 cases of duplicate kidney, 2 cases of multiple renal cysts, 2 cases of renal cystic dysplasia, 1 case of medullary sponge kidney, 3 cases of small kidney, 1 case of isolated kidney, and 1 case of horseshoe kidney.(2)Of the 66 children with hydronephrosis, 4 cases were lost to the follow-up; 8 cases were followed for less than six months with no significant changes found, and still in the follow-up observation; 54 cases were followed up for 1 year, among which 32 cases were returned to normal within 1 year, 3 cases were alleviated, 7 cases were aggravated, and 12 cases were unchanged. One case underwent surgery for repeated urinary tract infections and decreased renal function.(3) Abnormal fetal urinary ultrasound in the late pregnancy was found to be the most common in the high risk factors of CAKUT. There were 44 high-risk newborns with abnormal fetal urinary ultrasound,and 35 cases of CAKUT were diagnosed after birth. The incidence rate was 79.5%(35/44). (4)Among the 2 655 newborns screened, 2 611 newborns had normal antenatal urinary ultrasonography. Among these neonates with normal urinary ultrasound during pregnancy,47 cases of CAKUT were diagnosed after birth, with an incidence of 1.8%(47/2 611).Conclusion: The most common CAKUT in neonates is hydronephrosis and most cases with hydronephrosis had a good prognosis, but they should be followed up regularly. Urinary ultrasound screening for neonates, especially those high-risk neonates with abnormal fetal urinary ultrasound, has important clinical implications for the early detection of CAKUT.

Key words: Anomalies, kidney and urinary tract, congenital, Ultrasonography, Neonates

中图分类号: 

  • R726.2
[1] Pope JC, Brock JW, Adams MC , et al. How they begin and how they end: Classic and new theories for the development and deterioration of congenital anomalies of the kidney and urinary tract, CAKUT[J]. J Am Soc Nephrol, 1999,10(9):2018-2028.
[2] Caiulo VA, Caiulo S, Gargasole C , et al. Ultrasound mass scree-ning for congital anomalies of the kidney and urinary tract[J]. Pediatr Nephrol, 2012,27(6):946-953.
[3] Smakal O, Janout V, Zapletalova J , et al. Diagnostic accuracy of postnatal ultrasound screening for urinary tract abnormalities[J]. Pediatr Nephrol, 2010,25(2):281-287.
[4] Toka HR, Toka O, Hariri A , et al. Congential anomalies of kidney and urinary tract[J]. Semin Nephrol, 2010,30(4):374-386.
[5] 阳海平, 罗娟, 李翠萃 , 等. 14 256名无症状小儿泌尿系统超声筛查分析[J]. 重庆医科大学学报, 2010,36(6):926-929.
[6] 张斌, 王辉, 孙宁 , 等. 超声筛查26 989名儿童中先天性肾脏和尿路畸形的临床分析[J]. 中华儿科杂志, 2011,49(7):534-538.
[7] 孙琦, 康国贵, 孙晓明 , 等. 新生儿先天性肾脏和泌尿道畸形56例的临床分析[J]. 现代实用医学, 2016,28(8):1062-1063.
[8] 沈汉玲, 朱佑民, 黄高明 , 等. 新生儿先天性肾脏和尿路发育异常的超声筛查及随访管理[J]. 临床肾脏病杂志, 2013,11(11):496-499.
[9] 张鸾 . 2011—2012年闵行区高危儿泌尿系统发育异常筛查结果分析[J]. 中国儿童保健杂志, 2014,22(7):768-770.
[10] 宗冬梅, 孙琦, 张琦 , 等. 宁波部分地区高危新生儿泌尿系统超声筛查及随访结果分析[J]. 浙江临床医学, 2018,2(2):210-212.
[11] 程俊丽, 杜悦 . 儿童慢性肾脏病[J]. 国际儿科学杂志, 2016,43(10):788-792.
[12] Soliman NA, Ali RI, Ghobrial EE , et al. Pattern of clinical pre-sentation of congenital anomalies of the kidney and urinary tract among infants and children[J]. Nephrology, 2015,20(6):627-641.
[13] Winyard P, Chitty LS . Dysplastic kidneys[J]. Semin Fetal Neonatal Med, 2008,13(3):142-151.
[14] 王筱雯, 徐虹 . 先天性肾脏及尿路畸形研究策略:从基础到临床[J]. 中国中西医结合肾病杂志, 2018,19(12):1126-1128.
[15] Miyakita H, Ueno S, Nomura M . Neonatal hydronephrosis detected on routine health check-up[J]. Tokai J Exp Clin Med, 2001,26(3):101-105.
[16] 刘利平, 李思进, 康春松 , 等. 新生儿肾积水的超声评价和随访[J]. 中华超声影像学杂志, 2005,14(2):131-134.
[17] 王卫平, 毛萌, 李廷玉 , 等. 儿科学[M]. 8版. 北京: 人民卫生出版社, 2013: 94.
[18] Hadlock FP, Deter RL, Carpenter R , et al. Sonography of fetal urinary tract anomalies[J]. Am J Roentgenol, 1981,137(2):261-267.
[19] 张小英, 赵蕊, 李银华 , 等. 三维彩色多普勒超声对诊断胎儿泌尿生殖系统畸形的应用价值分析[J]. 黑龙江医学, 2014,38(4):449-450.
[20] Hálek J, Flögelová H, Michálková K , et al. Diagnostic accuracy of postnatal ultrasound screening for urinary tract abnormalities[J]. Pediatr Nephr, 2010,25(2):281-287.
[21] Broadley P, Mchugo J, Morgan I , et al. The 4 year outcome following the demonstation of bilateral renal pelvic dilatation on pre-natal renal ultrasound[J]. Br J Radiol, 1999,72(855):265-270.
[22] Mouriquand PD, Whitten M, pracros JP. Pathophysiology diagnosis and management of prenatal upper tract dilatation[J]. Prenat Diagn, 2001,21(11):942-951.
[23] Woodward M, Frank D . Postnatal management of antenatal hydronephrosis[J]. BJU Int, 2002,89(2):149-156.
[24] 周婉怡, 刘磊 . 儿童膀胱输尿管反流的诊疗研究现状及进展[J]. 实用医院临床杂志, 2017,14(4):250-253.
[25] 陆铭娜, 范琦慧, 李洁 , 等. 胎儿肾积水超声诊断的价值及结局随访[J]. 现代实用医学, 2018,30(11):1519-1521.
[26] Bouzada MC, Oliveira EA, Pereira AK , et al. Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of uropathy: A prospective study[J]. Ultrasound Obstet Cynecol, 2004,24(7):745-749.
[27] Tsuchiya M, Hayashida M, Yanagihara T , et al. Ultrasound screening for renal and urinary tract anomalies in healthy infants[J]. Pediatr Int, 2003,45(5):617-623.
[28] 张慧婧, 马京梅, 杨慧霞 , 等. 胎儿先天性肾脏和尿道畸形的研究进展[J]. 中华妇产科杂志, 2015,50(10):791-794.
[29] 马常建, 万志刚, 王媛媛 , 等. 儿童先天性肾脏及尿路畸形的研究现状[J]. 国际儿科学杂志, 2018,8(8):605-608.
[30] 龚一女, 张莺, 沈茜 , 等. 先天性肾脏和尿路畸形超声筛查三级转诊体系的高危儿肾盂扩张筛查和随访研究[J]. 中国循证儿科杂志, 2013,8(5):326-330.
[1] 汤莹, 张湧波, 吴丹红, 林炎鸿, 兰风华. 13例先天性双侧输精管缺如不育患者的致病基因突变检测[J]. 北京大学学报（医学版）, 2024, 56(5): 763-774.
[2] 原晋芳, 王新利, 崔蕴璞, 王雪梅. 尿促黄体生成素在女童中枢性性早熟预测中的应用[J]. 北京大学学报（医学版）, 2024, 56(5): 788-793.
[3] 李宇菲,闫亚妮,靳家扬,李春,裴秋艳. 合并胎儿心脏病变的抗SSA抗体阳性孕妇的临床及实验室特征[J]. 北京大学学报（医学版）, 2023, 55(6): 1053-1057.
[4] 傅强,高冠英,徐雁,林卓华,孙由静,崔立刚. 无症状髋关节前上盂唇撕裂超声与磁共振检查的对比研究[J]. 北京大学学报（医学版）, 2023, 55(4): 665-669.
[5] 王昱,张慧敏,邓雪蓉,刘伟伟,陈璐,赵宁,张晓慧,宋志博,耿研,季兰岚,王玉,张卓莉. 尿枸橼酸定量检测在原发性痛风患者肾结石诊断中的应用价值[J]. 北京大学学报（医学版）, 2022, 54(6): 1134-1140.
[6] 邓雪蓉,孙晓莹,张卓莉. 类风湿关节炎患者足踝部体征和超声下病变的一致性[J]. 北京大学学报（医学版）, 2021, 53(6): 1037-1042.
[7] 张璐,胡小红,陈澄,蔡月明,王庆文,赵金霞. 类风湿关节炎初治患者颈椎失稳情况及临床特征[J]. 北京大学学报（医学版）, 2021, 53(6): 1049-1054.
[8] 武竞衡, 田光磊, 田萌萌, 陈山林. 170例巨指(趾)患者临床特点分析[J]. 北京大学学报（医学版）, 2021, 53(3): 590-593.
[9] 杨广鑫,栾景源,贾子昌. 静脉造影和超声联合引导射频闭合治疗下肢静脉曲张[J]. 北京大学学报（医学版）, 2021, 53(2): 332-336.
[10] 王昱,邓雪蓉,季兰岚,张晓慧,耿研,张卓莉. 超声检测痛风患者肌腱受累的危险因素和诊断价值[J]. 北京大学学报（医学版）, 2021, 53(1): 143-149.
[11] 吴君怡,余淼,孙仕晨,樊壮壮,郑静蕾,张刘陶,冯海兰,刘洋,韩冬. 少汗性外胚层发育不良患者EDA基因突变检测及表型分析[J]. 北京大学学报（医学版）, 2021, 53(1): 24-33.
[12] 张璐,胡小红,王庆文,蔡月明,赵金霞,刘湘源. 类风湿关节炎合并颈椎失稳的人群分布及临床特征[J]. 北京大学学报（医学版）, 2020, 52(6): 1034-1039.
[13] 徐贝宇,漆龙涛,王宇,李淳德,孙浩林,王诗军,于峥嵘,赵耀,刘龙龙. 短期头盆环牵引配合手术治疗重度脊柱畸形的临床疗效[J]. 北京大学学报（医学版）, 2020, 52(5): 875-880.
[14] 李秀翠,周玉博,司可艺,李宏田,张乐,张亚黎,刘菊芬,刘建蒙. 孕晚期妇女与新生儿血浆维生素A水平的相关性分析[J]. 北京大学学报（医学版）, 2020, 52(3): 464-469.
[15] 宁晓然,王子乔,张珊珊,张霞,唐素玫,刘燕鹰. 超声评分系统在IgG4相关涎腺炎评估中的应用[J]. 北京大学学报（医学版）, 2019, 51(6): 1032-1035.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部