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中华诊断学电子杂志 ›› 2024, Vol. 12 ›› Issue (03) : 149 -154. doi: 10.3877/cma.j.issn.2095-655X.2024.03.002

临床研究

泌尿系超声检查联合降钙素原对儿童高级别膀胱输尿管反流的诊断价值
闫诺1, 邓伟1,(), 张英霞1, 贺丹阳1, 樊宁1   
  1. 1. 010000 呼和浩特,内蒙古医科大学附属医院超声医学科
  • 收稿日期:2024-06-13 出版日期:2024-08-26
  • 通信作者: 邓伟
  • 基金资助:
    内蒙古自治区卫生健康科技计划项目(202202157)

Diagnostic value of urinary system ultrasound combined with procalcitonin for high-grade vesicoureteral reflux in children

Nuo Yan1, Wei Deng1,(), Yingxia Zhang1, Danyang He1, Ning Fan1   

  1. 1. Department of Ultrasound Medicine, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, China
  • Received:2024-06-13 Published:2024-08-26
  • Corresponding author: Wei Deng
引用本文:

闫诺, 邓伟, 张英霞, 贺丹阳, 樊宁. 泌尿系超声检查联合降钙素原对儿童高级别膀胱输尿管反流的诊断价值[J/OL]. 中华诊断学电子杂志, 2024, 12(03): 149-154.

Nuo Yan, Wei Deng, Yingxia Zhang, Danyang He, Ning Fan. Diagnostic value of urinary system ultrasound combined with procalcitonin for high-grade vesicoureteral reflux in children[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2024, 12(03): 149-154.

目的

探讨肾脏和膀胱超声检查(RBUS)联合降钙素原(PCT)在儿童高级别膀胱输尿管反流(VUR)中的诊断价值。

方法

选择2019年12月至2023年12月内蒙古医科大学附属医院儿科首次诊断为尿路感染(UTI)的患儿81例,记录患儿RBUS及就诊24 h内PCT等结果,并行排泄性尿路超声造影(CeVUS)检查。以CeVUS结果作为VUR分级标准,分为无反流组43例,低级别反流组(Ⅰ~Ⅲ级)27例,高级别反流组(Ⅳ~Ⅴ级)11例。采用二分类Logistic回归分析VUR及高、低级别反流的影响因素;预测膀胱输尿管高、低级别反流采用受试者工作特征(ROC)曲线,曲线下面积比较采用Delong算法。

结果

肾盂分离、肾积水和输尿管扩张是VUR的独立危险因素(OR=4.624,5.777,10.460;均P<0.05)。肾积水、输尿管扩张和高PCT水平是高级别VUR的独立危险因素(OR=40.037,45.367,1.572;均P<0.05)。PCT预测高级别VUR的最佳截点值为3.42 μg/L,ROC曲线下面积为0.848(95%CI:0.706~0.985)。PCT与RBUS异常指标联合应用诊断高级别VUR的准确率为0.953(95%CI:0.830~0.995)。

结论

RBUS异常表现如肾积水、输尿管扩张与高级别VUR相关。PCT与UTI患儿VUR的严重程度相关,PCT联合RBUS异常指标诊断准确率高,可成为临床诊断VUR方便快捷的初筛方法。

Objective

To investigate the diagnostic value of renal and bladder ultrasonography (RBUS) combined with procalcitonin (PCT) in children with high-grade vesicoureteral reflux (VUR).

Methods

A total of 81 children diagnosed with urinary tract infection (UTI) for the first time in the Department of Pediatrics of the Affiliated Hospital of Inner Mongolia Medical University from December 2019 to December 2023 were selected. RBUS and the results of PCT within 24 h after treatment were recorded, and contrast-enhanced voiding urosonography (CeVUS) examination was performed. The CeVUS results were used as the grading standard for VUR. There were 43 cases in the no-reflux group, 27 cases in the low-grade reflux group (grade Ⅰ-Ⅲ), and 11 cases in the high-grade reflux group (grade Ⅳ-Ⅴ). Binary Logistic regression was used to analyze the influencing factors of high and low VUR. Receiver operating characteristic (ROC) curve was used to predict VUR, and Delong′s algorithm was used to compare the area under the curve.

Results

Pyelodissociation, hydronephrosis and ureteral dilation were independent risk factors for VUR (OR=4.624, 5.777, 10.460, all P<0.05). Hydronephrosis, ureteral dilation and high PCT level were independent risk factors for high-grade VUR (OR=40.037, 45.367, 1.572, all P<0.05). The optimal cut-off value for PCT prediction of high-grade VUR was 3.42 μg/L, and the area under ROC curve was 0.848 (95%CI: 0.706-0.985). The diagnostic accuracy of PCT and RBUS abnormality was 0.953 (95%CI: 0.830-0.995).

Conclusions

RBUS abnormalities such as hydronephrosis and ureteral dilation are associated with high-grade VUR. PCT is related to the severity of VUR in children with UTI. PCT combined with RBUS abnormal indicators has a high diagnostic accuracy, and can be a convenient and quick preliminary screening method for clinical diagnosis of VUR.

图1 膀胱输尿管反流患儿二维超声及超声造影图像注:a图为低级别膀胱输尿管反流患儿的二维超声图像,示右侧肾脏大小形态正常,实质回声均匀,肾盂无扩张;b图为低级别膀胱输尿管反流患儿超声造影图像,示右侧膀胱输尿管反流(Ⅱ级),肾盂肾盏内见造影剂,肾盂扩张(箭头所示);c图为高级别膀胱输尿管反流患儿的二维超声,示左侧肾积水,输尿管扩张(箭头所示);d图为高级别膀胱输尿管反流患儿超声造影图像,示左侧膀胱输尿管反流(Ⅴ级)并肾内反流,肾盂输尿管及肾实质内可见造影剂,肾盂肾盏明显扩张(箭头所示)
表1 UTI患儿RBUS异常结果(例)
表2 有无反流组UTI患儿RBUS结果比较[例(%)]
表3 膀胱输尿管反流发生风险多因素Logistic分析
图2 降钙素原诊断高、低级别膀胱输尿管反流的ROC曲线注:ROC为受试者工作特征
表4 高级别与低级别膀胱输尿管反流发生风险多因素Logistic分析
图3 多指标联合预测高级别膀胱输尿管反流的ROC曲线注:ROC为受试者工作特征
表5 各指标对高级别膀胱输尿管反流的诊断价值
图4 神经源性膀胱患儿泌尿系二维超声及超声造影图像注:a图、b图为神经源性膀胱患儿的二维超声图像,示右肾重度积水(箭头所示),右输尿管扩张(三角形所示);c图为其超声造影图像,示右侧膀胱输尿管反流(Ⅰ级),造影剂仅出现在输尿管,肾盂肾盏未见造影剂显影(箭头所示)
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