Smellie J M
University College Hospital, London, England.
J Urol. 1992 Nov;148(5 Pt 2):1676-8. doi: 10.1016/s0022-5347(17)37000-3.
The main findings of the IRSC after 5 years of observation are summarized. Of the 434 children entered 128 were from centers in America and 306 from Europe. They were randomly allocated and stratified to a medical or surgical regimen. Of the children 50% had scarred kidneys at entry evenly distributed between the groups. After 5 years of observation there was no difference in outcome between the 2 treatment groups in terms of renal size and growth, the development of new radiological renal scars or areas of parenchymal thinning, or of progression of established scarring. In Europe infection recurred in equal numbers of children but pyelonephritic symptoms were more common in the medical group. Nevertheless, new scars developed in 19 of 155 children treated medically and 20 of 151 children treated surgically, including 5 and 7, respectively, with previously normal kidneys. Factors influencing the choice of treatment include patient age, availability of expert surgical care and experienced medical supervision, parental choice and compliance. Followup studies indicate that renal scarring rather than persistence of reflux determines the prognosis and, therefore, emphasis should be placed on the prevention of scarring.
总结了国际反流研究协作组（IRSC）5年观察后的主要研究结果。在纳入研究的434名儿童中，128名来自美国的研究中心，306名来自欧洲。他们被随机分配并分层接受药物或手术治疗方案。这些儿童中，50%在入组时就有瘢痕肾，且在两组间分布均匀。经过5年观察，两个治疗组在肾脏大小和生长、新的放射学肾脏瘢痕或实质变薄区域的出现，以及已有的瘢痕进展方面，预后没有差异。在欧洲，两组复发感染的儿童数量相同，但药物治疗组肾盂肾炎症状更常见。尽管如此，接受药物治疗的155名儿童中有19名出现了新瘢痕，接受手术治疗的151名儿童中有20名出现了新瘢痕，其中分别有5名和7名儿童此前肾脏正常。影响治疗选择的因素包括患者年龄、专家手术护理的可及性和经验丰富的医学监督、家长的选择和依从性。随访研究表明，肾脏瘢痕而非反流的持续存在决定预后，因此，应着重预防瘢痕形成。
