Alizadeh Farshid, Taefnia Ali Mohammad, Haghdani Saeid
Department of Urology, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran.
Department of Urology, Hasheminejad Kidney Research Center (HKRC), Iran University of Medical Science (IUMS), Tehran, Iran.
J Pediatr Urol. 2018 Feb;14(1):62.e1-62.e4. doi: 10.1016/j.jpurol.2017.09.012. Epub 2017 Oct 13.
Ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis in children. One major challenge in the management of UPJO is to select the patients that must be subjected to early obstruction relief. Currently, there is no gold standard for this assessment. Therefore, the aim of the present study was to evaluate the urinary levels of carbohydrate antigen (CA) 19-9 and normalized CA 19-9 (Ca 19-9/Cr ratio) in UPJO patients before and after surgery and compare them with a control group to assess their potential clinical application as an assisting tool in diagnosis of UPJO patients.
From Jan 2013 to Jun 2016, 30 children with history of inguinal hernia, circumcision, hydrocele, and undescended testis as the control group (group 1) and 30 children with unilateral congenital UPJO (group 2) were enrolled in the study. Random CA 19-9 and random creatinine were measured in the voided urine samples of control group and proven congenital UPJO group preoperatively (group 2A) and at 6 months after dismembered pyeloplasty (group 2B). In addition, the random urinary CA 19-9/CR ratio was evaluated as a marker to normalized urinary CA 19-9.
The urinary CA 19-9/Cr ratio was significantly greater in the UPJO group than in the control group. The urinary CA 19-9 also was more in group 2A than in group 1; however, it was not statistically significant. The urinary CA 19-9/Cr ratio and renal pelvis anteroposterior diameter decreased significantly in the group 2B 6 month after complete relief of obstruction in comparison with group 2A preoperatively. Urinary CA 19-9 also decreased in 2B group though it was not significant.
Urinary CA 19-9/Cr ratio is suggested as a non-invasive marker that can assist in diagnosis and long-term follow-up of UPJO patients. This ratio is superior to urinary CA 19-9 as it is more strongly correlated with UPJ obstruction.
肾盂输尿管连接部梗阻（UPJO）是儿童肾积水最常见的原因。UPJO治疗中的一个主要挑战是选择必须尽早解除梗阻的患者。目前，对于这种评估尚无金标准。因此，本研究的目的是评估UPJO患者手术前后尿中糖类抗原（CA）19-9及标准化CA 19-9（Ca 19-9/Cr比值）水平，并与对照组进行比较，以评估其作为辅助诊断UPJO患者的潜在临床应用价值。
2013年1月至2016年6月，选取30例有腹股沟疝、包皮环切术、鞘膜积液和隐睾病史的儿童作为对照组（第1组），30例单侧先天性UPJO患儿（第2组）纳入研究。在对照组和确诊的先天性UPJO组术前（第2A组）及离断性肾盂成形术后6个月（第2B组）的晨尿样本中检测随机CA 19-9和随机肌酐。此外，将随机尿CA 19-9/CR比值作为标准化尿CA 19-9的标志物进行评估。
UPJO组尿CA 19-9/Cr比值显著高于对照组。第2A组尿CA 19-9也高于第1组；然而，差异无统计学意义。与术前第2A组相比，梗阻完全解除6个月后的第2B组尿CA 19-9/Cr比值和肾盂前后径显著降低。第2B组尿CA 19-9也有所下降，尽管差异不显著。
尿CA 19-9/Cr比值被认为是一种无创标志物，可辅助UPJO患者的诊断和长期随访。该比值优于尿CA 19-9，因为它与UPJ梗阻的相关性更强。
