- 期刊
Evaluation of Imaging Studies for Vesicoureteral Reflux in Infants with First Urinary Tract Infection
嬰兒第一次泌尿道感染後對膀胱輸尿管逆流影像學檢查之評估
摘要
背景：嬰兒第一次泌尿道感染時所安排的常規影像檢查，對於預測之後腎臟的斑痕化是否有臨床上的價值並無結論。 方法：共有一百一十四位診斷第一次泌尿道感染的小於一歲幼童納入本研究。所有病童皆有接受超音波、排尿時膀胱尿道攝影(VCUG)、核醫的Tc-99m DMSA腎臟皮質檢查(DMSA)等檢查，腎臟受損者四到六月後追蹤第二次DMSA檢查。 結果：發現雖然是否有膀胱輸尿管逆流和腎臟是否發生急性傷害有統計上相關性且其嚴重程度和逆流級數成正比，不過最初VCUG的檢查結果，我們發現即使有膀胱輸尿管逆流和最終發生腎臟的斑痕化並無有顯著意義的相關。而在最初DMSA的檢查結果，有較嚴重的腎臟損害，其發生腎臟永久斑痕化的機會有顯著統計意義的上昇。 結論：我們建議在嬰兒第一次泌尿道感染時，並不需要常規性安排VCUG檢查，而是在DMSA發現有異常時才考慮作此檢查。
並列摘要
Background: Routine imaging studies following first urinary tract infection (UTI) in infancy are clinically used to identify who has vesicoureteral reflux (VUR) and acute pyelonephritis or renal scars. The potential value of these images in avoiding children acquiring renal complication and whether the children benefited from these examinations were not well justified. Methods: Analysis was undertaken of 114 infants (228 renal units) at the time of first documented UTI. All underwent renal ultrasound, voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) renal scan on admission and repeated follow-up VCUG, DMSA or both after 4-6 months if initial examinations showed abnormal at first time. The VUR on VCUG when UTI and its statistical correlations with both acute and follow-up DMSA renal scan revealing renal scar were calculated. Results: Seventeen children (14.9%) had VUR detected by VCUG. Forty-six patients (40.4%) had abnormal findings on acute DMSA renal scans (acute pyelonephritis or renal scars). The sensitivity, specificity, positive prediction rate and negative prediction rates of DMSA for VUR were 63%, 82.6%, 32.7% and 94.3%, respectively. The initial identified VUR versus renal scarring on follow-up DMSA showed little correlation. Conclusions: There is limited effectiveness of routine investigation by VCUG in infants with first confirmed UTI. VCUG may be withheld in a child who presents with first UTI before the age of one year if there has been no demonstrable abnormal DMSA scan.
延伸閱讀
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