利尿肾动态显像对儿童肾盂输尿管连接处梗阻肾盂成形术疗效的预测价值

Predictive value of diuretic renal scintigraphy after pyeloplasty in children with ureteropelvic junction obstruction

目的探讨利尿肾动态显像对肾盂输尿管连接处梗阻(UPJO)患儿肾盂成形术疗效的预测价值。方法回顾性分析2016年1月至2020年1月期间于北京友谊医院行利尿肾动态显像并常规随访至少2次的UPJO患儿共170例[男136例,女34例,年龄(57.3±51.8)个月;UPJO位于左侧130例,位于右侧40例]。记录患儿一般资料、泌尿系统超声(患侧肾皮质、肾盂前后径)、手术方式、手术时间及临床随访情况。以术后临床随访(症状缓解情况、泌尿系统超声及利尿肾动态显像)为综合指标评价疗效,并据其将患儿分为好转组及无变化/恶化组。采用两独立样本t检验和χ^2检验分析数据;另行logistic回归分析利尿肾动态显像各参数对临床疗效的影响;应用受试者工作特征(ROC)曲线分析评价模型的预测价值。结果170例UPJO患儿行肾盂成形术后分为好转组131例,无变化/恶化组39例。术前分肾功能比例(DRF)及对呋塞米的反应情况(RFS)在2组中的差异均有统计学意义(t=-2.083,χ^2=12.870,均P<0.05)。单因素logistic回归分析显示,年龄[比值比(OR)=1.272,95%CI:1.015~1.537]、术前DRF(OR=12.584,95%CI:1.119~24.543)及术前RFS(OR=11.727,95%CI:2.263~60.780)与UPJO患儿肾盂成形术疗效有关(均P<0.05)。多因素logistic回归分析显示,术前DRF(OR=9.770,95%CI:1.800~19.356)及RFS(OR=10.599,95%CI:2.012~55.830)是影响UPJO患儿肾盂成形术疗效的关键因素(均P<0.05)。联合术前DRF与RFS对UPJO患儿肾盂成形术疗效进行预测的灵敏度为85.7%(96/112),特异性为63.8%(37/58),ROC曲线下面积为0.735(95%CI:0.66~0.80)。结论术前利尿肾动态显像DRF及RFS通过反映分肾功能及上尿路引流情况,对UPJO患儿手术时机选择及术后疗效评价有重要意义。

Objective To identify factors of diuretic renography for predicting the therapeutic effect in management of children with ureteropelvic junction obstruction(UPJO)after Anderson-Hynes pyeloplasty.Methods Between January 2016 and January 2020,170 children(136 males and 34 females,age:(57.3±51.8)months;UPJO of 130 in left and 40 in right)who were diagnosed as UPJO by diuretic renography and followed up for more than twice in Beijing Friendship Hospital were retrospectively collected.Patients′information including age,gender,symptoms,affected side,types of operation,pre and post diuretic renography and urinary ultrasound,duration of clinical follow-up were collected.Patients were divided into improvement group and no change/deterioration group according to the comprehensive evaluation indicators including postoperative follow-up,urinary ultrasound and diuretic renography.Clinical characteristics of 2 groups were compared by using independent-sample t test andχ^2 test.Predictors of therapeutic effect after Anderson-Hynes pyeloplasty were analyzed by logistic regression analysis and receiver operating characteristic(ROC)curves of independent prognostic factors were further constructed.Results After pyeloplasty in 170 children of UPJO,they were divided into improvement group(n=131)and no change/deterioration group(n=39).The differential renal fraction(DRF)and response to furosemide stimulation(RFS)before pyeloplasty were significantly different between 2 groups(t=-2.083,χ^2=12.870,both P<0.05).Age(odds ratio(OR)=1.272,95%CI:1.015-1.537),DRF(OR=12.584,95%CI:1.119-24.543)and RFS(OR=11.727,95%CI:2.263-60.780)before pyeloplasty were related to the therapeutic effect of UPJO children after pyeloplasty(all P<0.05).Multivariate logistic analysis identified DRF(OR=9.770,95%CI:1.800-19.356)and RFS(OR=10.599,95%CI:2.012-55.830)before pyeloplasty were independent predictors of therapeutic effect of UPJO children after pyeloplasty(both P<0.05).DRF and RFS combination predicted efficacy with a sensitivity of 85.7%(96/112),specificity of 63.8%(37/58),and area under curve of 0.735(95%CI:0.66-0.80).Conclusion DRF and RFS after pyeloplasty,which reflecting renal function and upper urinary tract drainage,are important for the timing of surgery and postoperative outcome evaluation in children with UPJO.