来自肛门直肠畸形网络注册研究（ARM-Net Registry）的肛门直肠畸形患者的重度膀胱输尿管反流：我们的筛查是否足够？
High-grade Vesicoureteral Reflux in Patients With Anorectal Malformation From the ARM-Net Registry: Is Our Screening Sufficient?
作者信息
van der Steeg H J J, Luijten J C H B M, Fascetti-Leon F, Miserez M, Samuk I, Stenström P, de Wall L L, de Blaauw I, van Rooij I A L M
机构信息
Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands.
Department of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands.
出版信息
J Pediatr Surg. 2024 Aug;59(8):1470-1476. doi: 10.1016/j.jpedsurg.2024.01.008. Epub 2024 Jan 19.
BACKGROUND
Vesico-ureteral reflux (VUR) is a common associated urological anomaly in anorectal malformation (ARM)-patients. High-grade VUR requires antibiotic prophylaxis to prevent urinary tract infections (UTI's), renal scarring and -failure. The exact prevalence of high-grade VUR in ARM patients is unknown. Hence, the aim of this study was determining the incidence of high-grade VUR in ARM-patients, and its associated risk factors.
METHODS
A multicenter retrospective cohort study was performed using the ARM-Net registry, including data from 34 centers. Patient characteristics, screening for and presence of renal anomalies and VUR, sacral and spinal anomalies, and sacral ratio were registered. Phenotypes of ARM were grouped according to their complexity in complex and less complex. Multivariable analyses were performed to detect independent risk factors for high-grade (grade III-V) VUR.
RESULTS
This study included 2502 patients (50 % female). Renal screening was performed in 2250 patients (90 %), of whom 648 (29 %) had a renal anomaly documented. VUR-screening was performed in 789 patients (32 %), establishing high-grade VUR in 150 (19 %). In patients with a normal renal screening, high-grade VUR was still present in 10 % of patients. Independent risk factors for presence of high-grade VUR were a complex ARM (OR 2.6, 95 %CI 1.6-4.3), and any renal anomaly (OR 3.3, 95 %CI 2.1-5.3).
CONCLUSIONS
Although renal screening is performed in the vast majority of patients, only 32 % underwent VUR-screening. Complex ARM and any renal anomaly were independent risk factors for high-grade VUR. Remarkably, 10 % had high-grade VUR despite normal renal screening. Therefore, VUR-screening seems indicated in all ARM patients regardless of renal screening results, to prevent sequelae such as UTI's, renal scarring and ultimately renal failure.
TYPE OF STUDY
Observational Cohort-Study.
LEVEL OF EVIDENCE
III.
背景
膀胱输尿管反流（VUR）是肛门直肠畸形（ARM）患者常见的泌尿系统相关异常。重度VUR需要预防性使用抗生素以预防尿路感染（UTI）、肾瘢痕形成和肾衰竭。ARM患者中重度VUR的确切患病率尚不清楚。因此，本研究的目的是确定ARM患者中重度VUR的发生率及其相关危险因素。
方法
使用ARM-Net注册中心进行了一项多中心回顾性队列研究，纳入了来自34个中心的数据。记录患者特征、肾脏异常和VUR的筛查及存在情况、骶骨和脊柱异常以及骶骨比例。根据复杂性将ARM的表型分为复杂型和非复杂型。进行多变量分析以检测重度（III-V级）VUR的独立危险因素。
结果
本研究纳入了2502例患者（50%为女性）。2250例患者（90%）进行了肾脏筛查，其中648例（29%）有肾脏异常记录。789例患者（32%）进行了VUR筛查，其中150例（19%）确诊为重度VUR。在肾脏筛查正常的患者中，仍有10%存在重度VUR。重度VUR存在的独立危险因素为复杂型ARM（OR 2.6，95%CI 1.6-4.3）和任何肾脏异常（OR 3.3，95%CI 2.1-5.3）。
结论
尽管绝大多数患者进行了肾脏筛查，但只有32%的患者进行了VUR筛查。复杂型ARM和任何肾脏异常是重度VUR的独立危险因素。值得注意的是，10%的患者尽管肾脏筛查正常，但仍有重度VUR。因此，无论肾脏筛查结果如何，所有ARM患者似乎都需要进行VUR筛查，以预防UTI、肾瘢痕形成以及最终的肾衰竭等后遗症。
研究类型
观察性队列研究。
证据级别
III级。
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