Pyelonephritis and Reflux Nephropathy in Young Infants with Urinary Tract Infection

腎盂腎炎和逆流性腎病變在年幼嬰兒之泌尿道感染

顏志瑋(Chih-Wei Yen) ； 洪焜隆(Kun-Long Hung)

《輔仁醫學期刊》 3卷4期 (2005/12) Pp. 221-229

摘要

背景和目的：我們針對本院及內湖分院小於三個月齡嬰幼兒泌尿道感染作四年的回溯性分析。方法：從1999年7月至2003年6月我們一共收集了152例年齡小於三個月因泌尿道感染而住院的病嬰。其中男孩127例，女孩25例，男女比約為5.1比1。結果：發燒為臨床上最常見到也是大多數病嬰唯一的症狀。20.4%的病童在尿液鏡檢時並無膿尿發現，也有10.5%的病童在鏡檢時找不到細菌。尿液試紙反應nitrite陽性率21.1%，明顯低於一般成人尿道感染的報告。所有檢體一共分離出152株細菌，最多的是大腸桿菌(86.8%)，其次是克列勃氏菌(5.9%)。大腸桿菌對ampicillin有高達87.1%的抗藥性。有96位接受膀胱輸尿管逆流攝影，27位(28.1%)證實有膀胱輸尿管逆流。而在50位接受DMSA腎臟核子醫學掃瞄檢查的病嬰中，有26位(52%)經掃瞄診斷為急性腎盂腎炎。經由腎臟超音波來預測病嬰是否可能有膀胱輸尿管逆流或腎盂腎炎的偵測敏感度不一，分別為31.3%及66.7%。膀胱輸尿管逆流以往經常被認為是造成急性腎盂腎炎的主因，但我們的急性腎盂腎炎病嬰中，僅26.9%證實有膀胱輸尿管逆流。我們從臨床症狀及一些急性炎症指標去分析膀胱輸尿管逆流或腎盂腎炎的危險因子，統計發現：在有膀胱輸尿管逆流的病童，其周邊血液白血球總數較高；而急性腎盂腎炎的病童其發燒天數及C-reactiveprotein值有明顯統計上的差異。結論：小於三個月因泌尿道感染而住院的病嬰，最多的是大腸桿菌，且對ampicillin有極高的抗藥性。逆流性病變的病嬰其血液白血球總數較高；而明顯較長的發燒天數及較高的C-reactive protein值則此病嬰有急性腎盂腎炎可能性較大。

關鍵字

泌尿道感染 ； 嬰兒 ； 腎盂腎炎 ； 膀胱輸尿管逆流

並列摘要

Background and Purpose: We attempted to evaluate the clinical data between reflux nephropathy and acute pyelonephritis in young infants with urinary tract infection (UTI). Methods: We retrospectively reviewed data on 152 young infants (127 boys and 25 girls) under 3 months of age who were hospitalized with their first known acute UTI from July 1999 to June 2003. Clinical presentations, laboratory data, and image studies were recognized and analyzed. Results: A low positive rate for the nitrite reaction (21.1%) was found with the urinary dipstick test. Escherichia coli was the most-common pathogen (132/152; 86.8%) and was exclusively resistant to ampicillin (87.1%). A voiding cystourethrogram was performed in 96 cases, among which 28.1% (27/96) of those patients showed vesicoureteric reflux. Fifty patients received 99mTcdimercaptosuccinic acid renal scans, and 26 cases (52%) had abnormal findings compatible with pyelonephritis. The positive predictive values of renal ultrasonography for vesicoureteric reflux and pyelonephritis were 31.3% and 66.7%, respectively. In pyelonephritis patients, only 26.9% also had vesicoureteric reflux. Higher peripheral blood white blood cell (WBC) counts were found in patients with vesicoureteric reflux, and patients with acute pyelonephritis had high C-reactive protein values. Conclusion: Escherichia coli was the most-common pathogen responsible for urinary tract infection in these young infants, and it had high ampicillin resistance. Leukocytosis indicated a risk of vesicoureteric reflux and a high C-reactive protein concentration, while prolonged fever duration indicated a risk of pyelonephritis.

並列關鍵字

urinary tract infection ； infant ； pyelonephritis ； vesicoureteric reflux