Zhang Xin, Xu Hong, Zhao Rui-fang
Department of Nephrology and Rheumatism, Children's Hospital of Fudan University, Shanghai 201102, China.
Zhonghua Er Ke Za Zhi. 2010 May;48(5):334-7.
To evaluate the efficacy of (99m)Tc-dimercaptosuccinic acid (DMSA) scanning in predicting vesicoureteral reflux (VUR) among young children with febrile urinary tract infection (UTI) and to investigate the priority in applying either micturating cystourethrography (MCU) or DMSA.
The medical records of children (age < or = 2 years), presenting with febrile UTI between January 2000 and December 2009, were retrospectively reviewed. All cases underwent DMSA renal scan within 1 week after diagnosis and MCU within 1 week after infection. According to the results of MCU, children were divided into groups of non-VUR, low-grade and high-grade VUR.
A total of 370 children (233 boys, 137 girls) were included, of whom 263 (71.1%) had abnormal DMSA results and 126 (34.1%) were identified as VUR on MCU. Among children with VUR, the number of high-grade was 103 (81.7%). The rate of abnormal results on DMSA of high-grade VUR group was significantly higher than the rates of the other two groups (P < 0.01). The sensitivity of DMSA for detecting high grade VUR was 99.0%. The negative predictive value was 99.1% and negative likelihood ratio was 0.03, respectively.
High-grade VUR remains an important risk factor of renal damage for young children with febrile UTI. The possibility to detect high-grade VUR on MCU is rather low when the result of DMSA is negative. It is recommended that DMSA be used before MCU to investigate the febrile UTI children at acute phase, because it would predict the majority of children with high-grade VUR while detecting renal lesions.
评估锝（99m）-二巯基丁二酸（DMSA）扫描在预测发热性泌尿道感染（UTI）幼儿膀胱输尿管反流（VUR）中的疗效，并探讨排尿性膀胱尿道造影（MCU）或DMSA的应用优先级。
回顾性分析2000年1月至2009年12月期间出现发热性UTI的儿童（年龄≤2岁）的病历。所有病例在诊断后1周内进行DMSA肾扫描，在感染后1周内进行MCU。根据MCU结果，将儿童分为无VUR组、低度VUR组和高度VUR组。
共纳入370名儿童（233名男孩，137名女孩），其中263名（71.1%）DMSA结果异常，126名（34.1%）在MCU检查中被确诊为VUR。在VUR患儿中，高度VUR者有103名（81.7%）。高度VUR组DMSA异常结果发生率显著高于其他两组（P<0.01）。DMSA检测高度VUR的敏感性为99.0%。阴性预测值分别为99.1%，阴性似然比为0.03。
高度VUR仍然是发热性UTI幼儿肾损伤的重要危险因素。当DMSA结果为阴性时，MCU检测到高度VUR的可能性相当低。建议在急性期对发热性UTI儿童进行检查时，先使用DMSA，因为它在检测肾脏病变的同时可以预测大多数高度VUR儿童。
