Leroy Sandrine, Adamsbaum Catherine, Marc Elisabeth, Moulin Florence, Raymond Josette, Gendrel Dominique, Bréart Gérard, Chalumeau Martin
Department of Pediatrics, Saint-Vincent-de-Paul Hospital, AP-HP, Université Paris V, Paris, France.
Pediatrics. 2005 Jun;115(6):e706-9. doi: 10.1542/peds.2004-1631. Epub 2005 May 2.
A first febrile urinary tract infection leads to the diagnosis of vesicoureteral reflux in 20% to 40% of children. Systematic voiding cystourethrography then is recommended. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, it is irradiating, painful, and expensive. Thus, selective approaches are needed. Because procalcitonin has been shown to be associated with severe pyelonephritis and renal scars, which are correlated to vesicoureteral reflux, we analyzed its relationship with vesicoureteral reflux.
A retrospective hospital-based cohort study included all children who were 1 month to 4 years of age and had a first febrile urinary tract infection. Univariate and multivariate analyses were performed.
Among 136 patients included, 25% had vesicoureteral reflux. The median procalcitonin concentration was significantly higher in children with reflux than in those without (1.2 vs 0.6 ng/mL). High procalcitonin (> or =0.5 ng/mL) was associated with reflux (odds ratio [OR]: 4.6; 95% confidence interval [CI]: 1.6-16.2). After logistic-regression adjustment for all potential confounders, the association remained significant (OR: 4.9; 95% CI: 1.7-14.0). The relationship was stronger for high-grade (> or =3) reflux (OR: 8.7; 95% CI: 1.2-382) than low-grade reflux (OR: 3.6; 95% CI: 1.1-15.3). High procalcitonin sensitivities were 85% (95% CI: 70-94) and 92% (95% CI: 65-99) for all-grade and high-grade reflux, respectively, with 44% specificity (95% CI: 35-54).
High procalcitonin is a strong and independent predictor of vesicoureteral reflux and could be used to identify low-risk patients to avoid unnecessary voiding cystourethrography.
首次发热性尿路感染会使20%至40%的儿童被诊断出存在膀胱输尿管反流。因此推荐进行系统性排尿性膀胱尿道造影。然而，对于60%至80%的儿童来说，排尿性膀胱尿道造影事后证明是正常的。此外，它具有辐射性、会带来疼痛且费用高昂。所以需要选择性的方法。由于降钙素原已被证明与严重肾盂肾炎及肾瘢痕相关，而这些又与膀胱输尿管反流相关，我们分析了其与膀胱输尿管反流的关系。
一项基于医院的回顾性队列研究纳入了所有年龄在1个月至4岁且首次发生发热性尿路感染的儿童。进行了单因素和多因素分析。
在纳入的136例患者中，25%存在膀胱输尿管反流。反流患儿的降钙素原浓度中位数显著高于无反流患儿（1.2对比0.6纳克/毫升）。高降钙素原（≥0.5纳克/毫升）与反流相关（比值比[OR]：4.6；95%置信区间[CI]：1.6 - 16.2）。在对所有潜在混杂因素进行逻辑回归调整后，这种关联仍然显著（OR：4.9；95% CI：1.7 - 14.0）。高级别（≥3级）反流的这种关系（OR：8.7；95% CI：1.2 - 382）比低级别反流（OR：3.6；95% CI：1.1 - 15.3）更强。对于所有级别和高级别反流，高降钙素原的敏感性分别为85%（95% CI：70 - 94）和92%（95% CI：65 - 99），特异性为44%（95% CI：35 - 54）。
高降钙素原是膀胱输尿管反流的一个强有力且独立的预测指标，可用于识别低风险患者以避免不必要的排尿性膀胱尿道造影。
