发热性尿路感染患儿Na+/K+失衡的发生率及影响因素

doi:10.3969/j.issn.1004-583X.2026.06.010

摘要/Abstract

摘要：

目的探讨发热性尿路感染(febrile urinary tract infection,FUTI)患儿Na⁺/K⁺失衡的发生率及影响因素。方法纳入2022年1月-2025年12月于天津市儿童医院住院治疗的FUTI患儿716例,回顾性分析其临床资料。将Na⁺/K⁺失衡分为低钠血症(血钠<135 mmol/L)、高钠血症(血钠>145 mmol/L)、低钾血症(血钾<3.5 mmol/L)、高钾血症(血钾>5.5 mmol/L),以及低钠血症伴高钾血症(血钠<135 mmol/L伴血钾>5.5 mmol/L)。计算各类型Na⁺/K⁺失衡的发生率。采用logistic回归分析探究出现低钠血症、高钾血症及低钠血症伴高钾血症的影响因素。结果纳入的716例患儿中,低钠血症305例(42.6%),高钾血症55例(7.7%),低钾血症12例(1.7%),高钠血症0例。此外,低钠血症伴高钾血症17例(2.4%)。在多因素logistic回归分析中,抗生素治疗后发热时间和C-反应蛋白均是FUTI患儿发生低钠血症的独立危险因素(OR=1.361、1.007; 95%CI: 1.203~1.540、1.004~1.010; 均P<0.01);年龄和先天性肾脏和尿路畸形(congenital anomalies of the kidney and urinary tract,CAKUT)均是FUTI患儿发生高钾血症的独立危险因素(OR=0.918、2.574; 95%CI: 0.862~0.978、1.409~4.701; P=0.008、0.002);C-反应蛋白和CAKUT均是FUTI患儿发生低钠血症伴高钾血症的独立危险因素(OR=1.011、3.445; 95%CI: 1.004~1.018、1.279~9.282; P=0.002、0.014)。即使在调整了肾发育不全、肾盂-肾盏扩张、输尿管扩张、非大肠杆菌感染后,CAKUT仍是FUTI患儿发生低钠血症伴高钾血症的独立危险因素(OR=8.098,95%CI: 2.196~29.863,P=0.002)。结论 FUTI患儿出现Na⁺/K⁺失衡以低钠血症最为常见,其次为高钾血症和低钠血症伴高钾血症。在儿童FUTI病程中,低钠血症可能提示更严重的炎症反应;对合并高钾血症的患儿需考虑到潜在CAKUT可能。

关键词: 尿路感染, 儿童, 继发性假性醛固酮减少症, 钠, 钾

Abstract:

Objective To investigate the incidence and associated risk factors of Na⁺/K⁺ imbalance in children with febrile urinary tract infection (FUTI). Methods A total of 716 children with FUTI hospitalized at Tianjin Children’s Hospital from January 2022 to December 2025 were included, and their clinical data were retrospectively analyzed. Na⁺/K⁺ imbalance was classified as hyponatremia (serum sodium <135 mmol/L), hypernatremia (serum sodium >145 mmol/L), hypokalemia (serum potassium <3.5 mmol/L), hyperkalemia (serum potassium >5.5 mmol/L), and hyponatremia with hyperkalemia (serum sodium <135 mmol/L accompanied by serum potassium >5.5 mmol/L). The incidence of each type of Na⁺/K⁺ imbalance was calculated. Logistic regression was used to identify factors associated with hyponatremia, hyperkalemia, and hyponatremia with hyperkalemia. Results Among the 716 included children, 305 cases (42.6%) had hyponatremia, 55 cases (7.7%) had hyperkalemia, 12 cases (1.7%) had hypokalemia, and no cases of hypernatremia were observed. In addition, 17 cases (2.4%) had hyponatremia with hyperkalemia. In multivariable logistic regression analysis, fever duration after antibiotic treatment and CRP were both independent risk factors for hyponatremia in children with FUTI (OR=1.361, 1.007; 95%CI: 1.203-1.540, 1.004-1.010; both P<0.01). Age and congenital anomalies of the kidney and urinary tract (CAKUT) were both independent risk factors for hyperkalemia in children with FUTI (OR=0.918, 2.574; 95%CI: 0.862-0.978, 1.409-4.701; P=0.008, 0.002). CRP and CAKUT were both independent risk factors for hyponatremia with hyperkalemia in children with FUTI (OR=1.011, 3.445; 95%CI: 1.004-1.018, 1.279-9.282; P=0.002, 0.014). Even after adjusting for renal hypoplasia, pelvicalyceal dilatation, ureteral dilatation, and non-Escherichia coli infection, CAKUT remained an independent risk factor for hyponatremia with hyperkalemia in children with FUTI (OR=8.098, 95%CI: 2.196-29.863, P=0.002). Conclusion Among children with FUTI, Na⁺/K⁺ imbalance most commonly manifests as hyponatremia, followed by hyperkalemia and hyponatremia with hyperkalemia. During the course of pediatric FUTI, hyponatremia may indicate a more severe inflammatory response, and children with concomitant hyperkalemia should be evaluated for possible underlying CAKUT.

Key words: urinary tract infection, children, secondary pseudohypoaldosteronism, sodium, potassium

中图分类号:

R691.3

杨群兰, 王文红. 发热性尿路感染患儿Na⁺/K⁺失衡的发生率及影响因素[J]. 临床荟萃, 2026, 41(6): 539-545.

Yang Qunlan, Wang Wenhong. Incidence and risk factors of Na⁺/K⁺ imbalance in children with febrile urinary tract infection[J]. Clinical Focus, 2026, 41(6): 539-545.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.06.010

https://www.lchc.cn/CN/Y2026/V41/I6/539

图/表 5

参考文献 25

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编号	年龄 (月)	血钠 (mmol/L)	血钾 (mmol/L)	血氯 (mmol/L)	CRP (mg/L)	阴离子间隙 (mmol/L)	血pH值	血HC ${O}_{3}^{-}$ (mmol/L)	血碱剩余 (mmol/L)	血醛固酮 (ng/L)	CAKUT
A	3	124	6.71	94.0	12.6	16.7	7.350	16.7	-6.9	>4 000	左肾积水
B	2	133	6.00	96.9	51.8	21.0	7.324	19.4	-4.9	472.61	右肾积水
C	2	127	6.19	94.7	24.0	19.8	-	-	-	2 202.84	左肾盂及输尿管全程扩张
D	3	134	5.87	98.7	127.6	23.4	-	-	-	311.18	无
E	1	128	5.96	92.7	221.2	27.9	7.342	17.7	-6.5	1 336.6	双肾积水伴输尿管全程扩张

编号	年龄 (月)	血钠 (mmol/L)	血钾 (mmol/L)	血氯 (mmol/L)	CRP (mg/L)	阴离子间隙 (mmol/L)	血pH值	血HC ${O}_{3}^{-}$ (mmol/L)	血碱剩余 (mmol/L)	血醛固酮 (ng/L)	CAKUT
A	3	124	6.71	94.0	12.6	16.7	7.350	16.7	-6.9	>4 000	左肾积水
B	2	133	6.00	96.9	51.8	21.0	7.324	19.4	-4.9	472.61	右肾积水
C	2	127	6.19	94.7	24.0	19.8	-	-	-	2 202.84	左肾盂及输尿管全程扩张
D	3	134	5.87	98.7	127.6	23.4	-	-	-	311.18	无
E	1	128	5.96	92.7	221.2	27.9	7.342	17.7	-6.5	1 336.6	双肾积水伴输尿管全程扩张

变量	低钠血症
变量	否(n=411)	是(n=305)		Z/χ²值	P值
男[例(%)]	202(49.1)	162(53.1)		1.012	0.294
年龄(月)	6(4, 11)	7(4, 12)		-1.004	0.315
低出生体重儿[例(%)]	31(7.5)	19(6.2)		0.465	0.495
早产儿[例(%)]	34(8.3)	27(8.9)		0.076	0.783
呕吐/腹泻[例(%)]	43(10.5)	43(14.1)		2.190	0.139
治疗前发热时间(d)	1(1, 2.5)	1(1, 2)		-1.131	0.258
治疗后发热时间(d)	2(1, 3)	2(2, 3)		-6.546	<0.01
最高腋温(℃)	39.2(38.8, 39.7)	39.5(39, 40)		-3.877	<0.01
血钠(mmol/L)	136(135, 138)	133(132, 134)		-23.056	<0.01
血钾(mmol/L)	4.67(4.3, 5.03)	4.55(4.22, 4.96)		-2.339	0.019
血氯(mmol/L)	100.6(99, 102.2)	96.9(95.05, 98.55)		-16.691	<0.01
急性肾损伤[例(%)]	6(1.5)	9(3.0)		1.897	0.168
CRP(mg/L)	52.6(28.1, 85.6)	69.4(38.6, 117.5)		-4.939	<0.01
降钙素原(ng/L)	0.42(0.18, 1.62)	0.89(0.29, 3.29)		-5.667	<0.01
血白细胞计数(×10⁹/L)	15.82(10.96, 19.86)	16.32(12.94, 21.16)		-2.662	0.008
中性粒细胞比例(%)	57.1(49.1, 66.2)	61.5(52.55, 72.7)		-4.654	<0.01
血小板计数(×10⁹/L)	372(296, 461)	341(277.5, 429.5)		-2.973	0.003
非大肠杆菌感染[例(%)]	44(10.7)	43(14.1)		1.888	0.169
CAKUT[例(%)]	75(18.2)	64(21.0)		0.837	0.360
双侧CAKUT[例(%)]	21(5.1)	24(7.9)		2.263	0.132
膀胱输尿管反流[例(%)]	5(1.2)	7(2.3)		1.236	0.266
巨输尿管[例(%)]	17(4.1)	18(5.9)		1.174	0.279
肾盂输尿管连接部梗阻[例(%)]	3(0.7)	2(0.7)		0.014	0.906
单侧或双侧肾发育不全[例(%)]	5(1.2)	3(1.0)		0.086	0.769
变量	高钾血症
变量	否(n=661)		是(n=55)	Z/χ²值	P值
男[例(%)]	330(49.9)		34(61.8)	2.874	0.090
年龄(月)	6(4, 12)		4(2, 6)	-5.388	<0.01
低出生体重儿[例(%)]	46(7.0)		4(7.3)	0.008	0.930
早产儿[例(%)]	53(8.0)		8(14.6)	2.776	0.096
呕吐/腹泻[例(%)]	82(12.4)		4(7.3)	1.266	0.261
治疗前发热时间(d)	1(1, 2)		1(1, 2)	-0.622	0.534
治疗后发热时间(d)	2(1, 3)		2(1, 3)	-0.043	0.966
最高腋温(℃)	39.4(38.9, 39.8)		39.1(38.7, 39.7)	-1.656	0.098
血钠(mmol/L)	135(133, 137)		136(134, 137)	-1.615	0.106
血钾(mmol/L)	4.57(4.24, 4.9)		5.79(5.63, 5.96)	-12.333	<0.01
血氯(mmol/L)	99(97, 101.1)		100.5(97.4, 102)	-1.936	0.053
急性肾损伤[例(%)]	14(2.1)		1(1.8)	0.022	0.881
CRP(mg/L)	60.6(31.6, 100)		54(25.6, 88.6)	-0.694	0.488
降钙素原(ng/L)	0.59(0.21, 2.24)		0.5(0.19, 2.93)	-0.286	0.775
血白细胞计数(×10⁹/L)	16.12(11.74, 20.32)		15.26(12.59, 20.75)	-0.089	0.929
中性粒细胞比例(%)	60(50.8, 69)		57.2(45, 65.3)	-1.942	0.052
血小板计数(×10⁹/L)	355(283.5, 440.5)		392(319, 478)	-2.442	0.015
非大肠杆菌感染[例(%)]	76(11.5)		11(20.0)	3.439	0.064
CAKUT[例(%)]	120(18.2)		19(34.5)	8.720	0.003
双侧CAKUT[例(%)]	39(5.9)		6(10.9)	2.163	0.141
膀胱输尿管反流[例(%)]	11(1.7)		1(1.8)	0.007	0.932
巨输尿管[例(%)]	33(5.0)		2(3.6)	0.201	0.654
肾盂输尿管连接部梗阻[例(%)]	5(0.8)		0	0.419	0.517
单侧或双侧肾发育不全[例(%)]	8(1.2)		0	0.673	0.412
变量	低钠血症伴高钾血症
变量	否(n=699)		是(n=17)	Z/χ²值	P值
男[例(%)]	354(50.6)		10(58.8)	0.444	0.505
年龄(月)	6(4, 12)		3(2, 7.5)	-2.754	0.006
低出生体重儿[例(%)]	48(6.9)		2(11.8)	0.613	0.434
早产儿[例(%)]	59(8.4)		2(11.8)	0.235	0.628
呕吐/腹泻[例(%)]	84(12.0)		2(11.8)	0.001	0.975
治疗前发热时间(d)	1(1, 2)		1(1, 2.5)	-0.142	0.887
治疗后发热时间(d)	2(1, 3)		3(2, 3)	-1.625	0.104
最高腋温(℃)	39.4(38.9, 39.8)		39.5(38.5, 39.7)	-0.505	0.614
血钠(mmol/L)	135(133, 137)		133(128.5, 134)	-4.336	<0.01
血钾(mmol/L)	4.62(4.26, 4.96)		5.95(5.85, 6.18)	-6.902	<0.01
血氯(mmol/L)	99.2(97.1, 101.3)		96.3(93.35, 98.75)	-3.857	<0.01
急性肾损伤[例(%)]	14(2.0)		1(5.9)	1.218	0.270
CRP(mg/L)	59.4(30.6, 98.4)		88.6(56.05, 156.4)	-2.385	0.017
降钙素原(ng/L)	0.57(0.21, 2.21)		1.29(0.45, 4.86)	-1.943	0.052
血白细胞计数(×10⁹/L)	16.08(11.73, 20.22)		19.67(13.92, 23.93)	-1.585	0.113
中性粒细胞比例(%)	59.7(50.5, 68.2)		60.2(49.4, 72.2)	-0.196	0.845
血小板计数(×10⁹/L)	356(285, 445)		395(367.5, 490.5)	-2.152	0.031
非大肠杆菌感染[例(%)]	84(12.0)		3(17.6)	0.493	0.483
CAKUT[例(%)]	131(18.7)		8(47.1)	8.507	0.004
双侧CAKUT[例(%)]	42(6.0)		3(17.6)	3.817	0.051
膀胱输尿管反流[例(%)]	12(1.7)		0	0.297	0.586
巨输尿管[例(%)]	34(4.9)		1(5.9)	0.037	0.847
肾盂输尿管连接部梗阻[例(%)]	5(0.7)		0	0.122	0.726
单侧或双侧肾发育不全[例(%)]	8(1.1)		0	0.197	0.657

变量	低钠血症
变量	否(n=411)	是(n=305)		Z/χ²值	P值
男[例(%)]	202(49.1)	162(53.1)		1.012	0.294
年龄(月)	6(4, 11)	7(4, 12)		-1.004	0.315
低出生体重儿[例(%)]	31(7.5)	19(6.2)		0.465	0.495
早产儿[例(%)]	34(8.3)	27(8.9)		0.076	0.783
呕吐/腹泻[例(%)]	43(10.5)	43(14.1)		2.190	0.139
治疗前发热时间(d)	1(1, 2.5)	1(1, 2)		-1.131	0.258
治疗后发热时间(d)	2(1, 3)	2(2, 3)		-6.546	<0.01
最高腋温(℃)	39.2(38.8, 39.7)	39.5(39, 40)		-3.877	<0.01
血钠(mmol/L)	136(135, 138)	133(132, 134)		-23.056	<0.01
血钾(mmol/L)	4.67(4.3, 5.03)	4.55(4.22, 4.96)		-2.339	0.019
血氯(mmol/L)	100.6(99, 102.2)	96.9(95.05, 98.55)		-16.691	<0.01
急性肾损伤[例(%)]	6(1.5)	9(3.0)		1.897	0.168
CRP(mg/L)	52.6(28.1, 85.6)	69.4(38.6, 117.5)		-4.939	<0.01
降钙素原(ng/L)	0.42(0.18, 1.62)	0.89(0.29, 3.29)		-5.667	<0.01
血白细胞计数(×10⁹/L)	15.82(10.96, 19.86)	16.32(12.94, 21.16)		-2.662	0.008
中性粒细胞比例(%)	57.1(49.1, 66.2)	61.5(52.55, 72.7)		-4.654	<0.01
血小板计数(×10⁹/L)	372(296, 461)	341(277.5, 429.5)		-2.973	0.003
非大肠杆菌感染[例(%)]	44(10.7)	43(14.1)		1.888	0.169
CAKUT[例(%)]	75(18.2)	64(21.0)		0.837	0.360
双侧CAKUT[例(%)]	21(5.1)	24(7.9)		2.263	0.132
膀胱输尿管反流[例(%)]	5(1.2)	7(2.3)		1.236	0.266
巨输尿管[例(%)]	17(4.1)	18(5.9)		1.174	0.279
肾盂输尿管连接部梗阻[例(%)]	3(0.7)	2(0.7)		0.014	0.906
单侧或双侧肾发育不全[例(%)]	5(1.2)	3(1.0)		0.086	0.769
变量	高钾血症
变量	否(n=661)		是(n=55)	Z/χ²值	P值
男[例(%)]	330(49.9)		34(61.8)	2.874	0.090
年龄(月)	6(4, 12)		4(2, 6)	-5.388	<0.01
低出生体重儿[例(%)]	46(7.0)		4(7.3)	0.008	0.930
早产儿[例(%)]	53(8.0)		8(14.6)	2.776	0.096
呕吐/腹泻[例(%)]	82(12.4)		4(7.3)	1.266	0.261
治疗前发热时间(d)	1(1, 2)		1(1, 2)	-0.622	0.534
治疗后发热时间(d)	2(1, 3)		2(1, 3)	-0.043	0.966
最高腋温(℃)	39.4(38.9, 39.8)		39.1(38.7, 39.7)	-1.656	0.098
血钠(mmol/L)	135(133, 137)		136(134, 137)	-1.615	0.106
血钾(mmol/L)	4.57(4.24, 4.9)		5.79(5.63, 5.96)	-12.333	<0.01
血氯(mmol/L)	99(97, 101.1)		100.5(97.4, 102)	-1.936	0.053
急性肾损伤[例(%)]	14(2.1)		1(1.8)	0.022	0.881
CRP(mg/L)	60.6(31.6, 100)		54(25.6, 88.6)	-0.694	0.488
降钙素原(ng/L)	0.59(0.21, 2.24)		0.5(0.19, 2.93)	-0.286	0.775
血白细胞计数(×10⁹/L)	16.12(11.74, 20.32)		15.26(12.59, 20.75)	-0.089	0.929
中性粒细胞比例(%)	60(50.8, 69)		57.2(45, 65.3)	-1.942	0.052
血小板计数(×10⁹/L)	355(283.5, 440.5)		392(319, 478)	-2.442	0.015
非大肠杆菌感染[例(%)]	76(11.5)		11(20.0)	3.439	0.064
CAKUT[例(%)]	120(18.2)		19(34.5)	8.720	0.003
双侧CAKUT[例(%)]	39(5.9)		6(10.9)	2.163	0.141
膀胱输尿管反流[例(%)]	11(1.7)		1(1.8)	0.007	0.932
巨输尿管[例(%)]	33(5.0)		2(3.6)	0.201	0.654
肾盂输尿管连接部梗阻[例(%)]	5(0.8)		0	0.419	0.517
单侧或双侧肾发育不全[例(%)]	8(1.2)		0	0.673	0.412
变量	低钠血症伴高钾血症
变量	否(n=699)		是(n=17)	Z/χ²值	P值
男[例(%)]	354(50.6)		10(58.8)	0.444	0.505
年龄(月)	6(4, 12)		3(2, 7.5)	-2.754	0.006
低出生体重儿[例(%)]	48(6.9)		2(11.8)	0.613	0.434
早产儿[例(%)]	59(8.4)		2(11.8)	0.235	0.628
呕吐/腹泻[例(%)]	84(12.0)		2(11.8)	0.001	0.975
治疗前发热时间(d)	1(1, 2)		1(1, 2.5)	-0.142	0.887
治疗后发热时间(d)	2(1, 3)		3(2, 3)	-1.625	0.104
最高腋温(℃)	39.4(38.9, 39.8)		39.5(38.5, 39.7)	-0.505	0.614
血钠(mmol/L)	135(133, 137)		133(128.5, 134)	-4.336	<0.01
血钾(mmol/L)	4.62(4.26, 4.96)		5.95(5.85, 6.18)	-6.902	<0.01
血氯(mmol/L)	99.2(97.1, 101.3)		96.3(93.35, 98.75)	-3.857	<0.01
急性肾损伤[例(%)]	14(2.0)		1(5.9)	1.218	0.270
CRP(mg/L)	59.4(30.6, 98.4)		88.6(56.05, 156.4)	-2.385	0.017
降钙素原(ng/L)	0.57(0.21, 2.21)		1.29(0.45, 4.86)	-1.943	0.052
血白细胞计数(×10⁹/L)	16.08(11.73, 20.22)		19.67(13.92, 23.93)	-1.585	0.113
中性粒细胞比例(%)	59.7(50.5, 68.2)		60.2(49.4, 72.2)	-0.196	0.845
血小板计数(×10⁹/L)	356(285, 445)		395(367.5, 490.5)	-2.152	0.031
非大肠杆菌感染[例(%)]	84(12.0)		3(17.6)	0.493	0.483
CAKUT[例(%)]	131(18.7)		8(47.1)	8.507	0.004
双侧CAKUT[例(%)]	42(6.0)		3(17.6)	3.817	0.051
膀胱输尿管反流[例(%)]	12(1.7)		0	0.297	0.586
巨输尿管[例(%)]	34(4.9)		1(5.9)	0.037	0.847
肾盂输尿管连接部梗阻[例(%)]	5(0.7)		0	0.122	0.726
单侧或双侧肾发育不全[例(%)]	8(1.1)		0	0.197	0.657

变量	单因素			多因素
变量	OR值	95%CI	P值	OR值	95%CI	P值
最高体温	1.143	0.886~1.473	0.304	-	-	-
治疗后发热时间	1.312	1.155~1.490	<0.01	1.361	1.203~1.540	<0.01
CRP	1.005	1.001~1.008	0.007	1.007	1.004~1.010	<0.01
血白细胞计数	1.017	0.991~1.045	0.207	-	-	-
血小板计数	0.999	0.997~1.000	0.072	-	-	-
降钙素原	1.014	0.993~1.036	0.186	-	-	-