目的　探讨小儿原发性膀胱输尿管反流的发病机制、临床特点、肾损害评价、治疗及预后。方法　回顾性研究 1990～ 2 0 0 2年复旦大学附属儿科医院 5 0例小儿原发性膀胱输尿管反流 ,对反流程度、尿路感染、肾疤痕形成、尿液分析及血管紧张素转化酶 (ACE)基因型进行了分析 ,并将药物和手术治疗组的随访结果进行比较。结果　 5 0例中双侧反流者 2 2例 (44 % ) ,单侧反流者 2 8例 (5 6 % ) ;39例行膀胱尿道造影检查发现反流Ⅰ度2 9 5 % (2 3/ 78) ,Ⅱ度 7 7% (6 / 78) ,Ⅲ度 14 1% (11/ 78) ,Ⅳ度 4 1 0 % (32 / 78) ,Ⅴ度 7 7% (6 / 78)。尿液 β2 微球蛋白、尿视黄醇结合蛋白、N乙酰半胱氨酸异常升高与肾疤痕形成相关 (P <0 0 5 ) ,血ACE基因型ID或DD型与肾疤痕形成相关 (P <0 0 5 )。药物与手术治疗组尿路感染复发率、肾疤痕形成率及反流有效控制率无显著差别。结论　小儿原发性膀胱输尿管反流需要及早诊断 ,同时通过对尿液微量蛋白及血ACE基因型检测 ,对肾损害作出预测 ,建立个体化的有效的治疗方案 Objective To investigate the pathogenesis, clinical features, renal damage evaluation, treatment and prognosis of children with primary vesicoureteral reflux. Methods A retrospective study of 50 children with primary vesicoureteral reflux in Children’s Hospital affiliated to Fudan University from 1990 to 2002 was conducted to evaluate the degree of reflux, urinary tract infection, renal scar formation, urinalysis and angiotensin converting enzyme (ACE) genotypes were analyzed, and the drug and surgical treatment group follow-up results were compared. Results Fifty-two cases had bilateral regurgitation in 22 cases (44%) and unilateral reflux in 28 cases (56%). 39 cases underwent bladder and urethra examination and found reflux Ⅰ degree 295% (2) 3/78), grade 7 7% (6/78), grade III 14 1% (11/78), grade 4 41 0% (32/78) and grade 7 7% (6/78). Urine β2-microglobulin, urinary retinol binding protein, N-acetylcysteine ​​abnormally increased correlated with renal scar formation (P <0.05), and ACE genotype ID or DD type correlated with renal scarring P <0 0 5). Drugs and surgical treatment group urinary tract infection recurrence rate of renal scar formation and effective rate of reflux control no significant difference. Conclusion The primary vesicoureteral reflux in children needs to be diagnosed early. At the same time, the renal damage should be predicted through the detection of urine microalbumin and blood ACE genotype, and to establish individualized and effective treatment plan