Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
J Urol. 2010 Feb;183(2):709-13. doi: 10.1016/j.juro.2009.10.037. Epub 2009 Dec 21.
When children are initially diagnosed with vesicoureteral reflux most undergo a period of antibiotic prophylaxis followed by serial imaging. Although improvement in reflux grade through time presumably predicts eventual resolution, the significance of changing grade through time is unknown. We examined whether improvement in reflux on serial imaging predicts resolution.
We retrospectively reviewed 1,761 children diagnosed with vesicoureteral reflux, of whom 965 had a minimum of 2 years of followup. We examined initial reflux grade and grade on serial imaging up to 5 years after the original diagnosis. For each child it was determined whether reflux was resolved, eventually resolved or never resolved. Groups were further stratified by clinical characteristics.
Multivariate analysis revealed that male gender (HR 1.33, p = 0.05), age younger than 1 year at diagnosis (HR 1.35, p = 0.004), lower grade at presentation (grade I HR 2.2, grade II HR 1.96, grade III HR 1.33; p <0.001) and unilateral reflux (HR 1.39, p = 0.001) were all independent predictors of reflux resolution. Multivariate analysis also showed that reflux improvement on imaging 1 year after diagnosis (HR 3.14, p <0.0001) and improvement from the previous year at any point during followup (HR 1.8, p = 0.009) were independent predictors of reflux resolution.
Consistent with previous findings, male gender, lower reflux grade at presentation, age less than 1 year at presentation and unilateral reflux were all predictive of reflux resolution. Our analysis also demonstrated that improvement in reflux grade on imaging study 1 year after diagnosis was predictive of resolution, and that reflux improvement from the previous year at any point during followup was an independent predictor of resolution. This information will prove valuable in clinical counseling and therapeutic decision making.
当儿童最初被诊断为膀胱输尿管反流时，大多数人会经历一段时间的抗生素预防治疗，然后进行连续影像学检查。尽管反流程度随时间的改善预计会导致最终的缓解，但反流程度随时间变化的意义尚不清楚。我们检查了连续影像学检查中反流程度的改善是否可以预测缓解。
我们回顾性分析了 1761 名被诊断为膀胱输尿管反流的儿童，其中 965 名儿童有至少 2 年的随访。我们检查了最初的反流分级和在原始诊断后 5 年内的连续影像学分级。对于每个儿童，确定反流是否得到缓解、最终得到缓解或从未得到缓解。根据临床特征进一步对各组进行分层。
多变量分析显示，男性（HR 1.33，p = 0.05）、诊断时年龄小于 1 岁（HR 1.35，p = 0.004）、较低的初始分级（I 级 HR 2.2，II 级 HR 1.96，III 级 HR 1.33；p <0.001）和单侧反流（HR 1.39，p = 0.001）均是反流缓解的独立预测因素。多变量分析还显示，诊断后 1 年影像学上的反流改善（HR 3.14，p <0.0001）和随访期间任何一年的反流改善（HR 1.8，p = 0.009）是反流缓解的独立预测因素。
与之前的发现一致，男性、较低的初始反流分级、诊断时年龄小于 1 岁和单侧反流均是反流缓解的预测因素。我们的分析还表明，诊断后 1 年影像学上反流分级的改善可以预测缓解，且在随访期间任何一年的反流改善是缓解的独立预测因素。这些信息将在临床咨询和治疗决策中具有重要价值。
