Gervaix A, Galetto-Lacour A, Gueron T, Vadas L, Zamora S, Suter S, Girardin E
Department of Pediatrics, University Hospital of Geneva, Switzerland.
Pediatr Infect Dis J. 2001 May;20(5):507-11. doi: 10.1097/00006454-200105000-00007.
Urinary tract infection (UTI) is a common problem in children. Because clinical findings and commonly used blood indices are nonspecific, the distinction between lower and upper urinary tract infection cannot be made easily in this population. However, this distinction is important because renal infection can induce parenchymal scarring. The objective of this study was to determine the accuracy of procalcitonin (PCT) compared with C-reactive protein (CRP) rapid tests to predict renal involvement in children with febrile UTI.
PCT and CRP were measured in the blood of children admitted to the emergency room with fever, signs and symptoms of urinary tract infection and/or a positive urine dipstick analysis. Renal parenchymal involvement was assessed by a 99mTc-labeled dimercaptosuccinic acid renal scan in the acute phase of infection in all children. Sensitivity, specificity and likelihood ratios were determined for both tests.
Fifty-four children with a proven urinary tract infection were enrolled: 63% had renal involvement; and 37% had infection restricted to the lower urinary tract. No difference was found for age, sex and total white blood cell count between the groups. The calculated likelihood ratios of procalcitonin and C-reactive protein rapid tests were between 3.8 and 7 and 1.5 and 2.8, respectively. A positive PCT value predicted renal involvement in 87 to 92% of children with febrile UTI, compared with 44 to 83% using CRP values.
A rapid determination of procalcitonin concentration could be useful for the management of children with febrile UTI in the emergency room.
尿路感染（UTI）是儿童常见的问题。由于临床表现和常用的血液指标缺乏特异性，在这一人群中很难区分上尿路感染和下尿路感染。然而，这种区分很重要，因为肾脏感染可导致实质瘢痕形成。本研究的目的是确定与C反应蛋白（CRP）快速检测相比，降钙素原（PCT）预测发热性UTI患儿肾脏受累情况的准确性。
对因发热、尿路感染体征和症状及/或尿试纸分析阳性而入住急诊室的儿童进行血液中PCT和CRP检测。在所有儿童感染急性期，通过99mTc标记的二巯基丁二酸肾扫描评估肾脏实质受累情况。确定两种检测方法的敏感性、特异性和似然比。
纳入54例确诊为尿路感染的儿童：63%有肾脏受累；37%的感染局限于下尿路。两组之间在年龄、性别和白细胞总数方面未发现差异。降钙素原和C反应蛋白快速检测的计算似然比分别在3.8至7和1.5至2.8之间。PCT值阳性预测87%至92%的发热性UTI患儿有肾脏受累，而使用CRP值时这一比例为44%至83%。
快速测定降钙素原浓度可能有助于急诊室对发热性UTI患儿的管理。
