Sun Jie,Sun Ning,Zhang Weiping,et al.Role of distal ureteral diameter ratio in predicting early breakthrough urinary tract infections in children with primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2023,22(10):917-923.[doi:10.3760/cma.j.cn101785-202305019-004]
输尿管远端直径比对儿童原发性膀胱输尿管反流早期突破性尿路感染的预测作用研究
- Title:
- Role of distal ureteral diameter ratio in predicting early breakthrough urinary tract infections in children with primary vesicoureteral reflux
- Keywords:
- Vesico-Ureteral Reflux; Distal Ureteral Diameter Ratio; Forecasting; Urinary Tract Infection; Child
- 摘要:
- 目的 探讨输尿管远端直径比在预测儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)早期突破性尿路感染中的应用价值。方法 回顾性分析2018年1月至2020年12月首都医科大学附属北京儿童医院泌尿外科经排尿性膀胱尿道造影(voiding cystourethrography,VCUG)诊断的VUR患儿临床资料,总结其临床特点,并对其进行门诊和电话随访,了解患儿在开始预防性抗生素治疗的12个月内是否发生突破性尿路感染,并对VUR患儿早期突破性尿路感染相关因素进行单因素及多因素Logistic回归分析。结果 本研究中符合纳入与排除标准的患儿共102例,其中男性75例,女性27例,年龄(25.30±26.57)个月;均于诊断VUR后予持续预防性抗生素治疗12个月,期间31例(31/102,30.3%)发生突破性尿路感染,71例(69.7%)未发生。多因素Logistic回归分析发现,性别、反流侧别、反流级别等因素与VUR患儿早期突破性尿路感染的发生无相关关系(P＞0.05),而输尿管远端直径比(P=0.042,OR=11.4,95%CI:1.259~141.919)和年龄(P=0.047,OR=0.975,95%CI:0.949~0.997)是VUR患儿早期突破性尿路感染的独立危险因素。结论 VUR患儿发病年龄越小,输尿管远端直径比越大,越有可能发生早期突破性尿路感染,临床应密切监控、积极治疗,防止发生泌尿系统感染。
- Abstract:
- Objective To evaluate the application value of distal ureter diameter ratio as a predictive factor for breakthrough urinary tract infection (BT-UTI) in children with primary vesicoureteral reflux (VUR).Methods From January 2018 to December 2020,retrospective review was performed for the clinical features of 102 VUR children.Clinical data were collected for identifying the predictors of BT-UTI.Demographics,VUR grade,laterality,distal ureter diameter and UDR were examined by univariate and multivariable analyses.Primary outcome was BT-UTI.Results Among them,31 children (30.3%) experienced BT-UTI events.Based upon multivariate analysis,gender,maximal grade of reflux and laterality were not the predictors of BT-UTI.Ureteral diameter ratio (UDR)(P=0.0417,OR=11.4,95%CI:1.259-141.919) and age (P=0.0467,OR=0.975,95%CI:0.949-0.997) were among the strongest predictors of early febrile BT-UTI in VUR children.Conclusion Children with elevated distal UDR are at an elevated risk for BT-UTI independent of reflux grade.As an objective measurement of VUR,UDR provides valuable prognostic information for risks of recurrent pyelonephritis and may assist with clinical decision-making.
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备注/Memo
收稿日期:2023-5-12。
通讯作者:孙宁,Email:drsunningbch@sina.com