Piepsz A, Tamminen-Möbius T, Reiners C, Heikkilä J, Kivisaari A, Nilsson N J, Sixt R, Risdon R A, Smellie J M, Söderborg B
Department of Nuclear Medicine, C.H.U.Saint-Pierre, Brussels, Belgium.
Eur J Pediatr. 1998 Sep;157(9):753-8. doi: 10.1007/s004310050929.
The results of serial dimercaptosuccinic acid (DMSA) imaging over 5 years are reported in 287 children with severe vesico-ureteral reflux entered into the European Branch of the International Reflux Study in Children. The children were randomly allocated to medical (n=147) or surgical (n=140) management and DMSA studies were performed during the follow up period at least 6 months after any urinary tract infection. Abnormal images were classified into four types: (1) large polar hypodensity with normal renal outline; (2) peripheral photon deficient defect(s) in a non-deformed kidney; (3) small renal image with normal contour; and (4) peripheral defect(s) with resultant irregularity of the renal outline. The DMSA findings were abnormal at entry in 235 (82%) with no difference in incidence or severity between the two treatment groups. During follow up, deterioration was observed in 25 medically and 23 surgically treated patients and comprised image deterioration alone in 17, image deterioration with corresponding reduction in differential function in 16 and reduction in relative function without image change in 15, with similar distribution between the two treatment groups. Deterioration was more frequent in children entering the study under the age of 2 years and in those with grade IV rather than grade III reflux. These findings, showing no difference in outcome between children managed surgically or medically, are consistent with the radiological results already published.
In the International Reflux Study the DMSA scintigraphic data showed no difference in outcome between children managed surgically or medically.
在国际儿童反流研究欧洲分会登记的287例重度膀胱输尿管反流患儿中，报告了5年期间连续二巯基丁二酸（DMSA）显像的结果。这些患儿被随机分为药物治疗组（n = 147）或手术治疗组（n = 140），在随访期间，于任何尿路感染至少6个月后进行DMSA研究。异常图像分为四种类型：（1）肾轮廓正常的大极低密度区；（2）未变形肾脏中的周边光子缺乏缺损；（3）轮廓正常的小肾脏图像；（4）周边缺损导致肾轮廓不规则。235例（82%）患儿在入组时DMSA检查结果异常，两组的发生率或严重程度无差异。随访期间，25例接受药物治疗和23例接受手术治疗的患者出现病情恶化，其中仅图像恶化17例，图像恶化伴相应的分肾功能降低16例，相对功能降低而图像无变化15例，两组分布相似。2岁以下入组的患儿以及IV级而非III级反流的患儿病情恶化更为频繁。这些结果表明手术治疗或药物治疗的患儿预后无差异，与已发表的放射学结果一致。
在国际反流研究中，DMSA闪烁扫描数据显示手术治疗或药物治疗的患儿预后无差异。
