应用 Tc-99m DMSA 肾闪烁显像建立可视评分系统预测小儿症状性尿路感染复发的危险。
Development of visual scoring system with Tc-99m DMSA renal scintigraphy to predict the risk of recurrence of symptomatic urinary tract infections in pediatric patients.
机构信息
Department Emergency Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea.
Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.
出版信息
Ann Nucl Med. 2019 Sep;33(9):708-715. doi: 10.1007/s12149-019-01379-0. Epub 2019 Jun 18.
OBJECTIVE
Vesicoureteral reflux (VUR) is a major risk factor for recurrent symptomatic urinary tract infection (UTI) in pediatric patients. In addition, dimercaptosuccinic acid renal scintigraphy (DMSA) is an important diagnostic modality of VUR. However, the value of DMSA for predicting recurrent pediatric UTI has not been studied. Therefore, we aimed to develop visual scoring system (VSS) with DMSA to predict the risk of recurrence of symptomatic urinary tract infection in pediatric patient under the age of 24 months.
METHODS
Pediatric UTI patients who visited our tertiary hospital emergency department and underwent DMSA for initial work-up from January 2006 to December 2014 were reviewed retrospectively. We developed a VSS with Tc-99m DMSA renal scintigraphy. We compared sensitivity and specificity between VSS with DMSA and other variables in predicting recurrent symptomatic UTI. Laboratory indices for systemic inflammation, abnormal finding on ultrasonography, VUR on voiding cystourethrogram (VCUG), and the VSS with DMSA were considered as variables. In addition, we used Kaplan-Meier estimator analyses and Cox proportional regression analyses to evaluate the predictive value of each variable for the recurrence of symptomatic UTI.
RESULTS
A total of 338 patients were enrolled. During the follow-up period, 42 patients (12.4%) had UTI recurrence. Visual scoring with DMSA resulted in 69.1% sensitivity and 79.4% specificity with an optimal cut-off value of score 2 (AUC = 0.790, p < 0.001). Significant predictive factors associated with recurrent symptomatic UTI were CRP ≥ 67.0 mg/L, VUR on VCUG and VSS with DMSA ≥ score 2. On multivariate analysis, the visual score with DMSA was the only independent prognostic factor for recurrent symptomatic UTI (p < 0.001; adjusted hazard ratio = 7.522; 95% CI = 2.799-20.224).
CONCLUSION
High scores in VSS with DMSA were associated with frequent recurrence and short recurrence periods in pediatric UTI patients. VSS with DMSA can stratify risk of recurrence in pediatric UTI patients.
目的
在儿科患者中，膀胱输尿管反流（VUR）是复发性有症状尿路感染（UTI）的主要危险因素。此外，二巯丁二酸肾闪烁显像（DMSA）是 VUR 的重要诊断方式。然而，DMSA 对预测小儿 UTI 复发的价值尚未得到研究。因此，我们旨在开发一种基于 DMSA 的视觉评分系统（VSS），以预测 24 个月以下小儿有症状尿路感染复发的风险。
方法
回顾性分析 2006 年 1 月至 2014 年 12 月期间因初始检查在我们的三级医院急诊就诊并接受 DMSA 的小儿 UTI 患者。我们开发了一种基于 Tc-99m DMSA 肾闪烁显像的 VSS。我们比较了 DMSA 视觉评分系统与其他变量在预测复发性有症状 UTI 方面的敏感性和特异性。将实验室炎症指标、超声异常发现、排尿性膀胱尿道造影（VCUG）中的 VUR 以及 DMSA 的 VSS 视为变量。此外，我们使用 Kaplan-Meier 估计分析和 Cox 比例风险回归分析来评估每个变量对有症状 UTI 复发的预测价值。
结果
共纳入 338 例患者。在随访期间，42 例患者（12.4%）发生 UTI 复发。DMSA 视觉评分的灵敏度为 69.1%，特异性为 79.4%，最佳截断值为评分 2（AUC=0.790，p<0.001）。与复发性有症状 UTI 相关的显著预测因素包括 CRP≥67.0mg/L、VCUG 中的 VUR 和 DMSA 视觉评分≥2 分。多变量分析显示，DMSA 视觉评分是复发性有症状 UTI 的唯一独立预后因素（p<0.001；调整后的危险比=7.522；95%CI=2.799-20.224）。
结论
DMSA 视觉评分系统的高分与小儿 UTI 患者频繁复发和复发期短有关。DMSA 视觉评分系统可对小儿 UTI 患者的复发风险进行分层。
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