McDonald A, Scranton M, Gillespie R, Mahajan V, Edwards G A
Department of Pediatrics, Central Texas Medical Foundation, Children's Hospital of Austin, Austin, Texas 78701, USA.
Pediatrics. 2000 Apr;105(4):E50. doi: 10.1542/peds.105.4.e50.
Many authorities recommend an interval of at least 3 to 6 weeks after a urinary tract infection (UTI) before performing a voiding cystourethrogram (VCUG). However, such an interval may reduce the likelihood of completing the procedure. This study was performed to investigate whether the length of the interval between a UTI and the performance of the VCUG influences the presence or severity of reflux, and whether it influences the likelihood of actually having the study performed.
We reviewed 352 admissions of children under 10 years old whose discharge diagnoses indicated UTIs. These admissions occurred over a 27-month period between October 1994 and December 1996 at the Children's Hospital of Austin, Texas. We identified 213 patients with confirmed UTIs and no other previously defined urinary tract pathology. These patients were divided into 2 groups according to whether they had a VCUG scheduled to be performed either within 1 week after the diagnosis of a UTI (the early group), or later than 1 week after the diagnosis (the late group). We compared the presence and severity of reflux in the 2 groups as well as the proportion of scheduled VCUGs that were actually performed.
Reflux was present in 19% of the patients studied within 1 week after UTI (95% confidence interval [CI]: 12.9-26.4) and in 18% of those studied after 1 week (95% CI: 6. 7-34.5). This difference was not statistically significant (chi(2) =. 034; DF = 1). However there was a substantial difference between the 2 groups with regard to the number of scheduled VCUGs actually performed. Whereas 100% of the scheduled VCUGs in the early group were performed, only 48% (95% CI: 35.9-60.1) of those scheduled in the late group were performed. This difference is statistically significant (chi(2) = 89.6; DF = 1).
In the hospitalized children who underwent VCUGs within a week after diagnosis of UTI, the presence of reflux is not significantly different from those studied later. Furthermore, late scheduling of VCUGs resulted in failure to perform the procedure in more than half of the patients. Some of the patients who were not evaluated would be expected to have vesicoureteral reflux and thus be at risk for chronic renal disease. Therefore, the traditional recommendation to perform the VCUG at 3 to 6 weeks after the diagnosis of UTI should be reconsidered, especially for hospitalized children.
许多权威机构建议在尿路感染（UTI）后至少间隔3至6周再进行排尿性膀胱尿道造影（VCUG）。然而，这样的间隔可能会降低完成该检查的可能性。本研究旨在调查UTI与VCUG检查之间的间隔时间长短是否会影响反流的存在或严重程度，以及是否会影响实际进行该项检查的可能性。
我们回顾了352例10岁以下儿童的住院病例，其出院诊断显示患有UTI。这些住院病例发生在1994年10月至1996年12月期间的27个月内，位于得克萨斯州奥斯汀儿童医院。我们确定了213例确诊UTI且无其他先前定义的尿路病理情况的患者。根据他们是否计划在UTI诊断后1周内（早期组）或诊断后1周后（晚期组）进行VCUG，将这些患者分为两组。我们比较了两组中反流的存在和严重程度，以及计划进行的VCUG实际完成的比例。
UTI后1周内接受检查的患者中有19%存在反流（95%置信区间[CI]：12.9 - 26.4），1周后接受检查的患者中有18%存在反流（95%CI：6.7 - 34.5）。这种差异无统计学意义（χ² = 0.034；自由度 = 1）。然而，两组在实际进行的计划VCUG数量方面存在显著差异。早期组计划的VCUG中有100%完成，而晚期组计划的VCUG中只有48%（95%CI：35.9 - 60.1）完成。这种差异具有统计学意义（χ² = 89.6；自由度 = 1）。
在UTI诊断后1周内接受VCUG检查的住院儿童中，反流的存在与较晚接受检查的儿童无显著差异。此外，VCUG检查安排过晚导致超过一半的患者未能进行该检查。一些未接受评估的患者预计会有膀胱输尿管反流，因此有患慢性肾病的风险。因此，应重新考虑在UTI诊断后3至6周进行VCUG检查的传统建议，特别是对于住院儿童。
