Garin Eduardo H, Olavarria Fernando, Araya Carlos, Broussain Monica, Barrera Claudia, Young Linda
Department of Pediatrics, University of Florida, P.O. Box 100296, Gainesville, FL, 32610, USA.
Pediatr Nephrol. 2007 Jul;22(7):1002-6. doi: 10.1007/s00467-007-0465-7. Epub 2007 Mar 21.
The aim of this study was to define in children younger than 2 years of age the diagnostic significance of clinical and laboratory findings to localize site of febrile urinary tract infection. We reviewed the records of 185 children younger than 2 years of age admitted to hospital with febrile urinary tract infection. Patients were divided into having either acute pyelonephritis or acute cystitis according to the presence or absence of acute lesions on dimercaptosuccinic acid (DMSA) renal scintigraphy. Clinical and laboratory [white blood cell count (WBC), urinalysis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] findings were compared between the two groups using Student's t test, chi-square test, and multivariate analysis. Patients with pyelonephritis had statistically significant higher age, WBC, ESR, and CRP than those with cystitis. Although the sensitivity of the tests was 80-100%, their specificity was <28%. On multivariate analysis, 33% of patients with cystitis were diagnosed as having pyelonephritis, whereas 22% of those with pyelonephritis were considered to have cystitis. Given the low specificity of clinical findings and available laboratory tests to define the site of urine infection in this age group, we recommend DMSA renal scintigram as the test of choice to make the diagnosis of acute pyelonephritis in these patients.
本研究的目的是确定2岁以下儿童发热性尿路感染部位的临床和实验室检查结果的诊断意义。我们回顾了185例2岁以下因发热性尿路感染入院儿童的记录。根据二巯基丁二酸（DMSA）肾闪烁显像有无急性病变，将患者分为急性肾盂肾炎组或急性膀胱炎组。采用Student's t检验、卡方检验和多因素分析比较两组的临床和实验室检查结果[白细胞计数（WBC）、尿液分析、红细胞沉降率（ESR）、C反应蛋白（CRP）]。肾盂肾炎患者的年龄、WBC、ESR和CRP在统计学上显著高于膀胱炎患者。尽管这些检查的敏感性为80%-100%，但其特异性<28%。多因素分析显示，33%的膀胱炎患者被诊断为肾盂肾炎，而22%的肾盂肾炎患者被认为患有膀胱炎。鉴于该年龄组临床检查结果和现有实验室检查在确定尿路感染部位方面特异性较低，我们建议将DMSA肾闪烁显像作为这些患者急性肾盂肾炎诊断的首选检查。
