在产前泌尿道扩张后诊断出的膀回流是否需要积极管理? 一个叙事审查
Marie-Klaire Farrugia1, Giovanni Montini2
1Chelsea & Westminster and Imperial College Hospitals (West London Children's Alliance), London, UK; Imperial College London, UK.
Journal of pediatric urology
|October 15, 2024
概括
在产前诊断的婴儿中,膀回流 (VESICOURETERIC REFLUX,简称VUR) 的过程往往不同于在有症状的情况下出现的情况. 预防可能提供有限的益处,主要是第一年的女孩,对脏痕没有影响.
科学领域:
- 儿科泌尿外科 儿科泌尿外科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医学诊断 医学诊断 医学诊断
背景情况:
- 在产前诊断的尿液流 (VUR) 通常呈现无症状,导致管理困境.
- 与发烧性尿路感染 (UTI) 后发现的VUR相比,产前VUR可能具有不同的自然史.
- 之前的研究经常结合了无症状和症状的VUR队列,混了结果.
研究的目的:
- 批判性地评估关于无症状VUR的自然史和管理的文献.
- 评估抗生素预防在预防突破性尿路感染和脏痕的有效性.
- 基于最近的证据,挑战当前的管理实践.
主要方法:
- 18篇文章的系统审查,包括829名无症状婴儿VUR.
- 分析了PREDICT试验的数据,这是一项随机对照试验,针对无症状VUR的预防与不治疗.
- 对现有的文献和试验数据进行批判性评估.
主要成果:
- 一项系统性审查显示,15.4%的婴儿尽管进行了预防,但仍患有突破性尿路感染.
- 在PREDICT试验中,在前六个月减少发烧性尿路感染方面,预防的益处很小,但抗药性感染增加.
- 在2年的随访中,在预防和不治疗组之间没有观察到新的脏痕的显著差异.
结论:
- 无症状VUR的抗生素预防可能具有有限的益处,可能仅适用于生命第一年的女孩.
- 目前的证据不支持对所有无症状VUR病例进行例行预防,因为缺乏明确的益处和潜在风险.
- 需要进一步的研究来确定无症状VUR的最佳管理策略.
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