Abstract：ObjectiveTo investigate the diagnostic value of renal and bladder ultrasonography (RBUS) combined with procalcitonin (PCT) in children with high-grade vesicoureteral reflux (VUR). MethodsA 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 24h 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.ResultsPyelodissociation, 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 3.42μg/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). ConclusionsRBUS 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.
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]. 中华诊断学电子杂志, 2024, 12(3): 149-154.
Yan Nuo, Deng Wei, Zhang Yingxia, He Danyang, Fan Ning. Diagnostic value of urinary system ultrasound combined with procalcitonin for high-grade vesicoureteral reflux in children. zhzdx, 2024, 12(3): 149-154.
［1］Kurt-Sukur ED，zakar ZB，Haznedar-Karakaya P，et al.Clinical characteristics and outcome of childhood vesicoureteral reflux［J］.Arch Argent Pediatr，2020，118(1):e16-e21.DOI: 10.5546/aap.2020.eng.e16.
［2］Chirico V，Tripodi F，Lacquaniti A，et al.Therapeutic management of children with vesicoureteral reflux［J］.J Clin Med，2023，13(1):244.DOI: 10.3390/jcm13010244.
［3］Gavrilovici C，Dusa CP，Iliescu Halitchi C，et al.The role of urinary NGAL in the management of primary vesicoureteral reflux in children［J］.Int J Mol Sci，2023，24(9):7904.DOI: 10.3390/ijms24097904.
［4］Stein R，Dogan HS，Hoebeke P，et al.Urinary tract infections in children:EAU/ESPU guidelines［J］.Eur Urol，2015,67(3):546-558.DOI: 10.1016/j.eururo.2014.11.007.
［5］Subcommittee on Urinary Tract Infection.Reaffirmation of AAP clinical practice guideline:the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2-24 months of age［J］.Pediatrics，2016，138(6)：e20163026.DOI: 10.1542/peds.2016-3026.
［6］Valério FC， Lemos RD， de C Reis AL， et al. Biomarkers in vesicoureteral reflux: an overview［J］.Biomark Med，2020，14(8):683-696.DOI: 10.2217/bmm-2019-0378.
［7］Fang NW,Chiou YH,Chen YS,et al.Nomogram for diagnosing acute pyelonephritis in pediatric urinary tract infection［J］.Pediatr Neonatol,2022,63(4)：380-387.DOI:10.1016/j.pedneo.2022.03.006.
［8］Lebowitz RL， Olbing H， Parkkulainen KV， et al. International system of radiographic grading of vesicoureteric reflux.International reflux study in children ［J］.Pediatr Radiol，1985，15（2）：105-109.DOI:10.1007/BF02388714.
［9］Fuente M， Costa TS， García BS， et al. Practical approach to screen vesicoureteral reflux after a first urinary tract infection［J］.Indian J Urol，2014，30(4):383-386.DOI: 10.4103/0970-1591.142055.
［10］Leroy S，Bouissou F，Fernandez-Lopez A，et al.Prediction of high-grade vesicoureteral reflux after pediatric urinary tract infection: external validation study of procalcitonin-based decision rule［J］.PLoS One，2011，6(12):e29556.DOI: 10.1371/journal.pone.0029556.
［11］王辉，沈颖.儿童原发性膀胱输尿管反流诊治现状及建议［J］.中华实用儿科临床杂志，2020，35(5):326-330.DOI: 10.3760/cma.j.cn101070-20200225-00244.
［12］中华医学会小儿外科学分会泌尿外科学组.儿童原发性膀胱输尿管反流专家共识［J］.临床小儿外科杂志，2019，18(10):811-816.DOI: 10.3969/j.issn.1671-6353.2019.10.002.
［13］Klubdaeng A，Chaiyapak T，Sumboonnanonda A，et al.Model for predicting high-grade vesicoureteral reflux in young children presenting with febrile urinary tract infection［J］.J Pediatr Urol，2022，18(4):518-524.DOI: 10.1016/j.jpurol.2022.06.006.
［14］Chang JW，Liu CS，Tsai HL.Vesicoureteral reflux in children with urinary tract infections in the inpatient setting in Taiwan［J］.Clin Epidemiol，2022（14）：299-307.DOI: 10.2147/CLEP.S346645.
［15］Duran C，Beltrán VP，González A，et al.Contrast-enhanced voiding urosonography for vesicoureteral reflux diagnosis in children［J］.Radiographics，2017,37(6):1854-1869.DOI: 10.1148/rg.2017170024.
［16］邹翔宇，孙佩璇，石静，等.排尿性尿路超声造影对儿童原发性膀胱输尿管反流的诊断价值［J］.临床小儿外科杂志，2022，21(2):151-155.DOI: 10.3760/cma.j.cn101785-202006044-010.
［17］沈永棋，梁水齐，王中雄.80例尿路感染患者血清C-反应蛋白、淀粉样蛋白、降钙素原水平的变化及其临床意义［J/CD］.现代医学与健康研究（电子版），2022，6(16):86-89.
［18］Halimi-Asl A，Hosseini AH，Nabavizadeh P.Can procalcitonin reduce unnecessary voiding cystoureterography in children with first febrile urinary tract infection?［J］.Iran J Pediatr，2014，24(4):418-422.
［19］康艳，张林.降钙素原对尿路感染儿童膀胱输尿管反流的诊断价值及其关联性［J］.中国循证儿科杂志，2016，11(6):441-444.DOI: 10.3969/j.issn.1673-5501.2016.06.008.
