维生素A有预防急性肾盂肾炎后瘢痕形成的作用【摘要】目的评估维生素A在预防儿童急性肾盂肾炎后肾瘢痕形成中的作用。方法挑选经临床及二毓基丁酸（DMSA）肾显像扫描确诊的急性肾盂肾炎的儿童进行临床试验研究，86例患者被随机分为两组,实验组接受头抱曲松和维生素A治疗，对照组只接受头泡曲松治疗，疗程6个月。治疗前与6个月后，进DMSA肾显像扫描，并比较两组之间的肾瘢痕形成及肾损伤的程度。结果共有86例患者（男女比例为17:69）进入本研究，平均年龄为3.7+1.2岁，实验组维生素A的平均水平为67±21Ug/dL,对照组为63±28ug/dLo实验前，两组间DMSA扫描肾损伤的程度无明显差异（P>0.05）,6个月后DMSA扫描结果显示，与对照组相比，实验组肾功能损伤及瘢痕形成的程度明显改善（P【关键词】肾盂肾炎维生素A肾脏瘢痕DMSA肾扫描中图分类号：R726.9文献标识码：A文章编号：1005-0515（2012）1-030-03VitaminAdecreasesrenalscarringafteracutepyelonephritisQinDayong(DepartmentofUrology,HuangchuanCountyPeople'sHospital,Xinyang465150,China)[Abstract[ObjectiveInordertoevaluatetheroleofvitaminAinpreventingrenalscaringafteracutepyelonephritisinchildren.MethodsSelectedthepatientsofacutepyelonephritisinchildrenbyclinicalanddimercaptosuccinicacid(DMSA)renalscintigraphyscanintheclinicaltrials,86parentswererandomlydividedintotwogroups,studygroupreceivedceftriaxoneandvitaminAandcontrolgrouponlyreceivedceftriaxonefor6months・DMSArenalscintigraphywasperformedbeforethestartofthetreatmentand6monthslater,andcomparedthedegreeofrenaldamageandrenalscarringbetweenthetwogroups・ResultsAtotalof86patients(male:female17:69)enrolledinthestudy,andtheaverageageof3.7±1.2years・TheaveragelevelofvitaminAwas67±21pg/dLinthestudygroup,thecontrolgroupwas63±28|ig/dL.Beforetheexperiment,DMSArenalscintigraphywasnotsign讦icantdifferencebetweenthetwogroups(P>0.05),theresultsofDMSAscanafter6monthsshowthat,comparedwiththecontrolgroup,thedegreeofrenalscarringandrenalfunctionweresign讦icantchangein现泌尿系解剖异常或泌尿系结石，DMSA肾显像检查发现肾脏瘢痕存在者。肾盂肾炎后肾脏损伤程度的DMSA肾显像诊断标准［14］：①无损伤：未发现缺损;②轻度损伤：缺损面积30%。1.2方法入选患者随机分成2组，实验组接受头抱曲松钠和维生素A治疗，而对照组只接受头抱曲松钠治疗。头抱曲松给药剂量为75mg/kg,每日两次，静脉滴注，疗程为10天，一个疗程后口服头抱氨茉糖浆（15mg/kg）进行预防性治疗。维生素A给予剂量为1500U/kg/day（最大剂量不超过50000U）［15］,肌肉注射。开始治疗前，测量两组血清维生素A水平。治疗开始前进行99mTc-DMSA肾显像，6个月后复查，通过扫描图像比较两组瘢痕形成和肾脏损害的程度。1.3统计学方法所有数据采用SPSS13.0统计学软件处理，进行卡方检验和t检验，（P[10]MullinGE.VitaminAandimmunitythestudygroup(PIII级），神经源性膀胱，超声检查发[J].NutrClinPract,2011,26(4):495-496.[11]AtadzhanovUZh,UtegenovNU.Structural-functionaldamagetocellularmembranesindeficiencyofvitaminsA,E,B2,B6,PPinchildrenwithcalculouspyelonephritis[J].Urologiia,2003,(1):35-41.[12]MaqboolA,Graham-MaarRC,SchallJI,etal.VitaminAintakeandelevatedserumretinollevelsinchildrenandyoungadultswithcysticfibrosis[J].JCystFibros,2008,7(2):137-141.[13]MohkamM,MahamS,RahmaniA,etal.TechnetiumTc99mdimercaptosuccinicacidrenalscintigraphyinchildrenwithacutepyelonephritis:correlationwithotherimagingtests[J].IranJKidneyDis,2011,5(4):284・[14]ZakiM,BadawiM,AlMutariG,etal.AcutepyelonephritisandrenalscarringinKuwaitichildren:afollow-upstudyusing99mTcDMSArenalscintigraphy[J].PediatrNephrol,2005,20(8):1116-1119.[15]BennCS,DinessBR,RothA,etal.Effectof50,000IUvitaminAgivenwithBCGvaccineonmortalityininfantsinGuinea-Bissau:randomisedplacebocontrolledtrial[J].BMJ,2008,336(7658):1416-1420.[16]Gutierrez-MazariegosJ,TheodosiouM,Campo・PaysaaF,etal.VitaminA:Amultfunctionaltoolfordevelopment[J].SeminCellDevBiol,2011,22(6):603-610・[17]SadeghiZ,KajbafzadehAM,TajikP,etal.VitaminEadministrationattheonsetoffeverpreventsrenalscarringinacutepyelonephritis[J].PediatrNephrol,2008,23(9):1503-1510.[18]SharifianM,AnvaripourN,KarimiA,etal.Theroleofdexamethasoneondecreasingurinarycytokinesinchildrenwithacutepyelonephritis[J].PediatrNephrol,2008,23(9):1511-1516.[19]YagmurluA,BolekenME,ErtoyD,etal.Preventiveeffectofpentoxifyllineonrenalscarringinratmodelofpyelonephritis[J].Urology,2003,61(5):1037-1041・[20]SoyluA,KavukuS,SarioluS,etal.TheeffectofvitaminAonthecourseofrenalablationnephropathy[J].PediatrNephrol,2001,16(6):472-476.
