- 期刊
Mass Urinary Screening and Follow-up for School Children in Taiwan Province
台灣省學童之尿液篩檢及追蹤
摘要
台灣少於1990年起針對公私立國民中小學的學生進行尿液篩檢，每學期一次，每次大約3百萬人次，首次檢查異常者於10到15天後接受第二次尿液檢查，第二次仍異常者才視爲異常。1992年起對尿液篩檢異常者均抽血加上生化項目的檢查，包括肌酸酐等。所有尿液篩檢異常者依血尿、蛋白尿這嚴重等予以分級，嚴重蛋白尿者爲”D”級，當血清檢查肌酸酐超過1.7mg/dl者，視爲腎功能已變差，歸入末期腎病。第位D級及末期腎病之學童每學期均有縱向連續抽血及驗尿之記錄，吾人並實際調閱病例，或電話查訪。本研究之目的爲：探討1992到1996年間，每年台灣省國小、國中尿液篩檢嚴重蛋白尿(D級)之盛行率及進展至末期腎病之盛行率。結果顯示由1992至1996台灣省公私立國民中小學尿液篌檢人次共爲10,288,620人次，經篩檢結果爲嚴重蛋白尿個案者共5,980人，亦即嚴重蛋白尿四年之盛行率爲每萬人口有5.81人。其中男童爲每萬人口有4.83人，女童爲6.87人，女童多於男童。依年齡分佈女童最高峰在12歲，男童在13歲。有關1992至1996年台灣省公私立國民中小學尿液篩檢人次中，發生末期腎病的個案數爲189人，換算成台灣省國民中小學生末期腎病四年之盛行率爲每十萬人口有1.84人，其中男童爲每十萬人口吸2.24人，女童爲1.41人，男童比女童易進行至末期腎病。所有個案由10歲開始有較高的發生密度，男童以14歲爲最高峰，女童以12歲爲最高峰。就其病因而言，腎炎仍是尿液篩檢異常的主因，而國人續發性腎炎則以紅斑性狼瘡腎炎最重要。總結：台灣省國民中小學生嚴重蛋白尿四年盛行率女童高於男童，但是末期腎病四年盛行率則男童高於女童。男童較易進行至末期腎病，高峰期在14歲。對於尿液篩檢異常病童建議均加作抗核抗體檢查。
並列摘要
Mass urinary screening has been carried out among the students of public and private elementary and junior high schools in the Province of Taiwan each semester since 1990. About 3 million students were screened each time. The students who had abnormal urine screening results at the first time received a second urine analysis 10 to 15 days later to confirm the abnormal urine analysis. The blood samples of the students with abnormal urine examination were taken and biochemistry examinations including creatinine (Cr) etc. were performed since 1992. All students with abnormal urine screening results were graded by the severity of hematuria and proteinuria, the heavy proteinuria graded as ”D” Chronic renal failure (CRF) is defined as impaired renal function with the serum Cr over 1.7 mg/dl. Longitudinal continuous blood and urine examinations were performed each semester for the students of grade ”D” and with CRF. CRF was confirmed by either the hospital medical records or telephone visit. The purpose of this study was to delineate the prevalence of heavy proteinuria (grade D) and CRF in the students of elementary and junior high school in the Taiwan Province from 1992 to 1996. The results revealed the number of urinary screening was 10,288,620. There were 5980 cases with heavy proteinuria with four-year prevalence of 5.81×10^(-4), 4.83×10^(-4) for boys; 6.87×10^(-4) for girls. Girls were affected more often than boys. The peak age of girls was 12 years old and boys was 13 years old. The number of CRF cases was 189 with the four-year prevalence of 1.84×10^( -5), 2.24×10^(-5) for boys; 1.41×10^(-5) for girls. The incidence rate increased after the age of 10; the peak age of boys being 14-year-old and of girls 12-year-old. The exact contributing factors, such as location on islet or lack of pediatric nephrolo gist, need further study. In conclusion, the four-year prevalence of heavy proteinuria in the students of the elementary and junior high schools in Taiwan was higher in girls than in boys. Glomerular nephritis (GN) is still one of the major causes of urinary abnormalities. The most-important secondary GN was systemic lupus erythematosus (SLE) with lupus nephritis. The percentage of SLE patients among anti-nuclear antibody (ANA) positive was 72%. In contrast, the four-year prevalence of CRF disease was higher in boys with the peak age at 14-year-old. GN is still the major cause of urinary screening abnormality. ANA study is indicated in all Chinese students with abnormal urinary screening.