Department of Pediatric Urology, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA.
J Pediatr Urol. 2014 Dec;10(6):1249-54. doi: 10.1016/j.jpurol.2014.06.019. Epub 2014 Jul 24.
Surgical correction of vesicoureteral reflux (VUR) is influenced by recurrent urinary tract infection (UTI) risk and the likelihood of spontaneous resolution. We aimed to identify factors associated with VUR resolution in children less than 2 years of age and to design a simple scoring tool to predict improvement and resolution.
Children less than 2 years old with primary VUR were identified. Patient demographics, voiding cystourethrogram (VCUG) findings and clinical outcomes over time were assessed. Multivariate analysis with time to resolution was performed to identify factors predictive of VUR improvement and resolution. A random forest model was used to confirm the VUR index (VURx) with normalized importance.
Two-hundred and twenty-nine children met all inclusion criteria. Mean age at initial VCUG was 0.46±0.43 years. Median clinical follow-up was 1.6 years (range 0.5-4.4 years). Children with grade 4-5 reflux, complete ureteral duplication or periureteral diverticula, and filling phase VUR, as well as female gender, had significantly (p<0.01) longer time to improvement or resolution on multivariate survival analysis. VURx 1 to 5-6 had improvement/resolution rates of 89%, 69%, 53%, 16% and 11%, respectively.
Female gender, high-grade VUR, ureteral anomalies, and filling reflux are associated with longer time to improvement and non-resolution. VURx reliably predicts resolution of primary reflux in children less than 2 years of age.
外科手术矫正膀胱输尿管反流（VUR）受复发性尿路感染（UTI）风险和自发缓解可能性的影响。我们旨在确定与年龄小于 2 岁的儿童 VUR 缓解相关的因素，并设计一种简单的评分工具来预测改善和缓解。
确定了年龄小于 2 岁的原发性 VUR 儿童。评估了患者的人口统计学资料、排尿性膀胱尿道造影（VCUG）结果和随时间推移的临床结果。进行了多变量分析，以确定与 VUR 改善和缓解相关的因素。使用随机森林模型对 VUR 指数（VURx）进行归一化重要性验证。
229 名儿童符合所有纳入标准。初始 VCUG 的平均年龄为 0.46±0.43 岁。中位临床随访时间为 1.6 年（范围 0.5-4.4 年）。在多变量生存分析中，具有 4-5 级反流、完全输尿管重复或输尿管周围憩室、充盈期 VUR 的儿童，以及女性，其改善或缓解的时间明显延长（p<0.01）。VURx 1-5-6 的改善/缓解率分别为 89%、69%、53%、16%和 11%。
女性、高级 VUR、输尿管异常和充盈反流与改善和非缓解的时间延长相关。VURx 可可靠地预测年龄小于 2 岁的儿童原发性反流的缓解。
