Wang Zhengyan,Wang Wenjing,Xia Sili,et al.A preliminary study of contrast-enhanced voiding urosonography combine with serum cystatin C in the evaluation of renal damage caused by vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,2026,(05):452-456.[doi:10.3760/cma.j.cn101785-202506005]
尿路超声造影联合血清胱抑素C评估儿童膀胱输尿管反流肾损害的应用价值
- Title:
- A preliminary study of contrast-enhanced voiding urosonography combine with serum cystatin C in the evaluation of renal damage caused by vesicoureteral reflux in children
- 关键词:
- 膀胱输尿管返流; 尿路造影术; 半胱氨酸蛋白酶抑制物C; 外科手术; 儿童
- Keywords:
- Vesico-Ureteral Reflux; Urography; Cystatin C; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨尿路超声造影(contrast-enhanced voiding urosonography,ceVUS)联合血清胱抑素C(cystain C,Cys C)检测在评估儿童膀胱输尿管反流(vesicoureteral reflux,VUR)及相关肾损害中的应用价值。方法 回顾性纳入2019年12月至2025年3月苏州大学附属儿童医院收治的458例反复尿路感染患儿临床资料。患儿均行ceVUS检查评估VUR分级及肾内反流(intrarenal reflux,IRR)情况,其中180例同时检测血清Cys C和血清肌酐(serum creatinine,Scr)水平。采用卡方检验进行组间比较,采用Spearman相关分析评价各指标相关性,采用受试者操作特征曲线分析评估诊断效能。结果 ceVUS可精确评估VUR解剖学分级,其与IRR发生率呈显著正相关(r=0.680,P<0.01),反流达Ⅲ级时IRR风险显著增加;血清Cys C在双侧高级别VUR患儿中显著升高,与VUR严重程度呈中度正相关(r=0.435,P<0.01),总体异常率(35.3%)远高于Scr(3.3%),更易提示早期VUR相关肾损害;受试者操作特征曲线分析显示,Cys C鉴别双侧高级别反流的效能良好(曲线下面积=0.800)。结论 ceVUS联合血清Cys C可从解剖及功能层面实现VUR患儿风险分层,为儿童VUR无创、精准管理提供依据。
- Abstract:
- Objective Toexplore the detecting value of contrast-enhanced voiding urosonography (ceVUS) plus serum cystatin C (Cys C) in evaluating vesicoureteral reflux (VUR) and associated renal damage in children.Methods A retrospective case series study was conducted,including 458 children with recurrent urinary tract infections hospitalized from December 2019 to March 2025.And ceVUS was employed for assessing VUR grade and confirming the presence of intrarenal reflux (IRR).Among them,180 children also had serum Cys C and serum creatinine (Scr) level was measured.And χ2 test was utilized for inter group comparisons,Spearman’s correlation analysis for evaluating relationships among indicators and ROC curve analysis for assessing diagnostic performance.Results ceVUS accurately evaluated the anatomical grading of VUR,demonstrating a significant positive correlation with the incidence of IRR (r=0.680,P<0.01).In terms of functional assessment,serum Cys C spiked significantly in children with bilateral high grade VUR and demonstrated a moderate positive correlation with VUR severity (r=0.435,P<0.01).When vesicoureteral reflux reached Grade Ⅲ,the risk of IRR rose significantly.The overall abnormality rate of Cys C (35.3%) was much higher than that of Scr (3.9%),indicating that Cys C was more sensitive in detecting early VUR associated renal impairment.ROC curve analysis revealed that Cys C had some efficacy in identifying bilateral high grade reflux (AUC=0.800). Conclusion Combining ceVUS with serum Cys C for evaluation enables risk stratification of VUR children from both anatomical and functional perspectives,providing rationales for non-invasive and precise managements.
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备注/Memo
收稿日期:2025-6-4。
通讯作者:陆双泉,Email:lushuangquan0504@sina.com