儿童单侧肾盂输尿管连接处梗阻随访结局的早期预测

Early prediction of clinical outcome of children with unilateral hydronephrosis due to ureteropelvic junction obstruction

目的:分析儿童单侧肾盂输尿管连接处梗阻(ureteropelvic junction obstruction,UPJO)肾积水通过超声测量肾盂前后径(anteroposterior renal pelvic diameter,APD)及初次就诊资料与手术治疗时机选择的相关性。方法:收集2013年9月至2016年9月重庆医科大学附属儿童医院门诊诊断单侧UPJO肾积水患儿的临床资料。通过回顾性分析,分别从性别、侧别、初诊年龄及初诊积水程度进行病例分组,组间通过卡方检验验证统计学差异(P<0.05),并对相关因素进行二分类logistic回归分析,对初诊APD值与初诊年龄进行受试者工作特征曲线分析(receiver operator characteristic curve,ROC曲线)。结果:①随访结束时有效病例170例,共有41例患儿(24.11%)选择手术治疗,初诊APD值越高患儿手术率越高(χ2=42.534,P=0.000),不同性别、侧别组间患儿手术率差异没有统计学意义。②二分类logistic回归分析中,初诊APD值(χ2=34.465,P=0.000)与侧别(χ2=4.067,P=0.044)预测随访期间手术有统计学意义。③初诊APD值ROC曲线分析中曲线下面积(area under the curve,AUC)=0.894 (P=0.000;95%CI=0.826~0.962),最佳APD截断值1.75 cm,灵敏度82.9%,特异度86.8%;对于初诊年龄,AUC=0.345(P=0.003)。结论:初诊肾积水程度是儿童UPJO肾积水患儿手术决策重要相关因素。初次就诊APD值大于1.75 cm对于随访期间手术有预测价值,当初次就诊APD大于4 cm时,建议立即手术治疗。初诊超声检查对于儿童肾积水诊断治疗及手术决策具有指导意义。

Objective:To investigate the association of anteroposterior renal pelvic diameter(APD)measured by ultrasound and clinical data at initial visit with timing of surgical treatment in children with unilateral hydronephrosis due to ureteropelvic junction obstruc-tion(UPJO).Methods:A retrospective analysis was performed for the clinical data of the children with unilateral hydronephrosis due to UPJO who were diagnosed in the outpatient service of Children’s Hospital of Chongqing Medical University from September 2013 to September 2016.The children divided into groups based on sex,affected side,age at initial diagnosis,and degree of hydronephrosis at initial diagnosis,and the chi-square test was used for comparison between groups(P<0.05).A binary logistic regression analysis was per-formed for related factors,and a receiver operating characteristic(ROC)curve analysis was performed for APD and age at initial di-agnosis.Results:There were 170 valid cases at the end of follow-up,and among these children,41(24.11%)chose surgical treatment.The rate of surgical treatment increased with the increase in APD at initial diagnosis(χ2=42.534,P=0.000),and there was no significant difference in the rate of surgical treatment be-tween the children with different sexes or affected sides.The bi-nary logistic regression analysis showed that APD at initial di-agnosis(χ2=34.465,P=0.000)and affected side(χ2=4.067,P=0.044)were independent predictive factors for surgery during follow-up.At the optimal cut-off value of 1.75 cm,APD at initial diagnosis had an area under the ROC curve(AUC)of 0.894(95%CI=0.826-0.962,P=0.000),a sensitivity of 82.9%,and a specificity of 86.8%,and age at initial diagnosis had an AUC of 0.345(P=0.003).Conclusion:Degree of hydronephrosis at initial diagnosis is an important factor for surgical decision-making for children with hydronephrosis due to UPJO.APD>1.75 cm at initial diagnosis has a certain value in predicting surgery during follow-up,and imme-diate pyeloplasty is recommended in case of APD>4 cm at initial diagnosis.Ultrasound examination at initial diagnosis has a guiding significance in the diagnosis and treatment of hydronephrosis and surgical decision-making.