预测患有后尿道的儿童慢性病进展情况
John K Weaver1, Mandy Rickard2, Corey Weinstein3
1Center for Pediatric Urology, Cleveland Clinic Children's, Cleveland, OH, USA.
Journal of pediatric urology
|December 8, 2024
概括
低水平的肌素和膀外流是慢性病 (CKD) 在患有后尿道 (PUV) 的儿童中进展的关键指标. 早期识别有助于预测脏结果和管理儿科脏健康.
科学领域:
- 儿科脏病学 儿科脏病学
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 医疗成像医学成像
背景情况:
- 后尿道 (PUV) 可以导致儿童慢性病 (CKD) 和功能衰竭.
- 功能保存有所不同,有些功能维持到成年.
- 预测CKD进展对于及时干预至关重要.
研究的目的:
- 评估早期成像特征与PUV儿童中CKD进展之间的关联.
- 为了确定成像发现和nadir肌素是否可以预测未来的功能.
- 确定儿童PUV患者风险分层的早期标志物.
主要方法:
- 在两个机构进行的回顾性队列研究 (1990-2022).
- 包括在90天内出现初始RBUS和VCUG的PUV在生命第一年出现的儿童.
- 结核病进展定义为ESKD或>50%的eGFR下降;使用Cox回归分析了RBUS发现,VUR和nadir肌素.
主要成果:
- 在274名符合条件的患者中,55名 (20%) 达到初级结局 (CKD进展).
- 多变量分析确定了任何程度的膀外逆流 (HR 3.1) 和nadir肌素 (HR 5.53) 作为CKD进展的显著预测因素.
- 纳迪尔肌单独达到0.89的AUC来预测CKD进展.
结论:
- 纳迪尔肌素是儿童PUV患者中CKD进展和ESKD的强有力的预测因素.
- 膀外逆流 (任何程度或横向性) 也是CKD进展的重要预测因素.
- 这些发现支持在PUV管理中使用早期成像和肌素水平进行风险评估.
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