降钙素原对儿童膀胱输尿管反流的预测价值

Prediction of procalcitonin in children with vesicoureteral reflux

目的初步探讨降钙素原对儿童尿路感染伴膀胱输尿管反流(VUR)的诊断价值及其与反流严重程度的关系。方法收集2011年1月至2012年3月该院所有连续就诊并诊断为首次发生尿路感染的患儿的降钙素原(PCT)、C反应蛋白(CRP)、尿液细菌培养、泌尿系统B超、排尿期膀胱尿道造影(VUCG)等结果。以VUCG作为VUR与非VUR的分组标准及VUR分级标准。结果共146例尿路感染患儿纳入研究,其中VUR患儿51例(占34.9%),VUR患病年龄、性别比例差异无统计学意义(P>0.05)。VUR组的PCT、CRP水平高于非VUR组(P<0.05),ROC曲线显示PCT诊断性能优于CRP。高PCT水平(≥0.5ng/mL)与VUR的级别密切相关(优势比为5.5,95%置信区间2.3～12.9),且与轻度、中度VUR均密切相关(优势比分别为4.6、9.1,95%置信区间分别为1.8～11.7、1.4～61.7)。结论 PCT对于判断是否存在膀胱输尿管反流具有一定的临床价值,可作为预测反流级别的独立指标,可能有助于减少不必要的VUCG。

Objective To explore the predictive value of procalcitonin（PCT） in the diagnosis of urinary tract infection in children with vesicoureteral reflux（VUR） and the relationship with the degree of VUR.Methods Children that came from January 2011 to March.2012 and admitted with the first urinary tract infection from out-patient and in-patient were recruited in the study.The results of PCT,CRP,urine bacterial culture,ultrasonography of the urinary system,voiding cystourethrography（VUCG）were collected for analysis.Results Among 146 children included,51 children（34.9%）had VUR.There was no difference in age and sex in children with VUR（P0.05）.The levels of PCT and CRP in VUR group were significantly higher than in those of non-VUR group（1.05 vs 0.4 ng/mL,11.2 vs 13.9 mg/L,P0.05）.The diagnostic performance of PCT was superior to CRP.High procalcitonin（≥0.5 ng/mL） was associated with the degrees of VUR（odds ratio 5.5,5% confidence interval 2.3-12.9）.The relationship was stronger in middle-grade（odds ratio 9.1,95% confidence interval 1.4-61.7） than low-grade（odds ratio 4.6,95% confidence inerval 1.8-11.7）.Conclusion Procalcitonin was potentially a useful marker for determining the presence of vesicoureteral reflux and might be independently predicted the severity grade of vesicoureteral reflux to avoid unnecessary voiding cystourethrography.