Pediatric Uronephrologic Center, Queen Silvia Children's Hospital, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
J Urol. 2010 Mar;183(3):1177-84. doi: 10.1016/j.juro.2009.11.055. Epub 2010 Jan 22.
We studied variables with impact on cessation of congenital high grade vesicoureteral reflux in univariate analyses and provide a multivariate model for prediction of reflux resolution.
A total of 80 male and 35 female infants (median age 2.7 months) were included in this prospective observational study. Of the cases 71% were diagnosed after urinary tract infection and 26% after prenatal ultrasound. Reflux was bilateral in 70% of the patients and maximum grade was III in 16%, IV in 45% and V in 39%. The study protocol included repeat videocystometries, renal scintigrams, chromium edetic acid clearances and free voiding observations. Median followup was 36 months.
Overall spontaneous reflux resolution, including cases downgraded to grade I to II, was 38%. Variables significantly negatively correlated to resolution were breakthrough febrile urinary tract infection, bladder dysfunction, higher grade of reflux at inclusion, renal abnormality, subnormal renal function, increased bladder capacity, residual urine and passive occurrence of reflux. Multivariate Cox proportional hazard model with stepwise selection identified 3 independent predictors--renal abnormality (hazard ratio 0.45, 95% CI 0.31-0.64, p <0.0001), bladder dysfunction (hazard ratio 0.43, 95% CI 0.29-0.64, p <0.0001) and breakthrough urinary tract infection (hazard ratio 0.38, 95% CI 0.18-0.78, p = 0.009). Performance of the model was evaluated by the receiver operating characteristic curve, with a calculated area under the curve of 83%.
Overall resolution rate in congenital high grade vesicoureteral reflux is high during the first years of life. By multivariate analyses renal abnormality, bladder dysfunction and breakthrough febrile urinary tract infection were identified as strong independent negative predictive factors for reflux resolution.
我们在单变量分析中研究了对先天性高级别膀胱输尿管反流（VUR）中止有影响的变量，并提供了反流缓解的多变量预测模型。
本前瞻性观察研究共纳入 80 名男性和 35 名女性婴儿（中位年龄 2.7 个月）。在这些病例中，71%是在尿路感染后诊断的，26%是在产前超声检查后诊断的。70%的患者存在双侧反流，16%的患者反流最大级别为 III 级，45%的患者为 IV 级，39%的患者为 V 级。研究方案包括重复视频膀胱测压、肾闪烁扫描、依地酸铬清除率和自由排尿观察。中位随访时间为 36 个月。
总体上，自发性反流缓解率包括反流降级为 I 至 II 级的病例为 38%。与缓解显著负相关的变量包括突破性发热性尿路感染、膀胱功能障碍、纳入时反流程度较高、肾脏异常、肾功能减退、膀胱容量增加、残余尿和反流的被动发生。采用逐步选择的多变量 Cox 比例风险模型确定了 3 个独立的预测因素——肾脏异常（风险比 0.45，95%CI 0.31-0.64，p<0.0001）、膀胱功能障碍（风险比 0.43，95%CI 0.29-0.64，p<0.0001）和突破性尿路感染（风险比 0.38，95%CI 0.18-0.78，p=0.009）。通过接收者操作特征曲线评估模型的性能，计算曲线下面积为 83%。
在生命的头几年，先天性高级别 VUR 的总体缓解率较高。通过多变量分析，肾脏异常、膀胱功能障碍和突破性发热性尿路感染被确定为反流缓解的强独立负预测因素。
