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成都地区儿童青少年遗尿症流行病学调查及相关因素分析

【作者】 唐海铭

【导师】 张伟;

【作者基本信息】 重庆医科大学, 临床医学(专业学位), 2018, 硕士

【摘要】 目的:调查了解成都地区5-18岁儿童青少年遗尿症的流行病学特点、影响遗尿发生的相关因素,为本地区该疾病的防治提供参考依据。方法:随机分层整群抽取成都地区学校共12000名5~18岁儿童青少年进行无记名问卷调查,问卷内容包括:基本信息、遗尿的起始停止时间、遗尿的程度、遗尿有无其他伴随症状、有无遗尿家族史,父母文化程度及对遗尿子女的态度等。结果:实际发放调查问卷12000份,回收11348份,有效问卷10466份,有效问卷回收率为87.2%。1.现况调查10466人,其中男性5154人(49.2%),女性5312人(50.8%),成都地区儿童青少年遗尿症的总体患病率为3.9%。5岁患病率为9.4%,随着年龄增长遗尿症总体患病率呈下降趋势,12岁以后稳定于2.0%左右。5~11岁者326例(80.9%),12~18岁者77例(19.1%),5~11岁遗尿患儿明显多于12~18岁患儿。男性患病率(5.2%)高于女性(2.6%),差异有统计学意义(P<0.05)。2.回顾性调查5岁儿童遗尿症患病率为9.0%,8岁时为1.33%,9岁以后NE的患病率在1%以下,回顾性调查总体、男性和女性的遗尿症患病率均较现况调查低。3.患儿年龄、男性、性格内向、多动、注意力不集中、母亲怀孕时身体情况、遗尿家族史与儿童遗尿症发生具有明显相关性,通过对以上与儿童遗尿症发生具有明显相关性的因素进行Logistic回归得出患儿年龄、男性、性格内向、多动、有遗尿家族史是儿童遗尿症发生的危险因素(年龄:OR=1.029,95%CI 1.015~1.044,P<0.05;性别:OR=1.538,95%CI 1.393~1.698,P<0.05;性格内向:OR=1.321,95%CI 1.126~1.55,P<0.05;多动:OR=1.285,95%CI1.151~1.436,P<0.05;遗尿家族史:OR=3.691,95%CI 2.937~4.639,P<0.05)。4.本组资料,194例(50.5%)从1岁开始尿床,尿床最好发的季节为冬季(47.9%)。70%左右患儿平时喜欢吃甜食、睡前有喝水、喝饮料习惯。原发性遗尿症患儿225例(64.8%),继发性遗尿症患儿122例(35.2%)。54例(15%)伴日间下尿路症状者(尿频尿急、合并午睡时尿床),明显低于单症状性夜遗尿患儿296例(85%)。275例(70.7%)平均每晚睡眠时间≥9小时,但223例(57.9%)尿床后能醒来,208例(53.8%)尿床发生在入睡后5小时以后,175例(48.3%)患儿有睡眠过深难以唤醒的特点。尿床次数≤3次/周者278例(73.1%),4~6次/周者58例(15.2%),≥7次/周者43例(11.7%)。尿床频繁(>4次/周)的患儿在5~11岁和12~18分布不同,12~18岁组(30/74,40.5%)多于5~11岁(71/305,23.3%),差异有统计学意义(P<0.05)。本组资料241例(66.8%)父母认为尿床随着长大自然消失,不用就医;190例(52.6%)患儿有进行排尿训练,其中42例(22.1%)训练方法粗暴;175例(47.9%)既往使用纸尿裤。145例(39.9%)患儿既往因遗尿就医,94例(64.8%)采用行为治疗,49例(33.8%)采用口服去氨加压素治疗,2例(1.4%)采用行为治疗+药物治疗,97例(66.9%)患儿治疗后明显好转或症状消失,药物治疗与行为治疗效果差异无统计学意义。尿床次数≥4次/周,既往就医的患儿有60例(60/95,63.2%),明显高于尿床次数≤3次既往就医的患儿89例(89/260,34.2%),差异有统计学意义(P<0.05)。结论:1.成都地区儿童青少年整体遗尿症发生率为3.9%,5~11岁儿童为3.6%~9.4%,12岁以后遗尿症发病率在2.0%左右,整体遗尿症发病率随年龄增长呈下降趋势。2.本组资料,尿床频繁的患儿更容易将尿床症状持续至成年期。3.男性、性格内向、多动、遗尿家族史是本地区儿童遗尿症发生的危险因素,本地区遗尿症发病年龄稍大,继发性遗尿症发生率相对较高。4.本组资料显示家长对疾病的认知度、疾病治疗的依从性不足,应加强对该疾病防治的宣教,及该疾病进一步规范化治疗及管理等。

【Abstract】 Objective:To study epidemiological characteristics and the related factors of nocturnal enuresis in school children in Chengdu,to provide the reference for the prevention and treatment of the disease.Methods:We send a questionnaire randomly to parents of12000 school children,aged 5-18 years.The questionnaire included demographic characteristics of the child and family,cross-sectional questions about nocturnal enuresis and the age of stopping bedwetting.Results:12000 questionnaires were actually sent,and 11348 was in response.Of which,10466 questionnaires were finally used for statistic analysis.1.In cross-sectional study of 10466 children,5154 were boys(49.2%)and 5312 were girls(50.8%).The overall prevalence of NE was 3.9%,prevalence was 9.4% in 5-years group,decline with age,and stablized at around 2.0% after 12 years old.There were 326 cases nocturia children in 5 to 11 years old,and 77 cases in 12 to 18 years old,the former was significantly greater than the latter.The prevalence of NE among boys and girls was 5.9%and 2.6%,the difference was statistically significant.(P<0.05).2.Retrospective study the prevance of NE in 5-year group was9.0%,1.33% in 8-year group,and was under 1.0% after 9 years old.Retrospective study of Prevancre in both boys and girls of NE were lower than the cross-sectional study.3.Factors associated with NE include age,male gender,introversion,hyperactivity,inattention,physical condition of mother in pregnant,family history of enuresis.The Logistic regression showed that age,gender,introversion,hyperactivity,positive family history of enuresis was the risk factors of children in nocturnal enuresis(age:OR=1.029,95%CI1.015~1.044,P<0.05;gender:OR=1.538,95%CI1.393~1.698,P<0.05;introversion:OR=1.321,95%CI1.126~1.55,P<0.05;hyperacti vity: OR=1.285,95%CI1.151~1.436,P<0.05;positive family history of enuresis:OR=3.691,95%CI2.937 ~4.639,P<0.05).4.194 cases(50.5%)began to wet the bed from the age of 1 year,and the most favorable season for the bedwetting was winter(47.9%).About 70% of children used to eat sweets and drink water before going to bed.There were 225 children with PNE(64.8%)and 122 children with SNE(35.2%).54 patients(15%)were with symptoms of daytime urinary tract symptoms(urinary frequency,urgency,wetting bed during nap),which was significantly lower than the number of MNE(85%).Although 275 cases(70.7%)slept over 9hours per night,223 cases(57.9%)woke up after bedwetting,208 cases(53.8%)of bedwetting occurred 5 hours after sleep,and 175 cases(48.3%)slept too deep to wake up.There were 278 patient(73.1%)who wetted bed≤ 3 times per week,58 cases(15.2%)in 4~6 times per week,and 43 cases(11.7%)more than 7 times per week.The number of children with frequent bed-wetting was different between 5~11 years old and 12~18 years old.12 to 18 years old group(30/74,40.5%)was more than 5~11 years old group(71/305,23.3%),the difference was statistically significant(P<0.05).241 cases(66.8%)of parents thought that the bed-wetting should disappear without medical treatment.190 cases(52.6%)had urination training,of which 42 cases(22.1%)were violent.175 cases(47.9%)used diapers.145 cases(39.9%)went to a doctor for bedwetting treatment,94 cases(64.8%)treated with behavioral therapy,49 cases(33.8%)with oral desmopressin,2 cases(1.4%)with behavioral therapy and drug treatment,97 cases(66.9%)symptoms improved significantly or disappeared after treatment,there was no statistically significant difference effect of drug therapy and behavior therapy.There were 60 cases(60/95,63.2%)of the children with frequent bed-wetting who saw a doctor,which was significantly higher than the children with infrequent bed-wetting(89/260,34.2%),and the difference was statistically significant(P<0.05).Conclusion:1.The overall prevalence of NE is 3.9% in Chengdu area,the prevalence of children aged 5 to 11 is 3.6% to 9.4%,and around 2.0%after 12 years old,the overall morbidity of enuresis decreases with age.2.In this group,children with frequent bed-wetting were more likely to develop the symptoms of bed-wetting into adulthood.3.Male,introversion,hyperactivity and family history of the family may be the risk factors for children’s enuresis in the region.The incidence of NE in this area is slightly older,and the incidence of SNE is relatively high.4.The data showed that parents’ awareness of the disease and the compliance of disease treatment were insufficient.The prevention and treatment of the disease should be strengthened and further standardized treatment and management.

【关键词】 儿童遗尿症流行病学相关因素
【Key words】 school childenuresisepidemiologyrelated factor
  • 【网络出版投稿人】 重庆医科大学
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