Abstract：
OBJECTIVE: This meta-analysis aimed to predict the rate of spontaneous resolution and identify influencing factors among pediatric patients with primary vesicoureteral reflux (VUR). The primary objective was to construct a nomogram to facilitate clinical decision-making in the treatment of primary VUR by assessing the rate of spontaneous resolution and its determinants.
METHODS: A systematic search was conducted up to September 2023, encompassing databases such as PubMed, Web of Science, Scopus, and the reference lists of relevant studies. Inclusion criteria comprised 33 studies with a total of 8540 pediatric patients. Data extraction was performed independently by two reviewers, with discrepancies resolved by a third reviewer. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Form. The analysis included the assessment of various outcomes, such as the rate of spontaneous resolution, and identification of influential factors, including gender, age, laterality, and VUR grade.
RESULTS: The pooled spontaneous resolution rate among pediatric patients with primary VUR was 0.42 (95% CI: 0.38 to 0.47, Tau2 = 0.26), demonstrating high heterogeneity (Q = 429.9, df = 32, P < 0.001, I2 = 93%). Egger\'s regression test indicated no publication bias (p = 0.67). VUR grade emerged as the most significant determinant of spontaneous resolution, with varying rates for different grades: grade 1 (0.80, 95% CI: 0.72-0.86), grade 2 (0.67, 95% CI: 0.60-0.74), grade 3 (0.49, 95% CI: 0.42-0.56), and grade 4 (0.23, 95% CI: 0.18-0.30; Tau2 = 0.28, I2 = 0.49). While differences in gender and laterality were observed, statistical significance was not evident.
CONCLUSIONS: This study provides valuable insights into the spontaneous resolution rate of primary vesicoureteral reflux in pediatric patients. The constructed nomogram, based on VUR grading, serves as a useful tool for clinicians in decision-making. Despite observed variations in gender and laterality, only VUR grading demonstrated statistical significance in influencing spontaneous resolution. Further research is recommended to explore additional factors within larger populations to enhance our understanding of primary VUR resolution dynamics.
METHODS: A systematic search was conducted up to September 2023, encompassing databases such as PubMed, Web of Science, Scopus, and the reference lists of relevant studies. Inclusion criteria comprised 33 studies with a total of 8540 pediatric patients. Data extraction was performed independently by two reviewers, with discrepancies resolved by a third reviewer. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Form. The analysis included the assessment of various outcomes, such as the rate of spontaneous resolution, and identification of influential factors, including gender, age, laterality, and VUR grade.
RESULTS: The pooled spontaneous resolution rate among pediatric patients with primary VUR was 0.42 (95% CI: 0.38 to 0.47, Tau2 = 0.26), demonstrating high heterogeneity (Q = 429.9, df = 32, P < 0.001, I2 = 93%). Egger\'s regression test indicated no publication bias (p = 0.67). VUR grade emerged as the most significant determinant of spontaneous resolution, with varying rates for different grades: grade 1 (0.80, 95% CI: 0.72-0.86), grade 2 (0.67, 95% CI: 0.60-0.74), grade 3 (0.49, 95% CI: 0.42-0.56), and grade 4 (0.23, 95% CI: 0.18-0.30; Tau2 = 0.28, I2 = 0.49). While differences in gender and laterality were observed, statistical significance was not evident.
CONCLUSIONS: This study provides valuable insights into the spontaneous resolution rate of primary vesicoureteral reflux in pediatric patients. The constructed nomogram, based on VUR grading, serves as a useful tool for clinicians in decision-making. Despite observed variations in gender and laterality, only VUR grading demonstrated statistical significance in influencing spontaneous resolution. Further research is recommended to explore additional factors within larger populations to enhance our understanding of primary VUR resolution dynamics.
摘要：
目的：本荟萃分析旨在预测原发性膀胱输尿管反流（VUR）患儿的自发消退率并确定影响因素。主要目的是通过评估自发消退率及其决定因素来构建列线图，以促进原发性VUR治疗的临床决策。
方法：截至2023年9月，进行了系统搜索，包括PubMed等数据库，WebofScience,Scopus,以及相关研究的参考清单。纳入标准包括33项研究，共8540名儿科患者。数据提取由两名审阅者独立进行，差异由第三位审阅者解决。使用纽卡斯尔-渥太华质量评估表评估偏倚风险。分析包括对各种结果的评估，例如自发分辨率，并确定影响因素，包括性别,年龄,偏侧性,和VUR等级。
结果：患有原发性VUR的儿科患者的合并自发解决率为0.42（95％CI：0.38至0.47，Tau2=0.26），表现出高度异质性(Q=429.9，df=32，P<0.001，I2=93%)。Egger回归检验显示无发表偏倚(p=0.67)。VUR等级成为自发分辨率的最重要决定因素，不同等级的比率不同：1级(0.80，95%CI：0.72-0.86)，2级（0.67，95%CI：0.60-0.74），3级（0.49，95%CI：0.42-0.56），和4级（0.23，95%CI：0.18-0.30；Tau2=0.28，I2=0.49）。虽然观察到性别和偏侧性的差异，统计学意义不明显。
结论：这项研究为儿科患者原发性膀胱输尿管反流的自发消退率提供了有价值的见解。构造的列线图，基于VUR分级，作为临床医生决策的有用工具。尽管观察到性别和偏侧性的变化，只有VUR分级在影响自发消退方面表现出统计学意义。建议进一步研究以探索更大人群中的其他因素，以增强我们对主要VUR分辨率动态的理解。
方法：截至2023年9月，进行了系统搜索，包括PubMed等数据库，WebofScience,Scopus,以及相关研究的参考清单。纳入标准包括33项研究，共8540名儿科患者。数据提取由两名审阅者独立进行，差异由第三位审阅者解决。使用纽卡斯尔-渥太华质量评估表评估偏倚风险。分析包括对各种结果的评估，例如自发分辨率，并确定影响因素，包括性别,年龄,偏侧性,和VUR等级。
结果：患有原发性VUR的儿科患者的合并自发解决率为0.42（95％CI：0.38至0.47，Tau2=0.26），表现出高度异质性(Q=429.9，df=32，P<0.001，I2=93%)。Egger回归检验显示无发表偏倚(p=0.67)。VUR等级成为自发分辨率的最重要决定因素，不同等级的比率不同：1级(0.80，95%CI：0.72-0.86)，2级（0.67，95%CI：0.60-0.74），3级（0.49，95%CI：0.42-0.56），和4级（0.23，95%CI：0.18-0.30；Tau2=0.28，I2=0.49）。虽然观察到性别和偏侧性的差异，统计学意义不明显。
结论：这项研究为儿科患者原发性膀胱输尿管反流的自发消退率提供了有价值的见解。构造的列线图，基于VUR分级，作为临床医生决策的有用工具。尽管观察到性别和偏侧性的变化，只有VUR分级在影响自发消退方面表现出统计学意义。建议进一步研究以探索更大人群中的其他因素，以增强我们对主要VUR分辨率动态的理解。
