Objective: To explore the prognosis and risk factors of pyelectasis in high-risk infants. Methods: This was a retrospective study. Totally 960 high-risk infants, who accepted type B ultrasonic examination for fetus at 28th week of gestation and for newborns in 48 hours after birth, were included in the study in departments of obstetrics and eonatology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital during May 2012 to April 2013. The degree of pyelectasis was classified using Grignon grade and the paients were followed up for 3 years. The factors of epidemiology, high risk pregnant women, fetus and high-risk newborns that relate to pyelectasis were summarized. High-risk factors were analyzed by using logistic multivariate regression analysis. Results: Of 960 high-risk infants, 103 had abnormal urinary ultrasound results, 87 (9.1% of high-risk infants) were diagnosed with pyelectasis, 16 (1.7% of high-risk infants) were diagnosed with congenital anomalies of the kidney and urinary tract. According to the degree of pyelectasis, 68 infants were Grignon grade Ⅰ, male:female ratio=5.8∶1, left side:right side ratio=1.91∶1; 19 infants were Grignon grade Ⅱ, male:female ratio=5.33∶1, left side:right side ratio=2.12∶1. Postnatal follow-up results showed that pyelectasis disappeared in 48 cases (55% of pyelectasis cae), 40 infants were Grignon grade Ⅰ (59% of all Grignon grade Ⅰ patients), 8 infants were Grignon grade Ⅱ (42% of all Grignon grade Ⅱ patients); The result of risk factors analysis showed that the risk of pyelectasis in males was 4.368 times that of females (95%CI: 2.33-8.189, P<0.05); the risk of pyelectasis in low birth weight infants was 22.434 times that of non low birth weight infants (95% CI: 5.883-85.547, P<0.05). Conclusion: The incidence of pyelectasis in high-risk infants was 9.1%. The mitigation rate of pyelectasis in Grignon grade Ⅰ to Ⅱ in fetal or newborn period is high. Patients in Grignon grade Ⅲ and above in fetal or new born period had high risk of congenital anomalies of the kidney and urinary tract. The risk of pyelectasis of male was higher than that of female; the risk of pyelectasis of low birth weight infant was higher than appropriate for gestational age infants.
目的： 了解肾盂扩张在高危新生儿群体中的发生、发展及预后情况，分析肾盂扩张在高危儿群体中的相关危险因素。 方法： 回顾性分析2012年5月至2013年4月北京儿童医院顺义妇儿医院产科及新生儿科收治的960例分娩的高危儿，在孕28周及分娩后48 h分别进行1次胎儿及新生儿泌尿系B超筛查，采用Grignon方法进行肾盂扩张程度分级，并进行生后随访3年。分析高危儿肾盂扩张发生相关的人口学特征、孕产妇因素、胎儿及新生儿因素，采用Logistic多因素回归分析、筛选高危儿发生肾盂扩张的危险因素。 结果： （1）筛查的960例高危儿中，泌尿系B超异常103例，其中不明原因肾盂扩张87例（占高危儿9.1%），先天性肾脏及泌尿道异常16例（占高危儿1.7%）。（2）根据肾盂扩张程度分组，Grignon Ⅰ级68例，男∶女=5.8∶1，肾盂扩张侧左∶右=1.91∶1；Grignon Ⅱ级19例，男∶女=5.33∶1，左∶右=2.12∶1。（3）生后随访3年肾盂扩张消失48例，占不明原因肾盂扩张患儿55%，其中68例Grignon Ⅰ级患儿40例有肾盂扩张消失（59%），19例Grignon Ⅱ级患儿有8例肾盂扩张消失（42%）；（4）高危儿肾盂扩张危险因素：男性出现肾盂扩张的风险是女性的4.368倍（95% CI：2.33~8.189，P<0.05）；低出生体重儿出现肾盂扩张的风险是适于胎龄儿的22.434倍（95% CI：5.883~85.547，P<0.05）。 结论： （1）高危儿肾盂扩张发生率9.1%。胎儿期或新生儿期GrignonⅠ~Ⅱ级肾盂扩张缓解率高；胎儿期或新生儿期Grignon Ⅲ级及以上肾盂扩张合并有先天性肾脏及泌尿道异常可能性高。（2）男性高危儿发生肾盂扩张的风险高于女性，低出生体重高危儿发生肾盂扩张的风险高于适于胎龄儿。.
Keywords: Follow-up studies; High-risk; Pyelectasis; Risk factors.