From the *School of Medicine, Chung Shan Medical University Hospital; †Department of Pediatrics, Chung Shan Medical University Hospital; ‡School of Chinese Medicine, China Medical University; §Department of Pediatrics, China Medical University Hospital; ¶Institute of Medicine, Chung Shan Medical University; and ‖Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Pediatr Infect Dis J. 2013 Sep;32(9):e348-54. doi: 10.1097/INF.0b013e3182905d83.
The aim of this article was to assess the usefulness of procalcitonin (PCT) as a marker for predicting dilating (grades III-V) vesicoureteral reflux (VUR) in young children with a first febrile urinary tract infection.
Children ≤2 years of age with a first febrile urinary tract infection were prospectively evaluated. Serum samples were tested for PCT at the time of admission to a tertiary hospital. All children underwent renal ultrasonography (US), Tc-dimercaptosuccinic acid renal scan, and voiding cystourethrography. The diagnostic characteristics of PCT test for acute pyelonephritis and dilating VUR were calculated.
Of 272 children analyzed (168 boys and 104 girls; median age, 5 months), 169 (62.1%) had acute pyelonephritis. There was VUR demonstrated in 97 (35.7%), including 70 (25.7%) with dilating VUR. The median PCT value was significantly higher in children with VUR than in those without (P < 0.001). Using a PCT cutoff value of ≥1.0 ng/mL, the sensitivity and negative predictive value for predicting dilating VUR were 94.3% and 95.4%, respectively, for PCT, and 97.1% and 97.8%, respectively, for the combined PCT and US studies, whereas the positive and negative likelihood ratios were 2.03 and 0.107, respectively, for PCT, and 1.72 and 0.067, respectively, for the combined studies. By multivariate analysis, high PCT values and abnormalities on US were independent predictors of dilating VUR.
PCT is useful for diagnosing acute pyelonephritis and predicting dilating VUR in young children with a first febrile urinary tract infection. A voiding cystourethrography is indicated only in children with high PCT values (≥1.0 ng/mL) and/or abnormalities found on a US.
本文旨在评估降钙素原（PCT）作为预测儿童首次发热性尿路感染（UTI）时扩张性（III-V 级）膀胱输尿管反流（VUR）的标志物的作用。
前瞻性评估年龄≤2 岁且首次发热性 UTI 的患儿。在三级医院就诊时，对血清样本进行 PCT 检测。所有患儿均行肾脏超声（US）、Tc-二巯丁二酸肾扫描和排尿性膀胱尿道造影。计算 PCT 试验对急性肾盂肾炎和扩张性 VUR 的诊断特征。
272 例患儿进行了分析（男 168 例，女 104 例；中位年龄 5 个月），169 例（62.1%）患儿患有急性肾盂肾炎。97 例（35.7%）患儿存在 VUR，其中 70 例（25.7%）为扩张性 VUR。有 VUR 的患儿 PCT 值中位数显著高于无 VUR 的患儿（P<0.001）。当 PCT 截断值≥1.0ng/mL 时，PCT 预测扩张性 VUR 的敏感性和阴性预测值分别为 94.3%和 95.4%，PCT 和 US 联合检查的敏感性和阴性预测值分别为 97.1%和 97.8%，阳性和阴性似然比分别为 2.03 和 0.107，PCT 和联合检查的阳性和阴性似然比分别为 1.72 和 0.067。多变量分析显示，高 PCT 值和 US 异常是扩张性 VUR 的独立预测因子。
PCT 可用于诊断儿童首次发热性 UTI 时的急性肾盂肾炎，并预测扩张性 VUR。仅在 PCT 值较高（≥1.0ng/mL）和/或 US 检查发现异常的患儿中才需要进行排尿性膀胱尿道造影。
