Department of Urology, Division of Pediatric Urology, Marmara University School of Medicine, Istanbul, Turkey.
Department of Biochemistry, Göztepe Training and Research Hospital, Istanbul, Turkey.
J Urol. 2014 Jan;191(1):199-205. doi: 10.1016/j.juro.2013.08.025. Epub 2013 Aug 21.
Dimercapto-succinic acid scintigraphy and urodynamic studies are gold standards to evaluate renal scarring and neurogenic bladder dysfunction, respectively. We sought to establish the value of bladder wall thickness together with urine NGF, TGF-β1 and TIMP-2 to predict the urodynamic profile and upper urinary tract damage in children with myelodysplasia.
A total of 80 children with myelodysplasia underwent urodynamic investigation, bladder wall thickness measurement and dimercapto-succinic acid scintigraphy with basic neurourological evaluation. Two study and 2 control groups were created according to presence or absence of renal scarring on dimercapto-succinic acid scan (study and control groups 1) and according to detrusor leak point pressure greater or less than 40 cm H2O (study and control groups 2). Urine samples were analyzed with ELISA.
The study population consisted of 44 girls and 36 boys with a median ± SD age of 7.2 ± 3.6 years (range 2 to 17). Study and control groups 1 consisted of 35 and 45 children with abnormal and normal dimercapto-succinic acid scan findings, respectively. Study and control groups 2 included 30 and 50 children with detrusor leak point pressure greater and less than 40 cm H2O, respectively. Bladder wall thickness and urinary levels of TGF-β1, NGF and TIMP-2 were significantly increased in both study groups compared to controls.
Urine markers and bladder wall thickness measurement may predict urinary tract impairment in children with myelodysplasia. Such markers may differentiate at risk patients with either renal scarring or high detrusor leak point pressure, and decrease the need for urodynamics and renal scintigraphy.
双巯丁二酸闪烁扫描和尿动力学研究分别是评估肾瘢痕和神经性膀胱功能障碍的金标准。我们试图建立膀胱壁厚度与尿液神经生长因子（NGF）、转化生长因子-β1（TGF-β1）和金属蛋白酶组织抑制剂-2（TIMP-2）联合应用的价值，以预测脊髓发育不全患儿的尿动力学特征和上尿路损害。
共 80 例脊髓发育不全患儿接受了尿动力学检查、膀胱壁厚度测量和双巯丁二酸闪烁扫描，并进行了基本神经泌尿学评估。根据双巯丁二酸扫描有无肾瘢痕（研究组 1 和对照组 1）和逼尿肌漏点压＞40cmH2O（研究组 2 和对照组 2）将患儿分为 2 个研究组和 2 个对照组。采用 ELISA 法检测尿液标本。
研究人群由 44 名女孩和 36 名男孩组成，中位年龄±标准差为 7.2±3.6 岁（范围 2 至 17 岁）。研究组 1 包括 35 例和对照组 1 包括 45 例患儿，双巯丁二酸扫描结果分别异常和正常。研究组 2 包括 30 例和对照组 2 包括 50 例患儿，逼尿肌漏点压分别＞40cmH2O 和＜40cmH2O。与对照组相比，两组患儿的膀胱壁厚度和尿液 TGF-β1、NGF 和 TIMP-2 水平均显著升高。
尿液标志物和膀胱壁厚度测量可预测脊髓发育不全患儿的尿路损害。这些标志物可区分有肾瘢痕或高逼尿肌漏点压风险的患者，并减少对尿动力学和肾闪烁扫描的需求。
