尿中性粒细胞明胶酶脂质运载蛋白在神经源性膀胱患儿尿路感染诊断中的预测能力。
Predictive ability of NGAL in identifying urinary tract infection in children with neurogenic bladders.
机构信息
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
Department of Pediatrics and Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 42559, USA.
出版信息
Pediatr Nephrol. 2018 Aug;33(8):1365-1374. doi: 10.1007/s00467-018-3936-0. Epub 2018 Mar 12.
BACKGROUND
Distinguishing between urinary tract infection (UTI) and colonization (UTC) in patients with neurogenic bladders who require clean intermittent catheterization (CIC) is difficult. Urinary neutrophil gelatinase-associated lipocalin concentrations (uNGAL) are increased in UTIs. Our objective was to determine the predictive accuracy of uNGAL for UTI in CIC-dependent children.
METHODS
Cross-sectional study of CIC-dependent patients from August, 2015 to November, 2016. UTI was defined as (1) growth of ≥ 50,000 cfu/mL of a uropathogen, (2) > 10 urinary white blood cells/hpf, and (3) ≥ 2 of the following: temperature > 38 °C, abdominal pain, back pain, worsened incontinence, pain with catheterization, or malodorous/cloudy urine. Positive urine cultures that did not meet these criteria were grouped as UTC, and negative cultures were grouped as no growth.
RESULTS
Two hundred one patients were included (no growth = 100, UTC = 77, UTI = 24). Median (interquartile range) uNGAL was higher in the UTI group (UTI 1361 (931, 2516) μg/g creatinine, UTC 246 (106, 548) μg/g creatinine, no growth 36 (11, 179) μg/g creatinine, p < 0.01 for all comparisons). The area under the ROC curve for uNGAL for UTI versus no UTI was 0.89, 95% CI (0.80-0.98).
CONCLUSION
uNGAL is elevated in CIC-dependent children with UTI compared to those with negative cultures and those with UTC.
背景
对于需要清洁间歇性导尿（CIC）的神经源性膀胱患者，区分尿路感染（UTI）和定植（UTC）较为困难。尿中性粒细胞明胶酶相关脂质运载蛋白浓度（uNGAL）在 UTI 中增加。我们的目的是确定 uNGAL 在依赖 CIC 的儿童 UTI 中的预测准确性。
方法
2015 年 8 月至 2016 年 11 月进行了依赖 CIC 的患者的横断面研究。UTI 的定义为：（1）病原体≥50,000cfu/ml，（2）≥10 个尿白细胞/高倍视野，（3）以下至少两项：体温>38°C，腹痛，背痛，失禁加重，导尿时疼痛或尿液有异味/混浊。不符合这些标准的阳性尿液培养物被归类为 UTC，阴性培养物被归类为无生长。
结果
共纳入 201 例患者（无生长 100 例，UTC 77 例，UTI 24 例）。UTI 组的 uNGAL 中位数（四分位距）较高（UTI 1361（931，2516）μg/g 肌酐，UTC 246（106，548）μg/g 肌酐，无生长 36（11，179）μg/g 肌酐，所有比较均 p<0.01）。uNGAL 对 UTI 与无 UTI 的 ROC 曲线下面积为 0.89，95%CI（0.80-0.98）。
结论
与阴性培养物和 UTC 相比，依赖 CIC 的儿童 UTI 时 uNGAL 升高。
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