背景:后尿道瓣膜(PUV)是儿童慢性肾衰竭的主要原因。PUV婴儿的膀胱和后尿道畸形在初始排尿膀胱尿道图(VCUG)上变化很大。在确定病情的严重程度时,某些类型的畸形可能比其他类型的畸形更为重要。特定VCUG特征的识别可以允许简单的,对患者进行早期筛查评估。
目的:确定初始VCUG的形态特征是否与消融后第一年的肌酐最低点测量的肾脏结局相关。
方法:确定了在12个月大之前并在1年后通过初级瓣膜消融治疗的PUV儿童。评估初始诊断VCUG的膀胱高宽比(HW-B),后尿道高宽比(HW-PU),和前后尿道比值(PA-UR)。三名儿科泌尿科医师分配了小梁等级,并注意到反流。使用卡方和t检验的单变量分析比较消融后第一年肌酐最低点<0.8或≥0.8mg/dL的患者的膀胱和后尿道形态因素。进行线性回归以将形态值与真实肌酐最低点相关联。
结果:共有120名男孩在平均年龄为40.5天(范围0-342)时消融,随访5.9年(±3.85)。其中,21例(17.5%)的肌酐最低点≥0.8mg/dL。肌酐最低点<0.8与≥0.8mg/dL的患者之间的平均总HW-B和平均PA-UR没有显着差异。膀胱小梁分级与肌酐最低点无关。对于整个队列,只有肌酐最低点组之间的HW-PU差异有统计学意义,在最低点≥0.8的患者中,肌酐最低点的比率要高得多(p<0.001).线性回归显示HW-PU与肌酐最低点之间存在显着正相关(R2=0.097,p=0.002)。双侧反流的存在与肌酐最低点≥0.8mg/dL显着相关(p=0.001)。
结论:我们首次研究了PUV患者初始VCUG的形态学特征与肾脏结局的关系。通过较高的HW-PU比率量化的后尿道畸形与较高的肌酐最低点显着相关,而测量的膀胱形态指标则没有。HW-PU可能是后尿道瓣膜阻塞严重程度的间接测量。
结论:HW-PU似乎是肾脏结局的有意义的早期形态学指标。
Posterior urethral valves (PUV) is a leading cause of chronic renal failure in childhood. Bladder and posterior urethral deformity in infants with PUV are highly variable on initial voiding cystourethrogram (
VCUG). Some types of deformity may be more important than others in determining the severity of the condition. Identification of specific
VCUG features may allow for a simple, early screening assessment for patients.
Determine whether morphologic features on the initial
VCUG correlate to renal outcomes as measured by the creatinine nadir in the first year after ablation.
Children with PUV treated by primary valve ablation before 12 months old and followed >1 year were identified. Initial diagnostic
VCUG was evaluated for the bladder height to width ratio (HW-B), posterior urethral height to width ratio (HW-PU), and posterior-anterior urethral ratio (PA-UR). A trabeculation grade was assigned by three pediatric urologists, and reflux was noted. Univariable analyses with chi-square and t-test were used to compare bladder and posterior urethral morphology factors among those who obtained a creatinine nadir <0.8 or ≥0.8 mg/dL in the first year after ablation. Linear regression was performed to correlate morphology values with true creatinine nadir.
A total of 120 boys were ablated at mean age of 40.5 days (range 0-342) and followed for 5.9 years (± 3.85). Among these, 21 (17.5%) had a creatinine nadir ≥0.8 mg/dL. Mean overall HW-B and mean PA-UR were not significantly different between those with creatinine nadir <0.8 versus ≥0.8 mg/dL. Bladder trabeculation grade was not associated with creatinine nadir. For the entire cohort, only the difference in HW-PU was statistically significant between creatinine nadir groups with a much higher ratio among those with a nadir ≥0.8 (p < 0.001). Linear regression demonstrated a significant positive correlation between the HW-PU and creatinine nadir (R 2 = 0.097, p = 0.002). The presence of bilateral reflux is significantly associated with creatinine nadir ≥0.8 mg/dL (p = 0.001).
We investigate for the first time the association of morphology features on the initial
VCUG with renal outcome in PUV patients. Posterior urethral deformity as quantified by a higher HW-PU ratio is significantly correlated with a higher creatinine nadir, whereas measured bladder morphology metrics are not. HW-PU may be an indirect measure of the severity of obstruction in posterior urethral valves.
The HW-PU appears to be a meaningful early morphologic metric for renal outcome.