Huang Daniel Tsung-Ning, Huang Fu Yuan, Tsai Tsuen Chiuan, Tsai Jeng Daw, Chiu Nan Chang, Lin Chun Chen
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2007 Dec;40(6):513-7.
To evaluate clinical variables for diagnosing childhood acute pyelonephritis (APN) when technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy is not available.
We retrospectively reviewed the records of 590 children with febrile UTI seen from January 1999 to February 2004. On the basis of DMSA scintigraphy performed within 7 days after admission, they were divided into APN (n = 237) or non-APN (n = 353) groups. Gender, age, clinical presentation, absolute neutrophil count, C-reactive protein (CRP), urinalysis, culture, and sonographic findings were recorded from charts.
A CRP level of > or =66.4 mg/L, in patients with >2 days prior to admission had a sensitivity of 71.6% and a specificity of 72.5% for APN. Similarly, a CRP of >27.3 mg/L in patients with < or =2 days prior to admission and a white cell count of >14,990/mm3 had sensitivities of 68.6% and 62.0% and specificities of 66.1% and 63.0%, respectively. Combining two or more variables did not result in better discrimination.
If a DMSA scan is not available, it is reasonable to treat a febrile UTI as APN if the CRP is >66.4 mg/L in a patient with >2 days of fever or if the CRP is >27.3 mg/L in a patient febrile for < or =2 days.
当无法进行锝-99m二巯基丁二酸（DMSA）闪烁扫描时，评估用于诊断儿童急性肾盂肾炎（APN）的临床变量。
我们回顾性分析了1999年1月至2004年2月间590例发热性尿路感染患儿的记录。根据入院后7天内进行的DMSA闪烁扫描结果，将他们分为APN组（n = 237）或非APN组（n = 353）。从病历中记录性别、年龄、临床表现、绝对中性粒细胞计数、C反应蛋白（CRP）、尿液分析、培养及超声检查结果。
入院前发热超过2天的患者，CRP水平≥66.4 mg/L对APN的敏感性为71.6%，特异性为72.5%。同样，入院前发热≤2天的患者，CRP>27.3 mg/L及白细胞计数>14,990/mm³对APN的敏感性分别为68.6%和62.0%，特异性分别为66.1%和63.0%。联合两个或更多变量并不能提高鉴别能力。
如果无法进行DMSA扫描，对于发热超过2天且CRP>66.4 mg/L的患者，或发热≤2天且CRP>27.3 mg/L的患者，将发热性尿路感染按APN治疗是合理的。
